NATIONAL HARBOR, Md. — Single-payer healthcare is both “a way to crater the practice of medicine” or one thing that “expands access to affordable coverage,” in response to two completely different audio system at the American Medical Association’s (AMA) interim assembly of its House of Delegates right here on Saturday.

Single-payer, a system through which healthcare is paid for by the federal authorities, “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, talking on behalf of the Texas delegation, mentioned at a reference committee assembly.

He was referring to a decision which known as 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 mentioned. “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’s exactly as a result of the present system is damaged that we’d like to consider different alternate options, in response to Ryan Englander, a medical scholar from Connecticut who spoke on behalf of the New England delegation, which authored the decision.

“Let’s face it: our healthcare system is failing,” he mentioned. “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,” mentioned 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 previous president of the AMA, mentioned the decision was “well-crafted” however “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 mentioned. “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 additionally debated two resolutions aimed at rising insurance coverage protection for weight problems drugs. “In this country, diabetes is a disease and obesity is a disease,” mentioned 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 mentioned. “If the problem were merely genetic, why has the incidence increased in recent decades?”

Although GLP-1 agonists have been proven to trigger weight reduction, they arrive with limitations, particularly that “the weight loss plateaus after 60 weeks,” mentioned Rahman. “Secondly, after the medications are stopped, participants regain the weight, and third, they come with a hefty price tag.” Rather than spending the cash on drugs “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 mentioned.

Ethan Lazarus, MD, talking for the Obesity Medicine Association, mentioned he has been treating sufferers with weight problems 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 weight problems was first acknowledged as a illness, “we’ve gotten five new medications available,” mentioned Lazarus, of Lone Tree, Colorado, who’s on the speaker’s bureau for Novo Nordisk, maker of weight problems drug semaglutide (Wegovy).

“Chronic treatment is necessary,” he mentioned. “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.”