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The second largest American medical association analyzed the ailing U.S. healthcare system and prescribed public health insurance as the remedy. We discuss the diagnosis with ACP President Robert McLean.

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This is a rush transcript and may contain errors. It will be updated.

Greg Wilpert: It’s the Real News Network and I’m Greg Wilpert in Arlington, Virginia. The country’s largest medical specialist association, the American College of Physicians or ACP has endorsed single payer as a solution for addressing the healthcare coverage problems in the United States. The ACP is the national organization of internists. It published an extensive analysis of the current U S healthcare system in their main publication, the Annals of Internal Medicine where they look at why so many Americans lack healthcare coverage, why U S healthcare is so expensive and what alternative health care provision systems would address these problems.
They recommend two main solutions to the healthcare problem, either the creation of a single pair model, which is also known as Medicare for all or a public insurance option in order to achieve universal coverage. The ACP is the first medical specialist association to recommend such a solution to the healthcare provision problem. The American Medical Association or AMA, which is the largest general medical association in the United States, rejected a single payer proposal last June in a 53 to 47% vote against it. Joining me now to discuss the ACPs analysis and recommendations is ACP President, Dr. Robert McLean. Thanks for joining us today, Dr. McLean.

Robert McLean: Well, thank you very much for having me.

Greg Wilpert: So, let’s start with the ACPs diagnosis of the healthcare problem. Those of us who are familiar with the issue might know some of these figures, but they bear repeating, for example, that the United States is the only developed country in the world without a universal healthcare system. Also, that the U S spends about twice as much on healthcare as a percentage of its GDP than any other country in the world. And that 30 million Americans, nearly 10%, are uninsured and another 28% are under-insured. Now, what did you find are the main reasons for this lack of insurance and for the high cost of healthcare in the United States?

Robert McLean: Well, you pointed out very well that the main problems that we have found and experienced in the last couple decades is that too many of our patients are left behind and it’s really due to problems with affordability and accessibility. And that is kind of what led us to create these papers. I should say it’s helpful to understand where these came from. So, as you mentioned, there’s a tremendous problem with the uninsured and the under-insured and over the past 20 to 30 years, the ACP has had as one of it’s priorities, access to healthcare being a goal and then universal acts as being a primary goal. This goes back to around 1990 when we first did a policy paper on that. And the ACPs had a number of policy papers, many in the two thousands that look at the issues, which include inadequate primary care, problems with Medicare and Medicaid, lots of details.
And while the ACA got us farther than we had been in terms of the number of people who had insurance, there was still a significant affordability problem. And so, we asked the question, what would it take for us to get our healthcare system to reach certain goals? Goals being universal access, being protection for patients who have preexisting conditions and another huge goal being how do we simplify the tremendous amount of administrative burden that’s in our system? That’s experienced, especially by practicing physicians, but by hospitals and hospital systems and patients alike.
So, that was our goal. How do we get to that? And we asked that question or decided to give that as a charge to our policy committees and said, “What’s the evidence?” You know, we do evidence, we print practice guidelines and that’s what we do well. So, we said, “Listen, what’s the evidence out there?” Because there is a lot of evidence in the last 10 or 20 years of different countries that have done different things and different states that have essentially acted as kind of pilots. So, we analyze states, countries, various things that had been done, what works, what doesn’t work and we came to a significant conclusion, which was that two options could get us to that place of the things that I mentioned. And that would include a single pair financed option, government financed and also a public option within a system that still has much more regulated private insurance than we currently have.

Greg Wilpert: Yeah. I want to dig a little bit deeper on the issue of the single payer possibility that you examined.

Robert McLean: Mm-hmm (affirmative).

Greg Wilpert: You know it’s been a major issue in the presidential campaigns on the of the democratic party and give us an idea, a summary basically, of what this model would look like if it were implemented.

