Physicians’ Views on a New Public Insurance Option and Medicare Expansion
63% overall support public option and 10% support single payer = 73% support public plan.
The voices of physicians in the current debate have emanated almost exclusively from national physicians’ groups and societies. Like any special-interest group, these organizations claim to represent their members (and often nonmembers as well). The result is a well-established understanding of the interests of physicians’ societies but little, if any, understanding of views among physicians in general. Faced with this absence of empirical data, we conducted a national survey of physicians to inform federal policymakers about physicians’ views of proposed expansions of health care coverage. Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support: public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans; private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan; or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare. We also assessed the level of physician support for a proposal that would enable adults between the ages of 55 and 64 years to buy into the current Medicare program — a strategy that the Senate Finance Committee has proposed. Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%).  Panel A shows the proportion of survey respondents who favored public options only, those who favored both public and private options, and those who favored private options only. Panel B shows the proportions of respondents (according to their medical specialty) who supported, opposed, or were undecided about the expansion of Medicare to include adults between the ages of 55 and 64 years. The proportion of support was consistent across all four specialty groups (P=0.08).
Read it all in the New England Journal of Medicine
A portion of the suffering has been gauged: L. P. Casalino, S. Nicholson, D. N. Gans et al., “What Does It Cost Physician Practices to Interact with Health Insurance Plans?” Health Affairs Web Exclusive, May 14, 2009, gives us numbers–and they agree with my doctor.
Key Findings
* Physicians, on average, spent 142.3 hours per year interacting with health plans, or 3.0 hours per week and 2.7 physician work weeks per year. Primary care physicians spent significantly more time (164.9 hours per year) than medical specialists (123.7 hours) or surgical specialists (100.3 hours).
* Nursing staff spent an additional 23 weeks per year per physician interacting with health plans, while clerical staff spent 44 weeks and senior administrators spent 2.6 weeks doing so.
* Compared with other interactions, physicians, on average, spent more time dealing with formularies (78.2 hours for primary care doctors, for example), and the least on submitting or reviewing health plan quality data (1.9 hours annually for all physicians).
* Converted into dollars, practices spent an average of $68,274 per physician per year interacting with health plans; primary care practices spent $64,859 annually per physician, nearly one-third of the income, plus benefits, of the typical primary care physician.
The authors further note that “the estimated $31 billion in costs physician practices incur in their interactions with health plans comprises 6.9 percent of all U.S. expenditures for physicians and clinical services. That is six times the amount the federal government spends annually on the Children’s Health Insurance Program (CHIP). Read More... HEALTH REFORM WATCH:
by Angela Caputo
With the White House's final health care forum taking place in Los Angeles yesterday, advocates for a single-payer system rallied in downtown Chicago, determined not to be sidelined in the debate anymore. Among the nurses and doctors who denounced the insurance industry for hijacking and diluting a public mandate for reform was Quentin Young of the Physicians for a National Health Program. He said it's time to put an end to "the profit motive gone mad-system" that's "a catastrophe in the making" for the nation's economy.
One by one, nurses and doctors took to the mic to talk up single-payer as the best approach for patients, as well as businesses. They also warned that the White House-favored alternative would do little to rein in insurance companies that continue to put profits before quality coverage. As one nurse from Cook County's Stroger Hospital put it this afternoon, "We don't have to reinvent the wheel, we just have to get behind it."
There are now two bills floating through Congress -- Rep. John Conyers' (D-MI) HB676 and Sen. Bernie Sanders' (D-VT) Health American Security Act 2009 -- that would essentially extend Medicare to all Americans. But as these activists know all too well -- and as Luke Mitchell masterfully reported in a recent issue of Harper's -- the culture in Washington, D.C. is not at all friendly to the idea.
Meanwhile, State Rep. Mary Flowers (D-Chicago) once again put single-payer on the agenda here in Illinois by introducing HB 311 (one of a handful of state-level single-payer proposals floating around the country). At the rally, she said, "We shouldn't be talking about how much health care is going to cost us because we're spending the money already." Indeed, in a Progress Illinois column penned last year, Young spelled out how such a system would pay for itself in the state.
While Flowers' proposal -- which has 37 co-sponsors-- didn't make the cut among the flurry of bills that passed out of the Illinois House last week, Young said Gov. Pat Quinn, his old friend and fellow health care advocate, might be just the person to push the bill as a real solution for stabilizing the state's finances.
But if there was one common theme at the rally, it was this: If single payer is going to advance at either the state or federal level, it will happen because concerned citizens make their voices heard and begin to rival the insurance industry's influence.
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.
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