In the April 26, 2017, file photo, supporters of single-payer health care march to the Capitol in Sacramento, California. Large majorities of young Americans want to see an expansion of government services, including a single-payer health care program, according to polling. Credit: Rich Pedroncelli / AP

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Daniel C. Bryant of Cape Elizabeth is a retired physician.

On Sept. 8, at its annual meeting, the Maine Medical Association released its Revised Statement on Reform of the U.S. Health Care System. The document is the result of two years of work by its Ad Hoc Committee on Health System Reform, with extensive input from Maine physicians through listening sessions throughout the state and email and personal commentary.

The statement lists problems with our current health care system, including poor health outcomes, cost, emphasis on profit, poor access for many, administrative burdens for physicians, poor Medicaid and Medicare reimbursement, physician burnout and “moral injury,” restrictions inherent in the employer-based model, inequities and systemic biases. Desirable features of the physician-patient relationship and of an ideal health care system are described and the statement concludes with the organization’s call for major, not piecemeal, reform on the national level. The members present at the meeting moved to enthusiastically endorse it.

What is particularly interesting about this statement is its support for the role of the federal government in ensuring equitable health care for all U.S. residents: “federal health care reform that provides universal coverage through either an adequately funded single payer system or a combination of private and public financing where the federal government has, at minimum, regulatory powers over health care delivery to protect consumers and providers from private profit-driven motives.” This is very different from the cautious, non-specific, state-focused recommendation in the medical association’s previous reform statement (from 2017): “Our objective should be to achieve basic health care for every resident of Maine.”

The Maine Medical Association’s new recommendation is not unique. It reflects an evolution, over the last few decades, of the medical establishment’s attitude toward the health care system of which it is a crucial part. For example, the American Medical Association’s 1957 Principles of Medical Ethics was all about physician autonomy and responsibility to patients in their practices: “A physician may choose whom he [sic] will serve,” physicians shall render to each patient “a full measure of service and devotion;” but then a 2001 revision added, “A physician shall support access to medical care for all people.” In 2018, the Medical Student Section of the AMA went so far as to petition the organization (unsuccessfully, as it turned out) to drop its traditional opposition to the single-payer model. And four other state medical societies (New Hampshire, Vermont, Hawaii and Washington) have published resolutions supporting that model, as have a number of specialty societies such as the American College of Physicians.

Of course, not all physicians share this position, and much of the sometimes vigorous discussion during the workshopping of the MMA statement centered on the question of the federal government’s responsibility or right to ensure health care for all. Many physicians, thinking of Medicare and Medicaid reimbursement rates, fear their income may drop in a publicly funded plan, though some studies suggest that savings in a streamlined system like single payer would compensate for reduced reimbursement for most physicians. And there are practices that receive significant income from special insurance arrangements and side businesses that would be restricted, if not eliminated, in a publicly funded system. Should these physicians be deprived of this income? Does medical professionalism require that of them? The public expects it of them?

As we think about these questions and about the kind of health care reform we want, it will behoove us to consider the ideas expressed in the MMA’s statement. It would be important as well to ask our own physicians (if there’s time in a hurried appointment!) what they think of it, and to let them know our own opinion.