Letter: Majority of physicians favor national health insurance
MINNEAPOLIS, April 1, 2008—A letter published in the Annals of Internal Medicine describes a survey of 2,193 physicians throughout the country, which found that 59 percent favor legislation to create a national health insurance plan and 32 percent oppose it. A similar survey in 2002 showed 49 percent supported national health insurance and 40 percent opposed it.
According to the survey, 55 percent of physicians said they were in favor of achieving universal coverage through more incremental reform, and 25 percent opposed incremental reform.
Edward Langston, M.D., chair of the American Medical Association Board of Trustees, which opposes the idea of a national health insurance system, observed that the survey, as described in the letter, does not define what “national health insurance” is.
The nationwide survey was conducted by the Indiana University School of Medicine’s Center for Health Policy and Professionalism Research (CHPPR). CHPPR was established earlier this year as a think tank to conduct rapid turnaround research on health care topics. The Center is supported by Riley Hospital for Children and the Indiana University School of Medicine.
The results appear in the April 1 issue of the Annals of Internal Medicine. The letter was written by principal investigators Aaron Carroll, M.D., and Ronald Ackermann, M.D. Both are faculty members at Indiana University School of Medicine’s Center for Health Policy and Professionalism Research (CHPPR).
The survey said that that 83 percent of psychiatrists, 69 percent of emergency medicine physicians, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians, and 55 percent of general surgeons favor government action to establish national health insurance.
But physicians in some specialties opposed national health insurance, including radiologists, anesthesiologists and surgical subspecialists.
A 10-point increase in support for national health insurance, if true, means that about 80,000 physicians nationwide have changed their views in a relatively short period of time.
The survey, sent to a random selection of 5,000 physicians, asked 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?
To each question, physicians were asked to describe their support or opposition on a five-point scale. The survey also asked which organizations physicians belonged to, along with demographic, personal, and practice characteristics.
About 500 questionnaires were undeliverable, 197 were returned by physicians no longer in practice, and 2,193 were completed and returned — a 51 percent response rate.
Overall, 59 percent of respondents expressed support for legislation to establish a national health insurance program — 28 percent% "strongly," 31 percent "generally".
On the other side, 32 percent opposed national health insurance — 17 percent strongly and 15 percent generally. And 9 percent had no opinion.
On the second question, 55 percent of physicians said they were in favor of an incremental approach to universal coverage — 14 percent strongly, 41 percent generally. And 25 percent opposed incremental reform — 14 percent strongly, and 10 percent generally).
About 14 percent of respondents were in favor of incremental reform but not national health insurance.
The Minnesota Medical Association in its policies has long opposed a single-payer system, on the grounds that too much concentration of market power in a single payer is detrimental to patients and physicians, that it limits patients' freedom to choose and physicians' ability to practice.
As recently as September of last year, the House of Delegates of the Minnesota Medical Association rejected a resolution calling for the MMA to support a single-payer plan in the event of the failure of its "Physicians' Plan for a Healthy Minnesota."
The AMA is currently engaged in a major push to achieve universal coverage, and believes that is the proper focus for reform.
The AMA proposal "for covering the uninsured builds on what’s great in our system -- world-class medical innovations and research, and doctors dedicated to the health of their patients,” Langston said in a statement.
The MMA has been working for health care reform in Minnesota that will result in health insurance for all Minnesotans, a strong public health system with an emphasis on disease prevention, systems that support high-quality care, and a health care market focused on value.
As this study makes clear, however, physicians across the U.S., are divided on the subject.
"I think that physicians are really seeing what the insurance crisis is doing," said Aaron Carroll, M.D., one of the principle investigators in the study. "We’ve tried very hard with incremental reforms, but the problems keep getting worse."