Healthcare reform has a new backer: the American College of Physicians; Conversation with ACP President Dr. Robert McLean

evergreen_web_banner.png

KBOO is open to the public! To visit the station, contact your staff person or call 503-231-8032.


Produced by: 
KBOO
Air date: 
Mon, 02/03/2020 - 5:45pm to 6:00pm
More Images: 

 

The American College of Physicians has just issued a call for action on healthcare reform, urging lawmakers to pursue either a single payer or public option model in order to achieve universal health coverage.

The ACP's call for action is entitled "Better Is Possible: The American College of Physicians’ Vision for U.S. Health Care."

KBOO’s Doug McVay spoke with the president of the American College of Physicians, Dr. Robert McLean.

Download audio file

 

Audio Transcript

Doug McVay  0:00  
The American College of Physicians is national organization of internists, the largest medical specialty organization and second largest physician group in the United States. Its 159,000 members include internists, internal medicine sub-specialists, medical students, residents and fellows. The ACP has just released a call to action for health care reform, entitled "Better is Possible: the American College of Physicians vision for the US health care system." To learn more, I spoke with the president of the American College of Physicians, Robert McLean, MD.

Robert McLean  0:37  
So my name is Robert McLean, internal medicine specialist as well as a rheumatologist, live in New- live and work in New Haven, Connecticut. I'm a- I'm a clinical academic appointment as the associate- as an associate Clinical Professor of Medicine at Yale School of Medicine. And I practiced and am a Medical Director with a group called Northeast Medical Group, which is part of the New Haven health system and I happen to also be, in my side job, the president of the American College of Physicians.

Doug McVay  1:09  
The ACP has just released a new call to action for health care reform published as a supplement to the journal Annals of Internal Medicine, entitled "Better is Possible: the American College of Physicians of vision for the US healthcare system." The ACP's call is a bold new prescription for health care policy. Dr. McLean, could you please summarize for us: what is the ACP's vision for the US healthcare system?

Robert McLean  1:32  
Well, the American College of Physicians has for many years, been advocating for universal access to affordable health insurance coverage for all Americans. And we have had multiple policy papers over many years that have talked about that in different ways and with slightly different perspectives. In starting a year ago, the ACP's leadership gave our policy committee the charge to- to really kind of do a reboot of sorts, and try to help put together a very complex series of issues in a way that was a bit more understandable for the people who need to understand this, which are legislators and policymakers as well as public lawyers. And so we did what the ACP usually does, we put out lots of different policy papers, guideline papers, and we- and we did what we do, which is evidence based review. And we look for what has happened in healthcare systems across the world, in different countries, in different parts of our country, what's been tried, what's worked, what's not worked, what happens in different states, and put all of that stuff together and came to some fairly big conclusions, which were that we need to really do a lot of stuff better and we can do a lot of stuff better. We need to address social factors in healthcare, we need to address administrative burdens in healthcare. And I think that the big conclusions people will pay attention to the most is that we are recommending transitioning to a system that it sees universal coverage with essential benefits and lower administrative costs through one of two potential approaches, and we've concluded that those two approaches could be either a single payer financing system or a publicly financed coverage option with regulated private insurance. We don't think that isolated market drift approaches work. And based upon all the evidence that we see, um, healthcare is not a commodity that really is appropriately dealt with in market based approaches, and historically, we have not done enough to get enough people affordable insurance.

Doug McVay  3:42  
If I can get you to unpack a couple of the concepts in this: now your call moves way beyond that, well worn catchphrase Medicare for All.

Robert McLean  3:51  
That's correct.

Doug McVay  3:52  
And you're talking about universal coverage. For the benefit of our listeners, could you explain a little bit about the concept of universal health coverage?

Robert McLean  4:01  
Well, so universal health coverage is essentially providing some that mechanism that every American is able to obtain health insurance coverage that is affordable. That's kind of the basic idea. You know, at this point, people who are the age of 65 or have disability qualify for a government sponsored plan called Medicare. And that has a certain defined premium for a month and certain defined co-pays and all this kind of stuff. That is in the grand scheme of things quite affordable. We have now many Americans who are covered by employer sponsored plans because of the way our system has evolved. And while that gives a lot of people insurance coverage, a lot of those people are in fact, relatively speaking, underinsured, because they have very high co-pays or deductibles or premiums. And while they may have insurance, it's not affordable and it is one the leading causes of family bankruptcies in this country-- health care bills, so it's not working. So universal health care, universal coverage is kind of trying to make it affordable for everyone who needs it and everyone needs health care at some point in their life.

Doug McVay  5:15  
In your call, you say that this unit- that universal health coverage could be achieved through either a single payer model or the public option. Again, could you explain a little bit about how those two models would work?