Robert McLean: Well, as you, I think, said earlier, these are some long detailed papers and I can’t quote all the details off the top of my head as you’re well aware. They really weren’t a good read. In summary, I think what we realize is that the only way to get rid of a lot of the administrative burden is to have a significant standardization of how healthcare payment is administered. Aim for value much more, aim for primary care better. To get at kind of the question I think you’re getting with single payer, you know, how would we pay for it? Well, in fact it would be subsidized premiums and payments. We know that people need care, certain primary care, certain aspects of chronic disease on us and we think that the system would do better by actually significantly either eliminating or reducing co-payments for a lot of those really critically important services because if people actually get care for those services, they won’t get sick down the road, they won’t go to the ER as much, they won’t get hospitalized as much. And so, the system of overall will improve things.
We think, and this is the first time we’ve said this, that there is in fact a role for global budgets for health systems for hospitals. That is a new recommendation from us. So, those are two, I think fairly major things. We think that there needs to be a lot more funding for primary care services as I said. One of the reasons that we’ve really avoided calling it Medicare For All is because some of the plans out there that are touted use that term. We don’t want to necessarily be grouped in with that because it’s not exactly the same. As an example, I think one of the proposals out there from one of the candidates talks about kind of just switching over to Medicare For All.
I think we clearly recognize that current Medicare rates are not sustainable for many private practice doctors and so, no, that would not work. Medicare has to be paying a reasonable rate for physicians to hospital systems so that they can actually afford to be in this system. We think that involvement in this system needs to be voluntary, on the basis of those people in it, but that we really need to have a way for all patients to have universal access to affordable care.

Greg Wilpert: All right. I want to dig a little bit deeper on the issue of how it would be paid for. I mean that has been one of the main controversial issues, particularly in this presidential campaign or where the critics of the system say would increase taxes on everyone and those kinds of arguments. What’s your response to that? And the response that we find in your paper.

Robert McLean: I think we explicitly say that there are situations here depending upon, I mean this is not a bill, so we do not have all the details ironed out, that’s the bill of the legislators, quite frankly. But I think that there needs to be recognition that there may well need to be a specific tax related to healthcare expenses. People obviously will push back on that. However, in a simplified system like this, we freely plan and anticipate that things like copays, deductibles, premiums could potentially and would be significantly less for many people. So, in the end the amount of money that they are spending on healthcare, but would be the same or potentially significantly less than it is now. So, it can’t be looked at just as there’s going to be an extra tax when on the backend so many other expenses we will expect and models would predict it’ll be lower.

Greg Wilpert: And finally, I’m wondering the medical profession more generally, has been very reluctant to endorse single payer it seems. That is the AMA, as I mentioned earlier, rejected the proposal just last June. Why do you think that is? Why have they been so reluctant?

Robert McLean: Well, I think there is a lot of a distrust of the government, of big government. There’s concern about lack of control, lack of autonomy, which a lot of physicians enjoy as kind of small businesses in certain ways. But I think that the recognition that the increasing administrative burden is making the practice of medicine increasingly challenging.
So many things are not working for the physician practices and for our patients and I think the vast majority of physicians are willing to kind of take a pause and say, and really recognize what is not working in our current system. And that’s what we really dive into in a lot of great detail with a lot of evidence. And I think taking a fresh look is really appropriate and necessary. I think a lot of doctors, if you ask the questions the right way, will agree with most if not everything that we say. I would say you’d pointed out at the top of the interview, the statistics on the vote at the AMA meeting and 53 to 47 is close. You know that is way different from what it would have been a few years, if not a few decades ago.
And I think that really does show that the physicians of today are much more willing to kind of look at change to recognize that the current system is just so dysfunctional for our patients especially and for us that I think they realize that with the right rules and guardrails in place, single payer system is not unreasonable. I mean, as I said, that does not mean that we would transition everything over to the current Medicare. Medicare has lots of problems, done a lot of good things in the last couple of years, which is great, but the payment that Medicare has would need to have significant changes for this kind of stuff to work and we put that in our proposal.

