October 4, 2001
Delegates adopt plan for health care for all Americans, call for building coalitions
BY JANE STOEVER
T he Congress of Delegates adopted a sweeping proposal Tuesday, "Assuring Health Care Coverage for All." Delegates also urged the AAFP Board to "engage in an inclusive process of coalition building" to rally support for the plan among Academy members and groups influencing U.S. health policy.
"We have our nation's defense provided through taxes. Education K through 12 is assured," AAFP Board Chair Bruce Bagley, M.D., of Albany, N.Y., said Sunday at a town hall meeting.
"Coming after all the rest of the developed countries, it's about time for this society to say all its citizens should have access to health care."
The plan would cover all people in the United States. They would receive basic benefits, some with no copay (such as maternity care and periodic evaluations) and some outpatient services with a 20 percent copay (such as office visits, ER services and mental health care). The plan would protect people from extraordinary costs by capping out-of-pocket expenses.
The plan retains the current insurance market; requires a national tax, such as a sales tax, value-added tax, payroll tax, or tobacco or alcohol tax; and calls for Congress to pass a law assuring basic health care for all.
A 1999 2000 AAFP task force wrote the forerunner of the blueprint the delegates approved. Last year, delegates called for widespread dissemination of the plan to seek reactions to it. Some 1,200 responses later -- from individual FPs, chapters and other groups -- the Board revised the plan and asked for its adoption.
At the town hall meeting, Bagley read AAFP's mission: to improve the health of patients, their families and the American public."You may tweak this plan," said Bagley. "But if you say this plan is not what we're about, then the next step is to change our mission."
BOTTOM LINES
Covering all people in America with the plan's benefits is estimated to cost $52.8 billion more than current health spending.
"Savings from a healthier, more productive work force is not taken into account in the estimate," AAFP President Richard Roberts, M.D., J.D., of Madison, Wis., said Sunday. "An investment in health care coverage will yield a lot of savings."
Delegate Daniel Derksen, M.D., of Albuquerque, N.M., said, "For a 5 percent increase in cost, you get 17 percent of the people insured," referring to the more than 40 million uninsured Americans. "All of us see patients who are uninsured. Most of us see from 10 to 20 cents on the dollar for these people. This plan might help us."
CHALLENGES
The difficulties of getting the plan into the public arena and to the U.S. Congress loomed large in delegates' discussions this week.
Joseph Leming, M.D., of Colonial Height, Va., the Virginia AFP president, said the groups the Academy would need to do battle with were the ones to make alliances with before going to the U.S. Congress: the American Hospital Association, the U.S. Chamber of Commerce, the Farm Bureau. Leming warned Sunday, "We could parse this plan to death. But what will happen is that somebody else will introduce a plan. We need to have our plan ready to roll, worked out with our stakeholders."
AAFP Past President Neil Brooks, M.D., of Vernon, Conn., parliamentarian, said he spoke for universal health care but not the proposal. "I rise with a heavy heart to oppose this plan," said Brooks. "What we propose now comes at a cost that's not affordable, and it puts us in opposition to others in medicine at a time when we're trying to promote unity."
Aside from financial considerations, some delegates feared members might misunderstand the plan. "Back home, perception is reality," said Jeffrey Akerson, M.D., of Sidney, Neb. "They'll see the headlines. The plan will be interpreted by the silent majority as socialized medicine, an intervention into their practices."
Akerson and many others advocated filing the report and continuing to use it and embrace its principles.
After lengthy discussion on the floor of the Congress Tuesday, delegate Michael Fine, M.D., of Pawtucket, R.I., suggested adopting the proposal "with reservation," one of eight options posed earlier by Speaker Michael Fleming, M.D., of Shreveport, La. Delegates approved Fine's resolution, adopting the plan 72 50.
LOOKING AHEAD
The delegates earned thanks Tuesday from AAFP Past President Lanny Copeland, M.D., of Frisco, Texas, chair of the 1999 2000 task force. "As family physicians, we're rebels, standard bearers," said Copeland. "The uninsured may be poor. They may be my son. They may be your brother. They may be illegal aliens. Because you adopted this plan, we'll be stronger in this country, and we'll serve our patients the best we know how."
The Academy will communicate the plan to members and dialogue with them and other groups about the plan.
After the vote Tuesday, Roberts said he'd been quiet during the delegates' lengthy debate. "I was listening," said Roberts. "That's what we on the Board will continue to do -- listen to you, listen to our members. You've given us a direction, and we will follow it." *
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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