1. The American College of Physicians recommends that the United States transition to a system that achieves universal coverage with essential benefits and lower administrative costs. a. Coverage should not be dependent on a person's place of residence, employment, health status, or income. b. Coverage should ensure sufficient access to clinicians, hospitals, and other sources of care. c. Two options could achieve these objectives: a single-payer financing approach, or a publicly financed coverage option to be offered along with regulated private insurance.

2. The American College of Physicians recommends that under either a single-payer or public choice model, coverage must include an essential health care benefit package that emphasizes high-value care, preferably based on recommendations from an independent expert panel that includes the public, physicians, economists, health services researchers, and others with expertise.

3. The American College of Physicians believes that, whether a single-payer or public choice model, cost sharing that creates barriers to evidence-based, high-value, and essential care should be eliminated, particularly for low-income patients and patients with certain defined chronic diseases and catastrophic illnesses. In general, when cost sharing is required for some services, it should be income-adjusted through a subsidy mechanism and subject to annual and lifetime out-of-pocket limits. In a public choice model, premiums should be income adjusted and capped at a percentage of annual income.

4. The American College of Physicians recommends that that in either a single-payer or public choice model, payment rates to physicians and other clinicians, as well as to hospitals and other facilities that offer health care services, must be sufficient to ensure access to needed care and should not perpetuate disparities in current payment methods. a. Current Medicare payment rates generally are insufficient to achieve the objectives of universal coverage. b. Physician payment policies must ensure robust participation and not undervalue primary care and cognitive services, including the primary, preventive, and comprehensive care provided by internal medicine physician specialists

5. The American College of Physicians believes that an automatic and mandatory enrollment mechanism should be developed under either a single-payer or public choice option system. In a public choice system, employers should be required to offer comprehensive coverage to their employees (and families) that is at least as generous as the public insurance option or pay a portion of the cost of their employees' public insurance plan coverage (that is, “pay or play”).

6. The American College of Physicians believes that relief from health care system administrative requirements should be a priority under either a single-payer or public choice model. To the furthest extent possible, billing and quality measure reporting should be standardized and streamlined.

7. The American College of Physicians recommends that a single-payer or public choice model be financed through government spending, employer contributions, progressive taxes on income, tobacco and alcohol excise taxes, value based cost sharing, reallocation of savings from reduced spending on administration, and system-wide savings and efficiencies described in this paper. a. Health care programs that serve special populations, including the Veterans Health Administration, Medicaid long-term services and supports, and Indian Health Service, should continue to operate alongside the new program.

8. The American College of Physicians supports greater investment in primary care and preventive health services, including support for the unique role played by internal medicine specialists in providing high-value primary, preventive, and comprehensive care of adult patients

9. The American College of Physicians supports efforts to reduce excessive list prices for goods and services, reduce price variation not associated with differences in the cost of providing services, reduce administrative costs at the system level and at the point of care, and improve the efficiency of the health care system

10. The American College of Physicians supports greater efforts to reduce low-value care and reduce costs associated with preventable disease.

11. The American College of Physicians supports greater adoption of innovative all-payer models, a global budgeting model, or health care growth benchmarks, informed by the experiences of states that have implemented such approaches.

12. The American College of Physicians recommends ongoing study of implemented health system budget reforms that measure the potential effects of the policy changes and identify and mitigate unintended consequences.

13. The American College of Physicians supports the adoption of well-designed reference pricing programs for certain elective health care goods and services based on timely, accurate, and accessible local market pricing data supported by all-payer claims databases (APCDs).

14. The American College of Physicians supports the rational stewardship of health care resources through the incorporation of cost-effectiveness analyses (CEAs) into coverage or pricing determinations made by public and private purchasers, as well as the incorporation of value statements into clinical guidelines.

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