The path forward: a more inclusive healthcare system

Editor’s note: This is the second post in a two-part series. Read the first part here.

In January 2020, the American College of Physicians (ACP) published “Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians” in the Annals of Internal Medicine outlining the ACP vision for a more inclusive healthcare system.

Specifically the statement envisions a health system

• where everyone has coverage for and access to the care they need, at a cost they and the country can afford;
• that ameliorates social factors that contribute to poor and inequitable health; overcomes barriers to care for vulnerable and underserved populations; and ensures that no person is discriminated against based on characteristics of personal identity, including but not limited to race, ethnicity, religion, gender or gender identity, sex or sexual orientation or national origin;
• where payment and delivery systems put the interests of patients first, by supporting physicians and their care teams in delivering high-value and patient-centered care.
• where primary care is supported with a greater investment of resources.

The U.S. healthcare system is exceedingly expensive and remains unaffordable for many. As a consequence, many Americans lack coverage for the care they need. Based on the 2020 CDC National Health Statistics Report, 31.6 million (9.7%) people of all ages were uninsured. The vast majority, 31.2 million (11.5%), were people under age 65. Among children, 3.7 million (5.0%) were uninsured, and among working-age adults, 27.5 million (13.9%) were uninsured.

The United States is the only high-income industrialized nation without universal health coverage. Despite spending far more per capita on healthcare than other wealthy country, the United States, in comparison, consistently ranks last or near-last in access, administrative efficiency, equity and healthcare outcomes.

The American College of Physicians has proposed ways to achieve universal coverage with improved access to care and has recommended ways to realize it in a series of policy papers. The three papers offer a comprehensive set of policies to guide the way to a better healthcare system for all.

• In “Envisioning a Better Health Care System for All: Coverage and Cost of Care,” ACP recommends transitioning to a system of universal coverage through either a single payer system or a public choice to be offered along with regulated private insurance.
• In “Envisioning a Better Health Care System for All: Health Care Delivery and Payment Systems,” ACP calls for increasing payments for primary and cognitive care services.
• In “Envisioning a Better Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health,” ACP calls for ending discrimination and disparities in access and care based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. This position paper calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and tobacco use.

The ACP believes that its recommendations, if adopted, would address many shortcomings of the U.S. healthcare system.

As a fellow of the American College of Physicians and co-chair of the TX-ACP Health and Public Policy Committee, I urge all readers to learn more about the ACP, promote the organization’s healthcare advocacy strategies and participate (if you are in internal medicine).

By Dr. Fabrizia Faustinella, professor of family and community Medicine, Baylor College of Medicine