Single Payer Health Care; Physicians Opinions

NEJM — Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion

NEJM — Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion:

“Overall, a majority of physicians (62.9%) supported public and private options. Only 27.3% supported offering private options only.”

I realized I didn’t have this posted yet! The 3/4 of physicians ties in nicely with my estimate that physicians groups representing 3/4 of physicians also support health care reform in general and HR 3200 in particular.

The companion article is instructive, too.

a large majority of respondents (78%) agreed that physicians have a professional obligation to address societal health policy issues. Majorities also agreed that every physician is professionally obligated to care for the uninsured or underinsured (73%), and most were willing to accept limits on reimbursement for expensive drugs and procedures for the sake of expanding access to basic health care (67%). By contrast, physicians were divided almost equally about cost-effectiveness analysis; just over half (54%) reported having a moral objection to using such data “to determine which treatments will be offered to patients.

…the 28% of physicians who consider themselves conservative were consistently less enthusiastic about professional responsibilities pertaining to health care reform.

This last bit is a bit interesting, as at our Pennsylvania Medical Society Board retreat we discussed this last bit and the overwhelming consensus, as best I could tell, was that this was not controversial, and that part of our jobs was making these determinations.

U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey

U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey:

MAIN RESULTS

1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance.

CONCLUSIONS
The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.

This is the article referenced in the post below this one on physicians and physicians’ organizations views on health care reform. The full article is here and in PDF.

AMA It’s not just about us

AMA It’s not just about us:

Some excerpts from the address of AMA President Nancy Nielsen:

“We need fundamental change in our health care system for ourselves, for our patients, for our nation. Right now annual health care costs exceed $2 trillion. That’s 16 percent of our nation’s GDP. Costs are estimated to reach $4 trillion and 20 percent of GDP in 10 years.

Right now, annual health care costs are the number one reason for bankruptcy. Right now, Americans get about half the preventive services that are recommended. Right now, we rank 19th among 19 developed countries in mortality that could be helped by health care. That means deaths that might have been prevented by health care. Nineteenth out of 19.

Forty-six million Americans have no health insurance, and another 29 million are underinsured. Those 75 million Americans are delaying or failing to obtain preventive care.

In our nation’s sick economy, job losses mean the loss of health insurance. Just yesterday, the government reported that employers cut 240,000 jobs in October alone. And so far in 2008, some 1.2 million jobs have been lost.

We as a nation have to do some serious soul searching. We are the most innovative, resilient, determined, self-reliant and creative nation in the world. Our health care system ought to be the best in the world but currently it is not.

Today we pay twice what other countries with better health outcomes pay. But we rank last or next to last in many health indices. And, that’s compared with Australia, Canada, Germany, New Zealand and the United Kingdom.

Now, we can try to protect the status quo. But the status quo is not serving patients well, and doctors are angry and unhappy. It is high time we do something about it and I’m not talking about single-payer. I am, however, talking about comprehensive change. I’m talking about responsible change that builds on the strengths of the current system. Isn’t it time to build a bridge to a new and better health system? A system where patients are better served and physicians are happier and more fulfilled in their work?”

…

“Do you remember this pivotal question during one of the presidential debates? “Is health care a right, a privilege or a responsibility?” Whatever our personal convictions on the answer to this question, the broader population seems to be moving fairly rapidly to the view that health care is a right.

But who will pay for this right, if that’s the country’s decision? Who will define the parameters of this right to health care? Because everyone cannot have everything, and society should not have to provide everything, nor can it afford to do so.

Take education as an example of setting parameters. Our society has decided that K-12 education is a right, but post-secondary education is a privilege and a responsibility.

Defining parameters for health care “rights” and “responsibilities” will require society’s honest deliberation and some difficult decisions. For sure we have to define the expectations of personal responsibility. What is fair to expect the individual to do? What should be up to the individual, and what should be society’s concerns?”

…

“As we participate with the rest of society in this debate, we cannot allow the discussion to descend into ideology and inflammatory labels. If we do, if we allow reason to be trumped by rhetoric, then we will have lost our chance to shape the change, to build the bridge to a better health system.

So I ask you, are we prepared to participate in that societal debate? Because the debate is going to happen. This is not just about doctors. It is not just about us. But physicians and patients will have to live with the outcomes. That’s why we have a central role to play.

We all use the commons and that is why we all have to do our part to protect it. Make no mistake, I am not in favor of a single-payer system. I am in favor of a health care system that works better for all of us, patients and physicians.

We’re in a time when our country is demanding change. We need change. Let’s harness that energy for our patients and ourselves. For sure, this is for us – we have to remove the sand from our shoes. But it is for so much more than us.”

…

“In many countries, when people are scared, they turn to government for protection. Even though many do not trust Washington politics, they may see it as their only option. There is great concern in our country. We need to help calm those fears. We need to embrace our role as healers in a time of need. We need to help craft a solution that is based on our professional ethics–one that is equitable and just, one that builds on the strengths of our system, addresses current weaknesses, and allows us to regain the joy and simple dignity of caring for our patients. “

Please go check out the whole thing. Credit where credit is due. It is a remarkable statement from the the AMA President.

I am concerned by the last paragraph I quoted, however. My goal is to turn to my government for fairness, and it is not our of fear, it is out of anger at the mismanagement of our system and at the giant sucking sound, to quote Ross Perot, that emanates from our insurers, Pharma, and ourselves that makes our system so inefficient. So, I hope this is not the line in the sand that the AMA is drawing, that a solution based upon strong government regulation is off the table.

NEJM — Campaign Contributions, Lobbying, and the U.S. Health Sector — An Update

NEJM — Campaign Contributions, Lobbying, and the U.S. Health Sector — An Update:

“As of July, people affiliated with the health sector and political action committees (PACs) associated with the sector had contributed about $29 million to presidential candidates, including $8.8 million to Obama, $6.6 million to Senator Hillary Clinton of New York, the former Democratic contender, and $4.7 million to McCain, according to the Center for Responsive Politics (www.opensecrets.org), a nonpartisan organization that researches money in politics. Although these contributions represent less than 3% of the funds raised by presidential candidates, it is remarkable that the health sector has reversed a long-standing pattern of favoring Republican candidates, by contributing substantially more money to Democrats ($17.7 million) than to Republicans ($11.2 million). This trend also holds when the presidential and congressional elections are considered together (see Figure 1): as of July, the health sector had contributed $54.5 million to Democrats and $46.1 million to Republicans. Democrats lead Republicans in contributions from health professionals and from individuals associated with hospitals, nursing homes, or health services or health maintenance organizations. Contributions linked to manufacturers of pharmaceutical and health care products are split about evenly between the parties. The last time Democrats raised more money from health care interests than Republicans was 1992, when Bill Clinton was elected president.”

Yaaaayyy! I am certainly getting this vibe from my colleagues more and more lately. You can only have insurers rub your nose in poo for so long before you understand that some (any!) sytem of universal coverage has to be better than this.

AMNews: April 21, 2008. More physicians backing national coverage — study … American Medical News

AMNews: April 21, 2008. More physicians backing national coverage:

“Physicians who support ‘government legislation to establish national health insurance’
————————-2002————-2007
All specialties————49%————–59%
Psychiatry—————64%————–83%
Pediatric subspecialties—71%————–71%
Emergency medicine—–53%————–69%
Pediatrics—————-64%————–65%
Internal medicine——–56%————–64%
Medical subspecialties—-50%————–63%
Pathology—————-n/a—————60%
Family medicine———-44%————–60%
Ob-gyn——————-48%————–58%
General surgery———-52%————–55%
Surgical subspecialties—-37%————–45%
Anesthesiology———–35%————–39%
Radiology—————-n/a—————30%

I will try to get more of the details to the original article from the April 1 Annals of Internal Medicine tomorrow, as I can’t access it here at home tonight.

Update: here is the link to the Annals page. Actually not much more info there but here is the full results summary:

Results: Of 5000 mailed surveys, 509 were returned as undeliverableand 197 were returned by physicians who were no longer practicing.We received 2193 surveys from the 4294 eligible participants,for a response rate of 51%. Respondents did not differ significantlyfrom nonrespondents in sex, age, doctoral degree type, or specialty.A total of 59% supported legislation to establish national healthinsurance (28% “strongly” and 31% “generally” supported), 9%were neutral on the topic, and 32% opposed it (17% “strongly”and 15% “generally” opposed). A total of 55% supported achievinguniversal coverage through more incremental reform (14% “strongly”and 41% “generally” supported), 21% were neutral on the topic,and 25% opposed incremental reform (14% “strongly” and 10% “generally”opposed). A total of 14% of physicians were opposed to nationalhealth insurance but supported more incremental reforms. Morethan one half of the respondents from every medical specialtysupported national health insurance legislation, with the exceptionof respondents in surgical subspecialties, anesthesiologists,and radiologists. Current overall support (59%) increased by10 percentage points since 2002 (49%). Support increased inevery subspecialty since 2002, with the exception of pediatricsubspecialists, who were highly supportive in both surveys.

The spin in the AMA News article is predictable (poorly worded survey questions), and, OK, fine, maybe some didn’t mean exactly as they answered. We’ve all taken surveys, and it is true, you can only answer the question that is asked.

But look at some of these numbers because they are astounding. When 45% of physicians in surgical subspecialties (we’re talking orthopods, urologists, and neurosurgeons here!) and 55% (!!!!) of general surgeons answer this way, there is a problem.

AMA Policy is against single payer. But AMA policy is determined by it’s House of Delegates. This is a very democratically structured body, but frankly, delegates are far older and more conservative than all other AMA members and AMA members are older and more conservative than physicians as a whole, so this is a problem that will take a leader from within the AMA leadership to take up and champion. Which, knowing the culture a bit, would be courageous, but history making.

Putting this together with the Minnesota and Jackson and Coker surveys, we may finally be acheiving critical mass.

Jackson and Coker Physician Survey on “Universal Healthcare”

Survey details:

“As a result, Jackson & Coker commissioned a survey to determine the opinions of health professionals, especially practicing physicians, on the topic of healthcare reform. The survey results convey their views and advance the ongoing debate at this point in the presidential election cycle.”

Jackson and Coker is a physician recruiting firm. I actually got an e-vite to this survey and took it. Most respondents were in practice 15 years or longer, making them likely significantly more Republican and “conservative,” so take it with a tablespoon of salt.

I frankly didn’t find many surprises in it, much like surveys done by “The Factor” or Lou Dobbs, but I did find a ray of hope in the morass:

When asked, “Should health insurance be controlled by the government or private companies?”
25% said “The Federal Government” and 39% said “Private companies with government oversight.”

That gives a surpisingly large (can I say overwhelming?) 64% majority in this survey who sound like they would accept a Single Payer system in the sense of something like a Medicare-for-All system of government contracted payers.

Wow. The seeds are there.

Doctors demand action on private health insurance

CNW Group CANADIAN DOCTORS FOR MEDICARE Doctors demand action on private health insurance:

“TORONTO, March 12 /CNW Telbec/ – Canadian Doctors for Medicare today called on the federal and provincial governments to immediately take all necessary steps to stop the spread of private health insurance for medically necessary services in British Columbia.

‘The recent exposé that Acure Health Corp is selling ‘Medical Access Insurance’ for services already covered under Medicare undermines the public health care system to the detriment of the vast majority of Canadians, and contravenes the Canada Health Act’, said Dr. Danielle Martin, Chair of Canadian Doctors for Medicare.
…
“Those who think private health insurance is a panacea for our system should take a look at the Australian experience. The major beneficiaries there have been higher income Australians, private insurance companies, private hospitals and medical specialists – and not the wider Australian community,” said Dr. Martin.
…
“In its 2006, in its discussion paper “It’s About Access”, the Canadian Medical Association reviewed all the evidence and found: – Private insurance for medically necessary physician and hospital services does not improve access to publicly insured services
– Does not lower costs or improve quality of care
– Can increase wait times for those who are not privately insured; and
– Could exacerbate human resource shortages in the public system.”