Single-Payer Backing by AAFP Rebuffed

Marcia Frellick

September 30, 2019

PHILADELPHIA — A proposal to choose single-payer as the healthcare delivery system supported by the American Academy of Family Physicians (AAFP) was rejected last week after a lengthy debate in a reference committee hearing.

The resolution put forward by the New York chapter here at the 2019 Congress of Delegates came amid intense focus on the subject from Democratic presidential candidates and repeated attempts to revamp the Affordable Care Act.

Michael Munger, MD, AAFP board chair, said he opposes the proposal and believes that the healthcare-for-all policy passed last year should stand.

The tenets of that policy are that healthcare is a human right, that all Americans need meaningful, affordable coverage, and that it must be based in fundamental primary care, he explained.

We're not even at the starting line of a meaningful discussion on any one of those ways to achieve this.

But "we're not even at the starting line of a meaningful discussion on any one of those ways to achieve this. It's rhetoric; it's sound bytes. There isn't anything there," he said.

"We can't get too far out before the dialogue even begins," he added. Political whims can change and the AAFP could lose credibility by locking in with one delivery plan prematurely.

Student and resident delegations were deeply conflicted, but the majority of those groups came down against the proposal.

"I think the Academy has been very thoughtful in how we approach healthcare reform," said Matthew Peters, MD, resident delegate from Oregon, who spoke on behalf of the student and resident caucuses. "This is a deeply nuanced issue and this resolution specifically poses more consequences than many of our colleagues realize."

Although students and residents generally favor single-payer ideologically, going all in is "neither fully evidenced-based nor politically feasible" in the current political climate, he explained.

Sydney Doe, an alternate student delegate from Chicago, speaking on behalf of herself, pointed out that "single payer is the only system that allows patients to collectively bargain to decrease healthcare costs. This is a unique moment. The AAFP has an opportunity to contribute to the discussion meaningfully to legitimize single-payer by endorsing it."

Heather Paladine, MD, an AAFP member from New York, speaking on her own behalf, said she supports the single-payer option, and added that health equity can only truly be achieved with a single-payer system.

"My patients do have insurance but they still can't get consultations, certain medications, or other services at the same level as people with private insurance," she said. "The AAFP can discuss other health systems but should advocate for single-payer as our preferred system to ensure equitable care."

Fix Medicare First

Robert Jackson, MD, a delegate from Michigan, speaking on his own behalf against the proposal, noted the low reimbursement from Medicare.

"I can't stay in practice on Medicare alone," he said. "We need to fix Medicare before we fix other things."

He pointed out that Medicare originated at a time when seniors had no other alternatives to pay for the healthcare that was draining their pensions. But now there are other options.

The Massachusetts delegation split 50/50 over whether to support the resolution.

However, Dennis Dimitri, MD, one of that state's delegates, said the group strongly supports another proposal to allow people 55 to 64 years of age to buy into Medicare.

"I do think that indicates some momentum," he said.

Munger said the one thing all members agree on is meaningful, affordable coverage for everyone.

"We will get there. I wish it were a short game. It's going to be a long game," he said.

Munger, Peters, Doe, Paladine, Jackson, and Dimitri declared no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2019 Congress of Delegates. Presented September 23, 2019.

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