Greg Wilpert: Finally, how do you think that this proposal would proceed? I mean, do you hope that members of Congress will pick it up or that it will be integrated in some of the plans that are currently existing? How do you envision this to move forward?

Robert McLean: Yeah, I think that’s it. I mean we put this out this time of year, this has been in the planning for a year and a half. The idea was if things aren’t working, it’s time for some bold changes. The ACA had taken us a certain distance. It’s still done a lot of great stuff with Medicaid expansion, but when Medicaid is not paying adequately, there still is not enough affordable insurance in many states and the goal was to put out something that is evidence based that people can look at as a non partisan proposal. It’s political because this is policy and people will regard this as being political. Yes it is political because you can’t do policy without being in politic.
But it’s not a partisan, we are not endorsing anyone else’s plan. We’re not endorsing any other candidate and we hope that the candidates will look at this and take it or aspects of it and incorporate it into what they’re thinking. This is much more detailed than any of the proposals and bills out there because it just has to be, this is complex stuff. I think one of the things that we’ve been frustrated with and we hope to help change the dialogue and elevate the conversation is it’s really, I think tiresome to hear medical issues be simplified as rhetoric on the campaign trail as you know, one or two sentence paragraphs of some really complicated stuff.
And our hope is to educate the legislators and the elected officials that this needs to be looked at with a fresh look. And the other thing too, to really empower our patients to understand some of these issues better and for them to stand up and really demand of their election officials that healthcare is not a commodity like other commodities and it has been treated as such. Our analysis as I said, came to these two conclusions as possible paths. We clearly concluded that purely market driven approaches will not work to get us, if those are the goals that at least we have and I think most people have, which are pretty straight forward things that most people would agree with. But everyone, I’m a doctor in Connecticut and I see patients every week who can not afford their prescription drugs, they cannot afford copays. They complain about having gone to the ER and now having huge deductibles and the financial burdens are huge.
And there was a poll, I think just a week or two ago, how the highest causes of either family and individual bankruptcy in this country, our medical bills. So, we think the time is right for people to kind of really wake up and hopefully look at some bold proposals which have lots of facts and evidence behind them and push things along. That’s our hope.

Greg Wilpert: I think that your last point is extremely crucial, especially considering the nature of the presidential debates and discourse where each candidate gets only a minute to present their proposal, which obviously doesn’t do anywhere near the justice that these kinds of topics deserve. So, I think this is really great that you have presented such a detailed analysis and proposal, but we’re going to have to leave it there for now. I’m speaking to Dr. Robert McLean, President of the American College of Physicians. Thanks again for having joined us today.

Robert McLean: And if people want to go and find it, it’s online at There are links to the policy papers where I’d really encourage people to take a look. Thank you very much.

Greg Wilpert: Okay, well we’re certainly going to link to it when we publish this story.

Robert McLean: Well, thank you very much for having me.

Greg Wilpert: And thank you for joining the Real News Network.

Studio: Will Arenas, Bababtunde Ogunfolaju
Production: Bababtunde Ogunfolaju, Andrew Corkery

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Gregory Wilpert is Managing Editor at TRNN. He is a German-American sociologist who earned a Ph.D. in sociology from Brandeis University in 1994. Between 2000 and 2008 he lived in Venezuela, where he first taught sociology at the Central University of Venezuela and then worked as a freelance journalist, writing on Venezuelan politics for a wide range of publications and also founded, an English-langugage website about Venezuela. In 2007 he published the book, Changing Venezuela by Taking Power: The History and Policies of the Chavez Government (Verso Books). In 2014 he moved to Quito, Ecuador, to help launch teleSUR English. In early 2016 he began working for The Real News Network as host, researcher, and producer. Since September 2018 he has been working as Managing Editor at The Real News. Gregory's wife worked as a Venezuelan diplomat since 2008 and from January 2015 until October 2018 she was Venezuela's Ambassador to Ecuador.