At its meeting on November 5, the Ohio Academy of Family Physicians Board of Directors held a focused discussion on single-payer health systems. OAFP Delegate to the American Academy of Family Physicians Congress of Delegates (COD) Jeff Bachtel, MD, introduced the single-payer health system topic and then OAFP Alternate Delegate to the AAFP COD Lisa Righter, MD, provided an overview of Board Report F that was presented at the 2017 AAFP COD.
As a result of referrals from the 2016 COD, the AAFP Board commissioned RTI International to conduct a study (which resulted in Board Report F) on the “effects of a national publicly-financed, privately-delivered health care system for all Americans.”
When discussing single-payer health systems, it is very important to specifically define what is meant because the term “single-payer” means different things to different people. The AAFP study examined three specific models:
•Medicare for All (a single publicly financed and privately administered system)
•Bismarck Model (system of statutory health insurance involving multiple nonprofit payers)
•Public Option (a publically administered health plan that competes for customers against
Each model was analyzed as to coverage and access, number of general practitioners per 1,000 people, physician satisfaction, expenditures, and population health outcomes. The thing that really stands out is the number of general practitioners in the United States versus other countries who utilize one of these three other health system models. A vastly improved primary physician pipeline and primary care physician-to-subspecialist ratio would be key to making a single-payer system work here in the United States.
The conclusion of the study reads as follows: “In most cases, the effects of different coverage and financing models depend on the specific details of the health care system and proposals for reform. One consistent finding is that by most measures of health, countries with a single-payer system or universal coverage through a Bismarck model have better overall health outcomes than the United States. Further, these countries spend less per capita and as a percentage of GDP on health care, although they also spend more than the United States does on social supports. In most cases, physician satisfaction is higher in single-payer and Bismarck health care systems (apart from Germany) than in the United States. The optimal system for the United States may be some combination of components from different models, adapted and customized to fit the unique circumstances in the United States.”
Current AAFP policy supports universal access to basic health care services for all people. The AAFP believes this goal can be attained with a pluralistic approach to the financing, organization, and delivery of health care. A pluralist health care delivery approach naturally involves competition based on quality, cost, and service.
At the present time, the AAFP does not see a viable path that would allow for the establishment of a new, publicly-financed, privately-administered health care system. The AAFP also does not see the creation and implementation of a true, single-source health care system as viable or even practical as the current economic and political environments do not lend themselves to the development and implementation of such policies.
While this is really a national debate, the OAFP board discussed the current economic and political environments in Ohio and also concluded that creation and implementation of a true, single-source health care system in Ohio is not currently viable. However, the OAFP can prepare for what might come in the future by working to grow the primary care physician pipeline and improving the primary care physician-to-subspecialist ratio in this country. Also ideas and support can also bubble-up from the state level to the national conversation. The ultimate goals are for all patients to have access and receive the care they need and for physicians and other health care professionals to find more professional satisfaction in providing that care to patients.
The board felt that it was important to inform the membership about the work the AAFP has done on the single-payer health system topic. Watch for a future President’s Message in The Ohio Family Physician and creation of a single-payer resource page on the OAFP website.