Surveyed Physicians Favor Mix of Public Option/Private Insurance Coverage

Usually, healthcare starts with the doctor.

So it's important for people, especially politicians, to know what the typical provider on the frontlines of medicine thinks about the current healthcare debate, and the public option that seems to be so divisive.

Two New York researchers realized that evidence documenting how most physicians are leaning on this crucial issue is lacking.

So they decided to close the knowledge gap. They created a survey and sent it out starting in June to a randomly selected list of some 5,000 physicians culled from the roster of the American Medical Association. They received responses back from 43.2%.

The physicians were asked which of three proposals that would expand health insurance coverage they most strongly supported:

1. A mix of public and private options, in which people younger than age 65 would have a choice between enrolling in a new public health insurance plan like Medicare or purchasing private plans
2. Private options only, in which the government would provide low-income people with tax credits or subsidies so they could buy private insurance without creating a new public plan
3. A public option only, similar to a single-payer system, in which no one buys private insurance and everyone is covered through a plan like Medicare.

The answer? 62.9% supported the first option. Their survey, by Salomeh Keyhani, MD, MPH, and Alex Federman, MD, was published in Monday's online edition of The New England Journal of Medicine.

"Respondents—across all demographic subgroups, specialties, practice locations, and practice types—showed majority support (>57.4%) for the inclusion of a public option," Keyhani and Federman wrote.

So did physicians in every census region, with percentages ranging in favor from 589% in the South to 69.7% in the Northeast. Practice owners and those who don't own practices supported a mix of public and private options.

Physicians practicing in both rural areas and urban settings favored number 1 as well, a mix of public and private options.

Primary care doctors were the most likely to support a public option (65.2%).

Doctors in other specialty groups, such as radiologists, anesthesiologists, and nuclear medicine specialists who have less direct contact with patients "were the least likely to support a public option, though 57.4% did so."

Even 62.2% of those who identified themselves as AMA members, which two months ago voiced strong opposition to a public option, said they supported it.

As a bonus question, the researchers also asked physicians for their views on whether Medicare should be expanded to people between age 55 and 64, such as the Senate Finance Committee has proposed. More than 58% supported the expansion.

"The support was consistent across all four specialty groups (primary care providers, medical specialists or subspecialists, surgeons or surgical subspecialists, and all other doctors) with proportions in favor ranging from 55.6% to 62.4%."

Yes, there are lots of questions to be answered about how such a public/private health insurance offering would work, how it would meld with a pay or play rule, an insurance exchange or an individual mandate.

But as Keyhani and Federman wrote, large groups of organized medicine have been the ones to influence healthcare policy over the years, "and in doing so may have often obscured the collective views of individual physicians across the spectrum of specialties interests and regional affiliations."

"Our study of a national sample of physicians showed that a clear majority support a combined public-private approach to expanding health insurance," they wrote.

"It seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage," the authors wrote. "Therefore (it) should be carefully considered by lawmakers as they finalize legislation to reform healthcare and provide coverage for 47 million uninsured Americans."

It is not by coincidence, to be sure, that the study was released on the eve of the unveiling of the Senate Finance Committee's health reform package, a massive bill that does not contain provisions for a public option.