PNHP’s Comments on the Draft of the American College of Physicians -American Society of Internal Medicine Seven-Year Plan to Provide Affordable Coverage for All Americans
By Quentin Young, Don McCanne and Ida Hellander
Overview and Summary of Problems with Corporate Control of Medicine
Despite good intentions, the ACP-ASIM proposal for providing health care coverage for all cannot possibly meet that goal – and delays real reform by seven painful years in which the number of uninsured is expected to rise by 10 million or more. Further, while acknowledging that other problems with our health care system must be addressed, the ACP-ASIM proposal actually perpetuates these problems by keeping intact a system in which greatly flawed health financing and corporate control over health care is an integral part:
– The dominant impediment to decent health care for all is, and has been for two decades, the rapid domination of all aspects of the health system -hospitals, physicians’ practices, nursing homes, etc. – by profit-oriented venture capital. No reform is possible without the correction of this historic shift. The ACP-ASIM proposal is silent on this issue.
– The costs of a multi-payer, for-profit insurance system are so exorbitant as to preclude decent health access for all, not to mention the increasingly neglected sectors of long-term care, mental health services, and prescription drug coverage
– Crucial ethical issues – patient choice, physician’ autonomy, physicians’ ethical responsibility to care for the sick regardless of race, income, or insurance status, “first do no harm”, etc. – are being seriously degraded by the current system. The ACP-ASIM draft does not address the linkage between the delivery system and the systematic denial of services and degradation of medical ethics.
– The ACP-ASIM proposal fails to reject incremental strategies, precisely at the historical moment when employers are bailing out of their workplace insurance commitments and governments are slashing their medical and other health programs. Clearly, single payer national health insurance emerges not any longer as the best solution, but as the only solution!
– The reality that health care is a public good, not a for-profit, investor-owned commodity, has shaped the health programs of all democratic, advanced industrial nations. The ACP-ASIM draft does not examine the lessons our country can learn from the superior achievements – fiscally and medically – of other countries (Canada, Sweden, Norway, etc.).
The single-payer solution:
Universal coverage will never be achieved until we have one single system with an effective method of budgeting and cost control. And quality in health care will not be achieved until we have universal coverage with an effective method of health planning. These are inseparable, and the attempt to take on expanding coverage without reforming the fundamental structure of the health financing system would be like running our government without the Constitution.
Comment: Our response further describes the deficiencies in the ACP-ASIM proposal. By failing to address important policy issues, the ACP-ASIM proposal can never lead to an equitable, affordable system of health care for everyone. We propose an alternative which will accomplish that goal -the single payer solution.
The entire response is available at:
The ACP-ASIM proposal is available at: