Almost the entire health care industry is lined up against “Medicare for All.” Hospitals oppose it. Insurance companies oppose it.
Drug companies oppose it.
But not the American College of Physicians (ACP). That group made waves last month when it broke with other leading health players to endorse Medicare for All, along with an optional government plan, as a way to get to universal coverage.
The move by the ACP, which represents internal medicine doctors who are often a patient’s primary care physician, is a sign of changing attitudes among doctors.
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“A lot of this is driven from the grassroots membership,” Bob Doherty, senior vice president of governmental affairs and public policy for the ACP, said in an interview last week in the group’s Washington office.
“Physicians are increasingly frustrated with paperwork,” he said, which stems in part from having multiple insurers all with different rules and documentation requirements. One possible solution is to have just a single payer: the government.
And there is also a major medical justification for doctors to back Medicare for All, he says.
“That’s the frustration, they see the lack of insurance as standing in the way of their patients getting affordable care,” Doherty said. “And increasingly, they’re finding [that in] an employer-based private insurance system, because of rising deductibles, even people with insurance can’t afford the care.”
There are signs that doctors’ views could be shifting more broadly, especially as a new generation joins the ranks of the profession.
A motion in the American Medical Association’s (AMA) House of Delegates to end the group’s decades-long opposition to Medicare for All proposals failed by a close margin in June, going down 53 percent to 47 percent.
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ACP is the second-largest doctors group in the country after the AMA, and its new stance could have ripple effects.
“I think it’s certainly a crack in the foundation of organized medicine’s opposition to single-payer,” Doherty said. “I think it’s going to cause some other groups to say, ‘Well, if they reach this conclusion, yeah, you know, this is something we should look at.’ ”
Much of the health care industry opposes Medicare for All out of fear that it would lead to damaging cuts to their payments. The current Medicare program, for example, pays doctors rates well below those of private insurance.
Doherty acknowledged there are valid concerns in that area, saying payments to doctors under a single-payer system would have to be higher than current Medicare rates to be sustainable.
“There is a concern if you do have the payment levels set too low, particularly under a single-payer system, you could have coverage on paper, but the ability of physicians to work within that system would be hindered,” he said.
He noted doctors might be willing to receive somewhat smaller payments under Medicare for All if they made up for it if with savings on administrative costs from a simpler system.
The recommendations have the support of “most of our members,” Doherty said, but he noted there was a “spirited discussion” within the group between people with varying opinions.
This is far from the first health care fight that Doherty has seen since he joined the American Society of Internal Medicine, which later merged with the ACP, in 1979.
“I started working for organized medicine when Jimmy Carter
Jimmy CarterThis will be a wild weekend in New Hampshire Hollywood icon, Presidential Medal of Freedom recipient Kirk Douglas dead at 103 Feehery: No, this is not the worst of times in Washington MORE was president,” he said. The passage of the Affordable Care Act in 2009-2010 was the most intense time in his decades-long tenure, he said, adding that his experience serves as a warning sign for the chances of passing Medicare for All in the future.
“It’ll be a royal battle to see something like that become law,” he said.
A more immediate priority for the health care industry is legislation currently moving through Congress to protect patients from getting massive “surprise” medical bills when they go to the emergency room or other sources of care and one of their doctors happens to fall outside their insurance network.
The legislation has triggered a fierce battle, with hospitals and doctors fighting with insurers over the details of how payments will be structured once patients are taken out of the middle.
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The ACP sides with other doctor and hospital groups in pushing for the payment decisions to be given to an outside arbiter. Insurers and some consumer groups, however, favor setting a payment rate based on the median rate in that geographic area, which doctors warn would lead to cuts to their payments.
While the ACP is on the physicians’ side of the fight, Doherty said he does not approve of the tactics of some doctor-staffing companies that are owned by private equity firms and have run millions of dollars in ads against rival legislation.
“I think physicians’ credibility is hurt by being too linked to them,” Doherty said, noting that the internal medicine doctors whom the ACP represents are not a major source of surprise bills.
“Some of the practices that they do are hard to justify. Their business model, it’s hard to justify.”
When not fighting the health care wars, Doherty is a huge sports fan. The Mets, for whom he once worked as a Shea Stadium beer vendor, hold his primary allegiance. But he is also a season ticket holder for the hometown Nationals, which he says come in second for him, though it can be difficult when the two teams, which share a division, play each other.
One of his fondest memories is being in attendance for the famous Game 6 of the World Series in 1986, when the Mets came from behind to beat the Red Sox.
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Last year, however, “I did get on the Nats bandwagon for the World Series,” he says.
His father was an Irish immigrant, and Doherty, during college, worked behind the bar at Doherty’s Bar in New York.
Doherty hopes to get back to Ireland soon, but he also loves traveling to other places, including a trip last year to Argentina, where he had “great wine” and “great steaks.”
“I still like going out to a good Irish bar,” he said.
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