The Philadelphia-based American College of Physicians - the nation's second-largest physician group - endorsed a single-payer health-care system yesterday.
But the organization stopped short of saying that a single-payer system like Medicare, in which the government would get and pay most bills, is the best way to achieve universal health coverage.
The group said the country also could do that through expansion of the current mix of private insurance and government coverage. Under the proposal, people would be required to get health insurance.
While some physicians have formed organizations that push for single-payer, David Dale, president of the ACP, said his was the largest general-interest doctor group to support the controversial idea.
The group said change was necessary because access to health care had deteriorated.
The largest physician group in the United States, the American Medical Association, does not support single-payer. Earlier this year, it released a proposal to expand insurance coverage, primarily through tax incentives and changes in insurance regulations.
The ACP's membership includes 124,000 internal-medicine physicians and related specialists.
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After analyzing health care in the United States and 12 other industrialized countries, the group concluded that universal coverage had been successfully achieved elsewhere through single-payer and pluralistic systems.
Either could work here, the report said. The pluralistic system gives consumers more choice, but also leads to higher administrative costs and inequalities. Because it is what the United States already has, it is less of a political challenge. "It's like remodeling your house to make it better for your whole family," Dale said.
Single-payer has lower administrative costs, but is not politically popular, he said. "I'm not a political analyst. I'm just a doctor," Dale said. "But I think there will probably be resistance to that. That's why we don't have it now." He said his group added it to its proposal to "heighten the debate."
Thomas E. Getzen, a professor of insurance and health management at Temple University, said doctors had long resisted single-payer systems for fear it would give the government more control over them.
Because much of the growth in expense in the current system is in procedures performed by specialists or in increased use of technology like MRIs, doctors who work in those areas have the most to fear from a single-payer system, Getzen said. Internists, who serve as primary-care doctors for many people, have less to fear.
The ACP also called for better payments for primary-care doctors to help avert a shortage and for the creation of a uniform billing system and greater use of electronic health records to reduce administrative costs.
Dale said that some U.S. doctors and hospitals were better than their counterparts in other nations, but that this country's health system compares poorly. "Part of our call is, 'Look around, guys, and see how other people are doing,' " he said, "and they're doing better than us."