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72% of Physicians Support a Public Option
A few weeks ago, I wrote a column about the divisions between physicians on healthcare reform, particularly when it comes to the public option. At the time, I didn't have a recent survey of the general physician population to gauge the sentiment, so I placed the dividing line somewhere between the AMA's endorsement of a bill despite reservations about a public option and some of the more vocal opponents who are actively campaigning against reform.
Turns out, the split between physicians isn't as close to the middle as I initially thought.
More than 72% of physicians support a public option, according to a new study in the New England Journal of Medicine. Nearly 63% surveyed favored a combination of public and private plans—similar to what's being proposed in two of the current healthcare reform bills—and 9.6% preferred only public options. The remainder, 27.3%, supported private options only.
I initially fell into the trap of listening too closely to the loud voices of special interests and political extremes—it's like taking a drug rep's word for the effectiveness of a new treatment without data from an actual trial.
But I also misjudged the level of physician support for a public option because as long as I've been writing about physicians, I've been covering annual potential Medicare reimbursement cuts and hearing complaints about Medicare payment levels, in some cases even threats that physicians would begin dropping Medicare en masse.
If physicians don't like Medicare, which is a public payer, then why would they welcome another similar plan into the market that will likely reimburse at similar (albeit slightly higher, according to current legislation) rates?
The survey, which was conducted by researchers Mount Sinai School of Medicine and published by the Robert Wood Johnson Foundation, asked physicians about their payer preferences and confirmed what I had been hearing anecdotally. Physicians ranked Medicare very poorly on adequacy of payments and other financial factors, like timeliness of reimbursements.
But, physicians actually slightly preferred Medicare to private payers when it comes to autonomy in decision-making and the ease of obtaining services that patients need. It's not all about the money, at least outside of the associations and lobbyists representing physicians in Washington.
"I think the fact that physicians would be supportive of a public option, even in the face of feeling it in their pockets . . . speaks very positively of their overall experience with Medicare relative to private insurers, from a clinical standpoint," says Alex Federman, MD, MPH, assistant professor at Mount Sinai School of Medicine and coauthor of the survey.
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wrf (9/18/2009 at 8:26 PM)
Sigh...... The study is here: http://healthcarereform.nejm.org/?p=1790&query=home Statistical appendix here: http://content.nejm.org/cgi/data/NEJMp0908239/DC1/1 Here are the choices: Respondents were asked to indicate which of three options they would most strongly support: 1. Public and Private Options: Provide people under age 65 the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. 2. Private Options Only: Provide people with tax credits or low-income subsidies to buy private insurance coverage (without creating a public plan option). 3. Public Option Only: Eliminate private insurance and cover everyone in a single public plan like Medicare. Here is the response: Number 1. (Choice of public or private) 62.9% Number 2. (Private only) 27.3% Number 3. (Public only) 9.6% To favor allowing someone the ability to pick A or B does not mean one favors A or B. It means one favors the ability to choose. To conflate Number One (choice-62.9%) with Number Three (only public-9.6%), and conclude that "72% of Physicians support a Public Option", shows either a profound ignorance of basic English and basic statistics, or a profound bias. I suspect the latter. And this is a publication that is going to the people who claim the expertise to reform the American healthcare system? Give me a break.
Richard Besserman, M.D. (9/17/2009 at 5:26 PM)
In this NEJM study less than 10% favor the public option only, the equivalent of "socialized" medicine. Note that Investors Business Daily conducted a TIPP poll which revealed strikingly different results. In its most recent coverage of the subject Terry Jones reports that their poll reveals that "45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul." (http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199)
Martin Brubeck, MD (9/17/2009 at 3:42 PM)
One should not dismiss a poll (particularly one published in NEJM) because one doesn't agree with it. I believe the results because we all deal with patients who have become uninsured and understand their plight. We are also not scared of government involvement in medicine. In fact, dealing with Medicare is far easier than dealing with private insurance. Unfortunately, the AMA, with its overly conservative values, no longer speaks for the vast majority of doctors. The AMA remains obsessed with protecting physician incomes without considering why we became doctors in the first place--to take care of patients.