72% of Physicians Support a Public Option

HealthLeaders Media Staff, September 17, 2009

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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