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.

That statement initially surprised me given all the complaints I have heard about Medicare, but not as much as this next finding: More than half (58.3%) of physicians surveyed would support expanding Medicare to individuals 55 to 64 years of age.

The study didn't even find the substantial divisions in support between specialties noted in surveys from before the healthcare debate began. "We were mostly surprised by the consistency of the support," says Federman. "There was support of a public option in the southern regions of the United States, there was support for it among surgeons, there was support for it even among AMA members, and that's what really what surprised us."

The survey was conducted from June 25 through the end of August, when the public debate was at a fever pitch, and physician responses remained consistent throughout the period, explains Federman.

Of course, support for a public option doesn't necessarily translate into support for the other specifics of the reform legislation. And it doesn't discount the fact that there is genuine physician opposition to both.

But while the debate, even on the physician side, has been driven by the loudest voices, the survey suggests there is a largely silent majority of physicians that could have an impact on the outcome.

I keep going back to a poll conducted earlier this year by Gallup, only because it is so revealing: The public trusts physicians more than anyone else—politician or otherwise—to inform them about healthcare reform.

In that context, this week's survey showing physician support for the public option could prove more influential in its ultimate fate than even President Obama's endorsement during his address to Congress last week.