Universal Questions

Elyas Bakhtiari, for HealthLeaders Media, April 10, 2008

It's not uncommon when I'm interviewing a physician—and the topic could be just about anything related to healthcare—for the conversation at some point to turn to the state of the reimbursement system and the need for some type of healthcare reform. Increasingly these days, that means we're talking about universal healthcare.

Some think it is a necessary next step, particularly physicians whose reimbursement suffers because they treat a lot of underinsured and uninsured patients. Others take a look at the bureaucracy of Medicare and the current healthcare system and consider a movement to universal coverage the equivalent to throwing gasoline on a fire. But with the election in full swing and healthcare one of the key issues of the campaign, universal healthcare is on many physicians’ minds.

Which is why I found a survey released last week regarding physicians’ attitudes about universal healthcare particularly interesting. The verdict? Fifty-nine percent of the more than 2,200 physicians surveyed say they support legislation to establish national health insurance. This represents a 10 point increase from a similar survey conducted in 2002.

A second question was asked about whether physicians support achieving universal coverage through more incremental reform, which is essentially what the major presidential candidates are proposing, and support actually dropped to 55%. Aaron Carroll, MD, MS, a pediatrician who was lead researcher on the study at the Indiana University School of Medicine, thinks this reflects physicians’ impatience with previous reform efforts that didn’t go far enough in addressing the problems of the uninsured and rising healthcare costs.

“Everything seems to be going downhill, and all the incremental reforms over the last five, 10, 15, 20, 30 years are not doing a good job,” he says. “If anything, most people feel that everything is getting worse, and I think physicians are recognizing that we need to have much more radical reform.”

But some physicians still have reservations. Another survey came across my desk this week from the physician recruiting firm Jackson & Coker. It found that 47% of physicians think patient care would probably be worse under a universal healthcare system, and 60% think patient wait times would increase dramatically.

Many questions still linger as universal healthcare looms on the horizon. Is healthcare a right or a commodity? Will our healthcare system become less efficient? How will we pay for universal coverage? How can we offer universal coverage without limiting patient choice? Will physician reimbursement suffer? Senior editor Les Masterson poses some additional questions in this week’s Health Plan Insider.

Though these questions range from the philosophical to the practical, physicians’ answers may be more predictable than we think. Female physicians and younger physicians tend to be more supportive of universal healthcare, Carroll says. And the specialty breakdown may be most revealing. Only three groups in Carroll’s survey had less than 50% support for universal coverage—radiology, anesthesiology, and surgical subspecialties—all of which earn well over $300,000 annually.

In fact, self interest may be the strongest correlate to support for national insurance. The specialties that most strongly supported it—psychiatry, emergency medicine, pediatrics, and primary care—all make less than $200,000 (MGMA median levels) and often have patient panels with a lot of uninsured or Medicaid patients.

But it’s important to remember that these are only patterns. I know primary care physicians who strongly oppose universal coverage and surgical subspecialists who favor it. This is a very contentious issue, and as is the case in the general public, physician opinions about universal healthcare are far from universal.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.


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