Physicians Increasingly Support a Single-Payer National Health Insurance System

Laurie Barclay, MD

February 13, 2009 -- US physicians increasingly support a single-payer national health insurance system, according to the results of a survey reported online January 29 in the Journal of General Internal Medicine.

"Many politicians may mistakenly believe that single-payer national health insurance lacks support among key stakeholders such as doctors," lead author Danny McCormick, from Harvard Medical School and Cambridge Health Alliance (CHA), said in a news release. "Our finding that support for single-payer national health insurance now approaches that of tax-based incremental reforms suggests that a Medicare-for-all-type plan may be more politically viable than conventional wisdom suggests."

The goal of this US nationally representative mail survey was to evaluate physician opinion regarding financing options for expanding coverage for and access to healthcare.

Between March 2007 and October 2007, US physicians involved in direct patient care were asked to rate their support for reform options such as financial incentives to encourage people to buy health insurance and single-payer national health insurance, as well as to rate their views of several aspects of access to healthcare.

Of 3300 physicians sent the survey, 1675 (50.8%) responded; 49% prefer either tax incentives or penalties to promote the purchase of health insurance; 42% prefer a government-run, taxpayer-financed single-payer national health insurance program, which increased from 26% in a study 5 years previously; and only 9% prefer the current, employer-based financing system.

Regarding access to healthcare, 89% of physicians surveyed believe that all Americans should receive needed medical care regardless of ability to pay; 33% believe that the uninsured currently have access to needed care; and 19.3% believe that even the insured lack access to needed care. Opinions regarding access were independently associated with support for single-payer national health insurance.

"Surveys show that a majority of Americans support a single-payer system. It's not surprising that increasing numbers of doctors do," said coauthor David Bor, MD, also from Harvard Medical School and Cambridge Health Alliance. "Single payer is the only proposal that can cover all Americans, for all needed care, without driving up healthcare costs. National health insurance would eliminate the massive administrative costs and hassles imposed by our current multiplicity of private insurers."

Limitations of this study include modest response rate; the possibility that physicians strongly interested in health policy issues may have been more likely to respond; lack of generalizability to all physicians' views; and possible misinterpretation of question meaning or bias related to question wording and response option content.

"Although a plurality of physicians favored incremental health care reform proposals based on the use of tax credits and penalties, a substantial proportion of physicians preferred an entirely different health care financing system -- a government-run, taxpayer-financed single-payer [national health insurance] program," the study authors write. "Physicians play a central role in the health care system and these views could be influential in reforming the financing of the American health care system."

The Department of Medicine at the Cambridge Hospital funded this study. The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online January 29, 2009.