Most of the healthcare industry stands opposed to Medicare for All, a policy proposal floated by some Democratic presidential candidates that would expand the existing program to achieve universal health coverage. Hospitals, drug manufacturers and insurance companies all have their reasons for being opposed.
The American College of Physicians, which represents internal medicine doctors, has recently broken ranks with its industry peers by endorsing Medicare for All along with an optional government plan.
The ACP's reasons are numerous, as the group said such a policy would lower administrative costs and reduce barriers to care access. Physicians are becoming increasingly frustrated with the paperwork that comes with having multiple insurers with multiple rules and documentation requirements.
ACP said that cost-sharing could be eliminated under a single-payer system and that payments for care should be "sufficient to ensure access and not perpetuate existing inequities."
The group added that a plan with a public option -- an optional Medicare for All, essentially -- would be less disruptive to the industry but would still likely result in some reduced administrative costs.
Additionally, ACP cited some patients' lack of insurance as a medical justification for such a policy, as many uninsured patients forego seeking care entirely. Even in the employer-based private insurance system, rising deductibles have made seeking care prohibitive for those with insurance.
WHAT'S THE IMPACT
The stance is a sharp break from most of the healthcare industry, which remains firmly opposed to Medicare for All. Payers are against a plan that would eliminate private insurance. Hospital providers say a government-run health plan would ultimately result in lower reimbursement.
Responding to a 2019 bill introduced by House Democrats, the American Hospital Association said Congress has a history of slashing provider payments for government health programs and that Medicare and Medicaid reimburse providers less than the cost of delivering care.
"America's hospitals and health systems are working with policymakers to help expand coverage and improve affordability for all Americans," said AHA Executive Vice President Tom Nickels in 2019. "However, we are opposed to 'Medicare for All,' as it would impede our shared goals. The AHA believes there is a better alternative to help all Americans access health coverage -- one built on fixing our existing system rather than ripping it apart and starting from scratch."
The Federation of American Hospitals said it opposes legislation that would upend coverage for hundreds of millions of Americans, eliminate private health insurance and lead to a massive disruption in care for patients.
America's Health Insurance Plans is against what it calls the one-size fits-all government system. Under current coverage, Americans have choice and control over their options and treatment, AHIP said.
Congressional Republicans are also vehemently opposed to a single-payer system, instead favoring free-market approaches, and have even sought to dismantle the Affordable Care Act, though their efforts to do so have to date been largely unsuccessful.
The ACP's stance may have ripple effects, as it's the second-largest doctors group in the country after the American Medical Association.
THE LARGER TREND
Based on new surveys in a HealthPrep Data Service report, optional Medicare for All was the most popular policy among respondents at 45.4%. Keeping the current private system intact came in second at 33.3%, while a mandatory Medicare for All system garnered the least support at 21.2%.
This suggests that, while there's public support for a shift to some form of universal healthcare, voting age Americans are wary of a complete break from the current system. In short, a majority of voters reject mandatory Medicare for All, while a majority supports a Medicare for All option.
Sanders and Warren have been the most outspoken about their support for a mandatory Medicare for All system, whereas Buttigieg favors a Medicare for All opt-in that would retain private insurance models for those who want it. Former Vice President Joe Biden supports a public option such as Medicare for those who choose the coverage, offering premium-free access only for those who would otherwise qualify for Medicaid, but live in states that have not expanded Medicaid under the Affordable Care Act.
Minnesota Senator Amy Klobuchar, who placed a surprising fourth in Tuesday's New Hampshire primary, supports a public option.
Traditional Medicare is fee-for-service, which is at odds with the value-based care paradigm being promoted by the Centers for Medicare and Medicaid Services, in which reimbursement is tied more to care quality than to volume. An increasing number of seniors are choosing Medicare Advantage plans, which are paid on a capitation basis, and CMS has been supporting flexible benefits for MA plans.