乌鸦传媒

NATIONAL HARBOR, Md. -- Single-payer healthcare is either "a way to crater the practice of medicine" or something that "expands access to affordable coverage," according to two different speakers at the American Medical Association's (AMA) interim meeting of its House of Delegates here on Saturday.

Single-payer, a system in which healthcare is paid for by the federal government, "is the single way to crater the practice of medicine and the standard of care that our patients deserve," Ray Callas, MD, of Beaumont, Texas, speaking on behalf of the Texas delegation, said at a reference committee meeting.

He was referring to a resolution which called for the AMA to "remove opposition to single-payer healthcare delivery systems from its policy, and instead evaluate all healthcare system reform proposals based on [the AMA's] stated principles ... and support a national unified financing healthcare system that meets the principles of freedom of choice, freedom and sustainability of practice, and universal access to quality care for patients."

"Do we want to hand over our license to the federal government? Because that's what we're going to do by considering the single-payer model," Callas said. "It is complete insanity to think that we can take the current broken payment system of the federal government and say with good conscience that this is how we should be paid across the board."

But it is precisely because the current system is broken that we need to think about other alternatives, according to Ryan Englander, a medical student from Connecticut who spoke on behalf of the New England delegation, which authored the resolution.

"Let's face it: our healthcare system is failing," he said. "Our Medicare system is broken -- not because Medicare doesn't have the money, but because our society chooses to throw mountains of cash to hospital administrators and pharmacy benefit managers rather than the physicians who are actually providing care to patients."

"We are drowning in prior auth[orizations] as insurance giddily deny care to pad their record profits," said Englander. "Meanwhile, millions of our fellow Americans struggle without insurance, or insurance that is so skimpy and restrictive that they can't even afford to use it ... After decades of half-measures and false starts, it is apparent we need to think outside the box. It is time to open ourselves to the mere possibility that a single-payer plan may be proposed that expands access to affordable coverage, strengthening our ability to take care of our patients as we see fit."

Daniel "Stormy" Johnson, MD, a radiologist from Metairie, Louisiana and a past president of the AMA, said the resolution was "well-crafted" but "does single payer -- and does this resolution -- solve the problem that we seek to solve?"

"We have multiple single-payer models in our system already today -- Medicare, Medicaid, CHIP [the Children's Health Insurance Program], the VA [Department of Veterans Affairs]," he said. "But does any of them assure practice sustainability? We have a choice between price controls, which I've just described, and going to a market system, which we do not have. I suggest the reference committee ask themselves a question about where we're going with this resolution."

Delegates also debated two resolutions aimed at increasing insurance coverage for obesity medications. "In this country, diabetes is a disease and obesity is a disease," said Kevin Reavis, MD, of Portland, Oregon, a delegate from the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) who spoke on behalf of the Oregon delegation. "The vast majority of patients with diabetes are at least offered medical management ... Eventually a small percentage of patients with clinically severe obesity are offered medical management. We can do better than this."

But Vanita Rahman, MD, of Washington, who spoke for herself, opposed the resolutions. "It is a fallacy to assume that obesity and overweight are merely problems related to genetics that cannot be reversed with diet and lifestyle," she said. "If the problem were merely genetic, why has the incidence increased in recent decades?"

Although GLP-1 agonists have been shown to cause weight loss, they come with limitations, namely that "the weight loss plateaus after 60 weeks," said Rahman. "Secondly, after the medications are stopped, participants regain the weight, and third, they come with a hefty price tag." Rather than spending the money on medications "with limited and short-term benefits only, investing the same resources on diet and lifestyle can help far more Americans stay healthy for life," she said.

Ethan Lazarus, MD, speaking for the Obesity Medicine Association, said he has been treating patients with obesity for 20 years, "and 20 years ago I would have agreed with [Rahman]. However, long experience has shown that lifestyle intervention does not work over time."

In the decade since obesity was first recognized as a disease, "we've gotten five new medications available," said Lazarus, of Lone Tree, Colorado, who is on the speaker's bureau for Novo Nordisk, maker of obesity drug semaglutide (Wegovy).

"Chronic treatment is necessary," he said. "We can't treat a patient for 3 to 6 months and then stop treatment. Imagine treating diabetes without medication ... We have good drugs on the market; patients deserve them, but today only rich people can get them because almost no Americans have coverage. Let's fix this."

Comment