The second-largest doctors group in the United States is endorsing "Medicare for All" as well as a public option as possible routes for achieving the goal of universal coverage.

The endorsement of Medicare for All from the large doctors group, the American College of Physicians, is notable because much of the rest of the health care industry has expressed opposition to the idea, including the largest doctors group, the American Medical Association.

The American College of Physicians (ACP), which represents internal medicine doctors that often serve as a patient’s primary care physician, is known as more liberal than other groups, including speaking out forcefully against the repeal of ObamaCare.

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Still, the group's backing of Medicare for All, issued Monday night, is a crack in industry opposition.

“Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage,” the group said in a paper laying out its position. “The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many.”

The group endorsed both full-scale single-payer health insurance and an optional government-run plan as competing options that can both achieve universal coverage.

There are also signs that doctors overall are becoming less opposed to Medicare for All, which traditionally has been opposed as leading to cuts to doctor payments.

The American Medical Association’s House of Delegates came close to voting to overturn its long-standing opposition to Medicare for All in June, with the vote failing 53 percent to 47 percent.

The association then left the industry coalition fighting Medicare for All, the Partnership for America’s Health Care Future, in August.

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The ACP, in its new endorsement, also called for moving farther to a payment system for doctors and hospitals that incentivize quality care, rather than the old system of simply paying for the number of services provided.

Still, the group called for increasing payments for primary care, which many of its members practice, saying it is currently undervalued, so the group is not solely calling for sacrifice from doctors.

Lauren Crawford, executive director of the Partnership for America’s Health Care Future, responded to the ACP’s move by again criticizing the “one-size-fits-all system controlled by politicians.”

“The Partnership welcomes this discussion, and we are proud to represent the nation’s leading doctors, nurses, clinicians, community hospitals, health insurance providers and biopharmaceutical companies, who are all committed to working together to ensure every American has access to the affordable, high-quality coverage they deserve,” she said.

Dr. Robert McClean, president of the ACP, said: “We believe the status quo is an unsustainable model for our country and most importantly, our patients.”