Robert McLean  5:30  
We feel that, I mean, single payer option does not, first of all, I mean, the paper gets into a lot of the details of what these really mean. I think that one of the purposes of the paper is to get beyond a lot of the rhetoric that's out there in the news or on the election trail, where people talk about, you know, Medicare for All, but many people have analyzed, well what does that really mean? It may mean a little bit different from one candidate to the other, he's talking about it on the news. And so we're kind of trying to get through the rhetoric and the labels and say, you know, a single payer option would would not be a market driven approach. It would, it would basically look at having a standardized, centralized kind of payer, the government, that taxes would support people would be worried, oh my gosh, this means my taxes are going to go up. And there may well be some small health care directed taxes that might increase for some Americans depending upon the situation. However, people need to remember that when in fact a system like this goes into place and all the evidence review shows this, premiums go down, deductibles go down, all those other things that currently are making so many people not go get care because they're afraid of the cost or get the care and then go bankrupt because of the cost. Those things will be much lower or go away. So in aggregate the cost or expense to individuals should be clearly less. And quite frankly, based upon our analysis, and the analysis of many others, the cost to the system may be less, because you're going to be simplifying a lot of the administrative burden and allow the duplication and stuff that happens, that's driving our healthcare system to be so expensive. So that's, I mean, that's- that's a large picture view of single payer, there would still potentially be local insurance carriers that are doing the local management of claims and things and that, to this day, and when- when looked at with Medicare- the Medicare has a lot of private insurers that are doing a lot of the administrative enforcement and um- administrative kind of work that makes things happen at the state level and local level. So insurance companies would not go away which is a concern that people might have, but will be potentially playing a more regulated slightly different role. In the public option, you would have kind of what was in a way and signed through the Affordable Care Act, you would in fact, still have private insurance type plans, but you would also have a couple of options that would, it would envision had probably less administrative burden, less overhead and would essentially help drive the market expenses down to a more competitive way then it actually happened. 

Doug McVay  8:32  
The bottom line is really that people are already writing that check for their insurance, they just be writing it to someone different and it would be for a less amount.

Robert McLean  8:43  
Yes, and that is- that is our conclusion. And I think that, I said we looked at market driven approaches, and because healthcare is not a commodity, or should not be treated like a commodity like other entities within our society, purely market driven approaches simply do not work, there is two- the two- there is two larger roles for the public good, for public health. And it just doesn't work the way it is now. And we know that patients deserve better, we deserve better and we can get to a better place and all the evidence and research shows that we really can do much better. And we're trying to elevate the conversation, get beyond the rhetoric, and have people understand some complex issues. Unfortunately, healthcare is very complex, it cannot be drilled down to a sentence or two, you know, in the news or in an election cycle. And that's why we have, you know, four papers to get into some of this. It's unfortunately complicated, but we want people to to understand better and make better decisions on how we move forward.

Doug McVay  9:55  
It's inevitable that some people are going to complain about doctors getting involved in politics. While others will point out, quite sensibly, that you're doing the right thing by advocating for your patients. So I've got to ask why, has the ACP decided to step into the politics of reform?

Robert McLean  10:14  
Well, we've- so we stepped into the politics of reform going back in the early 1990s when we first put out a policy paper about the importance of access to care, and yes, we anticipate people will say, you know, doctors and healthcare people shouldn't be getting into politics. And- and quite frankly, our- my pushback is you can't get into trying to enact and improve policy without being in politics. So we are in politics here, and we have to be in politics, but what we're not doing is being partisan and that is, I think, a real significant distinction to make. We are not endorsing any other- any candidate's plan in this situation. We are not endorsing a party, or a party approach. We have done an evidence based review, and come to some conclusions on what evidence shows us works and what doesn't work. And we've put that out there. It may well be that some of those principles and positions line up with certain candidates. And that's great. But that's not why we did it. We did it because it's the right thing to do. It's what the evidence shows we need to do. And we want to make better policy. So if it- we have to throw it out there into the political realm to enact better policies.

Doug McVay  11:35  
Again, folks, we've been speaking with Dr. Robert McLean. He's president of the American College of Physicians. Dr. McLean, any closing thoughts for our listeners?

Robert McLean  11:45  
No, I think it's worth- it's worth people trying to take a little time to read into some of it. As I said, I think one of the concerns we've had on a lot of issues is that sometimes rhetoric runs the day and- and it's a complicated issue. Everybody is a patient at some point, this affects everyone. Most people are one illness away from- from tragedy and which can be financial and bankruptcy as well. And so these are really important issues for everyone, everyone's family, they cannot be done down too much. And we hope to really elevate the dialogue and help people understand where we need to go and why. And, and we hope that other position organizations jump on board and endorse this, we anticipate that will happen. We think that a lot of people, when they actually read some of these policies will agree with them. We hope even more that the legislators and policymakers read it and realize so much of this is common sense reform that needs to be done. We've been talking around about it for years, and we need to really get a comprehensive way, put all of it together and get to the right place.

Doug McVay  12:58  
Better is Possible: the American College Physicians Vision for US Healthcare was published January 21 2020, as a supplement to the Annals of Internal Medicine. Dr. McLean, thank you very much.

Robert McLean  13:11  
Well, thank you very much.

Doug McVay  13:13  
Reporting for KBOO News, I'm Doug McVay.

Transcribed by https://otter.ai
 

Audio by Topic: