Tuesday, September 15, 2009

New poll shows physician support for expanded government role in coverage

I have received quite a few comments from ACP members who say that the College's positions on health reform are not representative of most internists' views. For instance, on Friday an internist posted the following comment in response to my blog about Obama's speech to Congress:

"You will be hard-pressed to find a physician outside of a university setting that supports this ridiculous bill . . ."

Lately, such criticisms have come mostly from the right of the political spectrum. Over the years, though, I have heard from many ACP members who support a single payer system; they also claim most internists agree with them and that ACP is out-of-step with its membership.

A new poll, funded by the non-partisan Robert Wood Johnson Foundation, found that a large majority of physicians - almost 63% - "support proposals to expand health care coverage that include both public and private insurance options - where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans government." Fewer than one in ten of the physicians surveyed support a single government plan (Medicare for all) that replaces private insurance. Large majorities of physicians also support a Medicare buy-in option for people between the ages of 55 and 65. Primary care physicians - internists, pediatricians, and family physicians - were the most supportive of providing a public and private option, with 65.2% being in favor.

Physicians in all regions of the country supported a public-private option, with support ranging from a low of 58.9% in the south to a high of 69.7% in the northeast. 63.3% of physicians in urban areas and 59.6% in rural ones supported the public-private option. It wasn't just academic or salaried doctors who said they support a public plan option. Solid levels of support were found from physicians in private practices (59.7%), those who are involved in patient care more than 20 hours per week (62%), and those who get most of their income from direct billing rather than salary (58.9%). More than six out of ten AMA members expressed support for a public-private option.

Now, I have learned from experience that people tend to dismiss as being "biased" polls that do not agree with their own views. I also recognize that polls have their limitations, and some are more accurate than others. Some polls, especially those funded by advocacy organizations or political parties, should rightly be suspected of carrying bias. But there are a lot of highly respected researchers who are doing their best to capture accurate information about physicians' and the public's views, and I think this polls meets any reasonable standard of credibility.

Polls are snapshots of opinion, and opinions can change rapidly as circumstances change. Plus, complex issues like health reform aren't easily captured in a single poll. This poll did not ask the physicians about their specific views on President Obama's plan or the bills pending in Congress. Nor did it ask their views on financing health reform through higher taxes, or requiring that individuals buy insurance. Still, the poll suggests that there is broad and deep physician support for a larger federal government role in health care.

Now, just because physicians seem to agree on the need to provide the public with a choice of public and private plans doesn't make it the right policy prescription for America. A principled argument can be made against giving the government a bigger role in health care, just as a principled argument can be made for a single payer system. Still, physicians making such arguments should be aware that they seem to be at odds with where most of their colleagues stand.

Today's question: Do you agree with the poll's finding that most physicians support giving people the option of enrolling in a Medicare type program, along with private insurance? If you don't agree, are there alternative surveys or data on physicians' opinions that this blog's readers should know about?


BDoherty said...

When I posted this late yesterday, I said that I would gladly post on this blog any credible evidence on physician opinion that would lead to a different conclusion than that reached by the RWJ-sponsored poll, which showed strong physician support for an expanded role for government. I expect that some may point to a new poll by Investors Business Daily, which reports widespread physician opposition to the current health reform effort. In the interest of fair play, I am providing a link www.investors.com/NewsAndAnalysis/Article.aspx?id=506199 to an IBD news article about the poll. At the same time, I have my doubts about the accuracy about the IBD survey, in part because IBD was responsible for the myth that H.R. 3200 would outlaw private insurance. (See www.factcheck.org/2009/08/private-insurance-not-outlawed). Also, Nate Silver http://www.fivethirtyeight.com/, an analyst and self-declared statistical geek who has earned a reputation as an insightful and credible analyst of different pollsters, without regard to party or ideology, does not find the IBD poll to be believable (he is actually a lot stronger than that in his comments). Still, you can make up your own mind about which of the polls, RWJ or IBD, is the more accurate barometer of physician opinion.

Unknown said...

We should get a poll of physicians in countries that have a single payer system and ask them how they feel about the system. But then again, they have likely lived under the tyranny of that system for the entirety of their careers, so they may not know the difference.

Rich Neubauer MD said...

Whatever the final verdict is on the RWJ poll, it is good to know that there are a lot of physicians out there who have reached the conclusion that enough is enough and that we need change that will only happen with an expanded role of government in coverage.

A short list of other relevant instances where the government plays a strong role that is in direct competition with "the private sector" to the betterment of all:

1) Public Universities that compete with Private Universities
2) The NIH which competes for brainpower with private research organizations
3) The much maligned Post Office which competes with organizations like DHL and UPS. When I post a letter I still assume it will get there not the other way around