Election 2020: Comparison of the American College of Physicians' Vision for a Better U.S. Health Care System With the Presidential Candidates' Plans
Authors: Heather E. Gantzer, Jacqueline W. Fincher, William E. Fox, Gregory C. Kane, Thomas G. Cooney, George M. Abraham, Rebecca Andrews
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions1 December 2020Election 2020: Comparison of the American College of Physicians' Vision for a Better U.S. Health Care System With the Presidential Candidates' PlansFREEHeather E. Gantzer, MD, Jacqueline W. Fincher, MD, William E. Fox, MD, Gregory C. Kane, MD, Thomas G. Cooney, MD, George M. Abraham, MD, MPH, and Rebecca Andrews, MS, MDHeather E. Gantzer, MDPark Nicollet Clinic, Methodist Hospital, St. Louis Park, Minnesota (H.E.G.)Search for more papers by this author, Jacqueline W. Fincher, MDCenter for Primary Care, McDuffie Medical, Thomson, Georgia (J.W.F.)Search for more papers by this author, William E. Fox, MDFox and Brantley Internal Medicine, PLC, Charlottesville, Virginia (W.E.F.)Search for more papers by this author, Gregory C. Kane, MDThe Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (G.C.K.)Search for more papers by this author, Thomas G. Cooney, MDPortland VA Medical Center, Oregon Health and Science University, Portland, Oregon (T.G.C.)Search for more papers by this author, George M. Abraham, MD, MPHSaint Vincent Hospital, University of Massachusetts Medical School, Worcester, Massachusetts (G.M.A.)Search for more papers by this author, and Rebecca Andrews, MS, MDUConn Health, University of Connecticut Health Center, Farmington, Connecticut (R.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-7089 Annals Author Insight Video - William E. Fox, MD In this video, William E. Fox, MD, offers additional insight into the article, "Election 2020: Comparison of the American College of Physicians' Vision for a Better U.S. Health Care System With the Presidential Candidates' Plans." (Duration 2:11) SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editors' Note:This article was published at Annals.org on 27 October 2020, prior to the U.S. presidential election. Per Annals' usual practice, it now appears in a journal issue. Although the election has passed, readers may find the comparison of the ACP's views with those of the presidential administration that takes office in 2021 of interest.Health care in the United States costs too much, is unaffordable for too many, spends too much on administration, produces outcomes that are unfavorable compared with other countries, misaligns incentives with patient interests, and undervalues primary care and public health.These were the conclusions of a series of January 2020 American College of Physicians policy papers, “Better Is Possible: The American College of Physicians' Vision for the U.S. Health Care System” (1–4). These “New Vision” papers proposed a detailed framework designed to “achieve universal coverage with improved access to care, reduce per capita health care costs and the rate of growth in spending, reform clinician compensation, and reduce the complexity of our health care system.” The American College of Physicians (ACP) is a nonpartisan physician-led member organization but believes that it is important to identify key differences in the party policies on health care issues that affect our patients. As the election approaches, we compare the health care policies of the Republican and Democratic parties with ACP's policy proposals to see how they would probably affect key health care issues, including cost and coverage during their potential administrations in the 4 years ahead: 2021–2025.The United States remains the only Western industrialized nation without universal coverage. Job losses contribute to loss of insurance coverage, particularly during economic downturns such as the current coronavirus 2019 (COVID-19) pandemic, placing millions of Americans at risk for missing important health care screenings; losing control of chronic health care conditions; losing access to health care for new symptoms, injuries, or illnesses; and developing medical bankruptcy. Moving toward an improved health care system has never been more important than during the current coronavirus crisis, which has created economic, educational, health, and public health challenges for the United States and personal challenges for millions of Americans who have already lost coverage or who remain at risk for loss of coverage in the coming months.The COVID-19 pandemic has shined a bright light on the consequences for our patients of a health care system that fails to provide universal access to affordable, comprehensive coverage. Consider Carol's story.Carol is 61 years old, has a seizure disorder that is well controlled on lamotrigine, and has worked as a medical office assistant for 10 years. When the private office she worked for closed during the pandemic, she lost her employer-sponsored health insurance. She lived in a state that did not expand Medicaid under the Affordable Care Act and was too young for Medicare, and so was left uninsured. She could not afford the $200.30 per month out-of-pocket price of lamotrigine, forcing a change to a more affordable medication. She had 2 seizures within the month and was placed on driving precautions. She now cannot drive to search for a job that has employer-based health insurance, which would allow her to resume the medication that is most effective for her.Carol's story is all too common, and too many Americans can relate to this untenable situation.Table 1 compares the 2 presidential candidates' views on health care with ACP's own vision for a better U.S. health care system. Our focus in this article is access, coverage, and cost. Table 2 shows ACP's 10 vision statements that extend to public health and social determinants of health.Table 1. Comparison of ACP's New Vision for U.S. Health Care With Current Knowledge of the Republican and Democratic Presidential Candidates' Views*Table 2. The American College of Physicians' Vision of a Better U.S. Health System for AllAs the United States is in the throes of a pandemic that has shaken the foundations of health care systems worldwide, the ability to make an informed decision based on the health care priorities of the 2 candidates has never been more critical. The candidates' positions on the critical underpinnings of the College's proposals vary significantly, and we invite readers to inform their decision making by using this side-by-side comparison.In light of the public health shortcomings highlighted by the current pandemic and the stark economic realities that face us, ACP's vision of a system of universal coverage (either a public option along with regulated private insurance or a single-payer system), costs that are controlled by lowering excessive prices, increasing adoption of global budgets and all-payer rate setting, prioritizing spending and resources, reducing administrative costs, promoting high-value care, and rebalancing payments for primary and cognitive care services are what we see as some of the fundamental changes for which our current system cries out. In addition, ending discrimination and disparities in access and care, including the undersupply of primary care physicians and addressing social determinants of health, is integral to accomplishing the goals outlined above.In the end, the words of Henry Wadsworth Longfellow in “A Psalm of Life” ring true:Not enjoyment, and not sorrow,Is our destined end or way;But to act, that each tomorrowFinds us farther than today.References1. Doherty R, Cooney TG, Mire RD, et al; Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: a call to action by the American College of Physicians. Ann Intern Med. 2020;172:S3-6. doi:10.7326/M19-2411 LinkGoogle Scholar2. Crowley R, Daniel H, Cooney TG, et al; Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: coverage and cost of care. Ann Intern Med. 2020;172:S7-32. doi:10.7326/M19-2415 LinkGoogle Scholar3. Erickson SM, Outland B, Joy S, et al; Medical Practice and Quality Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: health care delivery and payment system reforms. Ann Intern Med. 2020;172:S33-49. doi:10.7326/M19-2407 LinkGoogle Scholar4. Butkus R, Rapp K, Cooney TG, et al; Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: reducing barriers to care and addressing social determinants of health. Ann Intern Med. 2020;172:S50-9. doi:10.7326/M19-2410 LinkGoogle Scholar5. Republican National Committee. Republican platform 2016. 2016. Accessed at https://prod-cdn-static.gop.com/media/documents/DRAFT_12_FINAL%5B1%5D-ben_1468872234.pdf on 11 October 2020. Google Scholar6. Republican National Committee. Resolution regarding the Republican party platform. Updated 2020. Accessed at https://prod-cdn-static.gop.com/docs/Resolution_Platform_2020.pdf on 11 October 2020. Google Scholar7. Democratic National Committee. 2020 Democratic party platform. 2020. Accessed at https://democrats.org/where-we-stand/party-platform on 20 October 2020. Google Scholar8. Kaiser Family Foundation. Health care and the 2020 presidential election. 6 October 2020. Accessed at www.kff.org/slideshow/health-care-and-the-2020-presidential-election on 20 October 2020. Google Scholar9. Mann C, Guyer J, Striar A, et al. The fiscal impact of the Trump Administration's Medicaid block grant initiative. The Commonwealth Fund. 6 March 2020. Accessed at www.commonwealthfund.org/publications/issue-briefs/2020/mar/fiscal-impact-trump-administration-medicaid-block-grant-initiative on 20 October 2020. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Park Nicollet Clinic, Methodist Hospital, St. Louis Park, Minnesota (H.E.G.)Center for Primary Care, McDuffie Medical, Thomson, Georgia (J.W.F.)Fox and Brantley Internal Medicine, PLC, Charlottesville, Virginia (W.E.F.)The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (G.C.K.)Portland VA Medical Center, Oregon Health and Science University, Portland, Oregon (T.G.C.)Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, Massachusetts (G.M.A.)UConn Health, University of Connecticut Health Center, Farmington, Connecticut (R.A.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-7089.Corresponding Author: Heather E. Gantzer, MD, Park Nicollet Clinic, Methodist Hospital, 3800 Park Nicollet Boulevard, St. Louis Park, MN 55416; e-mail, [email protected]com.Current Author Addresses: Dr. Gantzer: Park Nicollet Clinic, Methodist Hospital, 3800 Park Nicollet Boulevard, St. Louis Park, MN 55416.Dr. Fincher: Center for Primary Care, McDuffie Medical, PO Box 900, 505 Mount Pleasant Road, Thomson, GA 30824.Dr. Fox: Fox and Brantley Internal Medicine, PLC, 916 East High Street, Suite 1, Charlottesville, VA 22902.Dr. Kane: The Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 822, Philadelphia, PA 19107.Dr. Cooney: Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.Dr. Abraham: Saint Vincent Hospital, 123 Summer Street, Suite 385, Worcester, MA 01608-1320.Dr. Andrews: University of Connecticut Health Center, 263 Farmington Avenue, MC 1235, L 2104, Farmington, CT 06030.Author Contributions: Conception and design: H.E. Gantzer, J.W. Fincher, W.E. Fox, G.C. Kane, T.G. Cooney, G.M. Abraham.Analysis and interpretation of the data: H.E. Gantzer, J.W. Fincher, W.E. Fox, T.G. Cooney, R. Andrews.Drafting of the article: H.E. Gantzer, J.W. Fincher, W.E. Fox, G.C. Kane, T.G. Cooney, G.M. Abraham, R. Andrews.Critical revision for important intellectual content: H.E. Gantzer, J.W. Fincher, W.E. Fox, G.C. Kane, T.G. Cooney, R. Andrews.Final approval of the article: H.E. Gantzer, J.W. Fincher, W.E. Fox, G.C. Kane, T.G. Cooney, G.M. Abraham, R. Andrews.Administrative, technical, or logistic support: H.E. Gantzer, J.W. Fincher.Collection and assembly of data: H.E. Gantzer, J.W. Fincher, W.E. Fox, T.G. Cooney.This article was published at Annals.org on 27 October 2020. PreviousarticleNextarticle Advertisement Annals Author Insight Video - William E. Fox, MD In this video, William E. Fox, MD, offers additional insight into the article, "Election 2020: Comparison of the American College of Physicians' Vision for a Better U.S. Health Care System With the Presidential Candidates' Plans." (Duration 2:11) FiguresReferencesRelatedDetails Metrics 1 December 2020Volume 173, Issue 11Page: 929-932KeywordsCOVID-19DisclosureHealth careHealth care policyHealth economicsHealth insuranceHealth screeningPrevention, policy, and public healthPrimary care physiciansVision ePublished: 27 October 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...