- The country's second-largest physician group, the American College of Physicians, endorsed "Medicare for All" on Monday in its official journal, Annals of Internal Medicine. The article coincided with an open letter published in The New York Times signed by more than 2,000 doctors who support such a policy.
- The group said a public choice option should also be considered. The plan would be offered alongside private options in the Affordable Care Act exchanges. ACP also supports a Medicare buy-in for people aged 55 to 64.
- The organization, the largest of specialty physicians, said a single-payer approach would reduce administrative burden, thereby freeing more time for patient care. It noted, however, the change would be "politically difficult" and "highly disruptive."
Physicians have historically opposed a single-payer system as too much of a shift for U.S. healthcare. There are signals of a changing tide, however. In June, the nation's largest physician group, the American Medical Association, voted by only a narrow margin to continue its opposition to single-payer, with 47% willing to abandon the position against.
And Medicare for All is getting serious policy attention as Democratic presidential contenders have embraced the idea to varying degrees. Voters have also shown interest. Kaiser Family Foundation polling from November showed 53% of respondents in support of Medicare for All.
Steffie Woolhandler, one of the authors of the Annals editorial and a co-founder of Physicians for a National Health Program, told Healthcare Dive the shift that led to ACP's endorsement stemmed from doctors frustrated with paperwork that keeps them from the core part of their jobs: patient care.
"Doctors are always staring at the computers instead of staring at the patients, but we don't really have a choice," she said. "There's a tremendous amount of keystrokes and items we need to enter just to get the bill paid."
There's no question administrative burden is a serious issue for doctors. They frequently rate it as a high cause of burnout. The ACP's article cites research showing the U.S. spent more than $470 billion in billing and insurance-related costs in 2012 and those costs make up more than 30% of healthcare spending.
Hospitals and payers have pushed back as rhetoric supporting Medicare for All has ramped up on the campaign trail. They have some reason to worry, as a recent Moody's report found such a system would be a hit for private insurers profit margins.
The Trump administration also, unsurprisingly, remains staunchly opposed to single-payer. CMS Administrator Seema Verma has called it a "pipe dream" that would lead to rationed care and higher taxes.
Woolhandler, however, said doctors on the front lines see the issue differently. "Increasing numbers of doctors are finding that the healthcare payment system gets in the way of providing care," she said. "The payment system should facilitate taking care of patients yet it gets in the way a lot of the time."