72 Time November 4, 2019
that Obamacare, which was designed to safe-
guard access to quality insurance, wasn’t doing
enough, they argued. Why not push for a sys-
tem that skips insurance entirely and instead
offers access directly to quality care? “There’s a
growing recognition among physicians that the
current system, even with the ACA, costs too
much, leaves too many people behind,” says
Bob Doherty, senior vice president of govern-
mental affairs and public policy at the Ameri-
can College of Physicians (ACP).
Enter: renewed interest in single- payer
plans. In 2016, the American Academy of Fam-
ily Physicians, which has supported the idea
of “health care for all” since 1989, launched
a study of various payment models, hoping
to inform discussions of how to reform the
health care system. The American College of
Physicians, which supports a government-
funded option for health insurance, is devel-
oping its own recommendations too.
The AMA, which has maintained its oppo-
sition to Medicare for All, began softening its
rhetoric. “The AMA has and always will wel-
come debate at our House of Delegates on mov-
ing forward on health care reform,” says AMA
president Dr. Patrice Harris. Bonica, who led
the research on physician partisanship, says
that incremental shift makes a difference.
“There’s potential for physicians to organize
among themselves,” he says. “Conditions are
very ripe for that.”
At the AmA’s AnnuAl meeting in June,
members voted on a proposal to remove the
organization’s opposition to single-payer health
care. It lost, but narrowly—just 47% to 53%.
Outside the meeting, a group including doctors,
nurses and medical students held a rally and
shared stories about why they wanted to fight
for universal health care. Two months later, ad-
vocates for a government-backed health care
option scored another victory when the AMA
pulled out of Partnership for America’s Health
Care Future, the industry coalition aimed at
stopping single-payer and public-option plans.
Meanwhile, more doctors are joining ac-
tivist organizations. Physicians for a National
Health Program, an advocacy group of doctors
that has been pushing for single-payer since
the 1980s, now has 23,000 members across the
country and has added 14 new chapters since
- PNHP’s student arm, Students for a Na-
tional Health Program (SNaHP), has grown
rapidly as well, says Dr. Richard Bruno, who
helped found SNaHP in 2011. It has nearly
doubled its membership over the past three
years and now has 85 chapters at campuses
across the country. Peter Lorenz, a second-year
student at Rosalind Franklin University’s Chi-
cago Medical School who helped start a SNaHP
chapter this fall, says the base is energized.
The old guard “know things are changing,” he
says. He’s now working with his school’s stu-
dent chapter of the AMA, which wants to get
Illinois’s state physician group to drop its op-
position to single-payer health care.
It’s not just aspiring physicians joining the
fight. At Columbia, the SNaHP chapter in-
cludes students studying dentistry, physical
therapy and nursing. Nurses are also out in
force, says Bonnie Castillo, the executive direc-
tor of National Nurses United, whose members
have long advocated for single-payer health
care. Beginning in February, NNU knocked
on 20,000 doors and held nearly 2,000 events
talking to voters about Medicare for All. During
the congressional recess in August, 1,200 ac-
tivists organized in 49 House districts. “We’re
thrilled that we have this surge of youth and of
activism,” she says.
But the path forward is uphill. Part of the
struggle, PNHP’s Gaffney says, is educating
people about what health care reform actu-
ally means. Aside from repealing the ACA,
Republicans have not offered a coherent plan
for the future of health care, but most of the
Democratic presidential candidates are also
vague on details of how their health care pro-
posals would work. Whether the public sup-
ports Medicare for All depends on how poll-
sters describe the policy. Some universal health
care proposals would eliminate all private in-
surance while others would offer voters the op-
tion of choosing to access government health
care. In the meantime, medical students, doc-
tors and nurses are still debating exactly what
the nuts and bolts of an ideal policy would be.
Callahan, the medical student at Columbia,
sees education as central to the fight. This se-
mester, she is creating a workshop to help her
fellow medical students translate their frus-
trations into political action. To her, advocat-
ing for Medicare for All is, at its heart, a moral
fight. Doctors and nurses are consistently
ranked among the most trusted professions
in the U.S.—and that, she says, comes with an
obligation to reform a system that too often
leaves families in bankruptcy or forces patients
to forgo care that they need but can’t afford.
“The idea that things have to be done a certain
way because that’s the way they’ve always been
done—in the Trump era, that doesn’t hold a lot
of water,” says Callahan. “If we gain enough
power we can actually make that change and
bring about the world we want.” □56%
Percentage of physicians who
support single-payer health
care as of 2017, up from
42% just 10 years earlier23%
Percentage of professional
time physicians spend on
nonclinical paperwork66%
Percentage of doctors who
say that external factors such
as third-party authorizations,
treatment protocols and
electronic health records hurt
patient care