ACP vision of improving healthcare access
Donald Harvey Marks, M.D Ph.D.
Emeritus Fellow, American College of Physicians
Revised 31 October 2026
The American College of Physicians, the internal medicine professional society to which I belong as an Emeritus Fellow, in 2020 published a landmark series of policy papers and a comprehensive call to action titled "Better Is Possible: ACP’s Vision for the U.S. Health Care System" as a supplement in the Annals of Internal Medicine.
The core recommendations across the three interconnected companion position papers cover the following areas:
1. Coverage and Cost of Care
The ACP advocates for universal access by endorsing either a single-payer system or a publicly-financed option, eliminating out-of-pocket patient costs, and controlling prices through global budgets and rate-setting. Prior US presidents, including FDR (my favorite), Nixon and Clinton have agreed.
2. Healthcare Payment and Delivery Systems
The policy papers push for increasing payments for primary and cognitive care to address historical undervaluation, shifting performance metrics toward true patient outcomes, and reducing administrative and electronic health record burdens.
3. Barriers to Care and Social Determinants of Health
The ACP framework seeks to eradicate discrimination in healthcare settings, expand GME slots in primary care to combat workforce shortages, and implement national strategies addressing public health crises like climate change, maternal mortality, and substance use disorders.
The ACP Vision challenges the U.S. not to settle for the status quo, but to implement systematic health care reforms. An additional set of ACP policy papers, published in Annals of Internal Medicine, address issues related to coverage and cost of care, health care payment and delivery systems, barriers to care and social determinants of health, and more.
Although essentially a commendable set of proposals, I look forward to ACP giving more attention to the "essentially uninsured", meaning those with unaffordable premiums, high deductibles, and poor access to providers. Not being able to afford healthcare is equivalent to not having access to healthcare. Healthcare then becomes essentially not available. In addition, if a drug is unaffordable to those in need, it is essentially not available, and approval from FDA should be denied.
I have commented elsewhere, including posts on Substack and Instagram, why I think that all physicians should have their medical licensure contingent on accepting Medicare and Medicaid. I look forward to your comments on all these issues.
Related articles:
1, Reducing the influence of politics on health care, by Donald H. Marks, MD PhD
2. Should medical doctors be required to accept Medicare and Medicaid as a condition of licensure? by Donald H. Marks, MD PhD
3. How universal basic income UBI could be adapted to the homeless and the addicted. Thoughts for a post-labor economy. by Donald H. Marks, MD PhD
4. Fixing critical problems with the U.S. healthcare system by Donald H. Marks, MD PhD
5. The Pathology of Despair: From Systemic Failure to “Social Banditry” in American Healthcare. Is Luigi a Robin Hood / Pancho Villa? by Donald H. Marks, MD PhD
6. Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians, Annals of Internal Medicine 2020
