Creating a Better System

Les Masterson, for HealthLeaders Media, April 9, 2008

Imagine despising something so much that you’re willing to discard a system that puts you among the nation’s top earners. That’s what a majority of physicians recently surveyed thinks about the current health insurance system.

Five years after asking physicians about universal healthcare, Aaron E. Carroll, MD, MS, and Ronald T. Ackerman, MD, MPH, of the Indiana University School of Medicine in Indianapolis, revisited the question. They randomly selected 5,000 physicians from the American Medical Association Masterfile and asked them two questions:
• In principle, do you support or oppose government legislation to establish national health insurance?
• Do you support achieving universal coverage through more incremental reform?

The researchers found that 59% supported legislation to establish national health insurance and 55% approved of universal coverage through incremental reform. The 59% support for national health insurance increased from 49% in 2002.

The three specialties with the highest percentage of support for national health insurance are on the front lines facing the heart-breaking stories of uninsured Americans: Psychiatry, pediatric subspecialties, and emergency medicine. 

The results from the University of Indiana survey have been met with surprise, but should we really be shocked?

Many of physicians are frustrated with the current system. Disappointing reimbursements, patient care restrictions, bureaucracy impediments, and patients struggling with increased deductibles and copayments have created an unending series of headaches for physicians. 

Physician dissatisfaction is mirrored by the American people. Americans have been told in movies, in the press, and by presidential candidates that the healthcare system is broken. They see universal care as a panacea.

I would like to see a study done with the American people that goes beyond the standard: Do you support universal healthcare? Instead, the survey should ask more probing questions about the actual services Americans want and receive from their health plans. I think that kind of survey would actually show that Americans’ healthcare expectations and reality mirror one another. As I have written previously, managed care and health plans are a convenient whipping boy in the press and politics. Americans have been told so often to hate managed care that it is part of the country’s fabric.

That’s not to say the current system is perfect or that health insurers don’t regularly shoot themselves in the foot. There are weekly reminders about the latest managed care misstep.

But is universal healthcare the best way to insure the 47 million uninsured Americans while not crippling other parts of the system? How about decreasing requirements so those in need can afford mandate-lite plans? What about creating greater governmental oversight to ensure that managed care is spending a dedicated portion of its money on care and not on bloated salaries? How can we provide health insurance to more Americans while not reducing quality, erecting barriers to care for those currently insured, and creating a government bureaucracy that swells costs?

This is your opportunity to sound off on one of the biggest issues facing this nation. E-mail me your thoughts by clicking

Les Masterson is senior editor for Health Plan Insider. He may be reached at

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