Widely trumpeted in the press, a nonscientific survey shows that 59% of American physicians purportedly favor legislation to establish national health insurance (NHI), while only 32% are opposed.
“The debate over physician support of national health insurance is over,” comments Don McCanne, M.D., on the website of Physicians for a National Health Program (PNHP).
The survey was published as a letter to the editor in the April 1 issue of the Annals of Internal Medicine (2008;148:566-567). Authors are Aaron Carroll, a board member of PNHP, and Ronald T. Ackermann, M.D., M.P.H., associate director of the Center for Health Policy and Professionalism Research at Indiana University. [In the 2008 Annals and in some reports, the name is spelled “Ackerman.”]
A survey sent to 5,000 randomly selected names from the AMA Physician Masterfile asked two questions: 1) “In principle, do you support or oppose government legislation to establish national health insurance?” 2) “Do you support achieving universal coverage through more incremental reform?” Responses were received from 2,193 physicians, or 51% of the 4,294 eligible participants. (Responses from physicians no longer in active practice were discarded.)
In answer to question #1, 38% “strongly” and 31% “generally” supported NHI; 9% were neutral; 17% “strongly” and 15% “generally” opposed it. In response to question #2, 14% “strongly” and 41% “generally” supported “incremental reform”; 21% were neutral; and 14% “strongly” and 10% “generally” opposed it.
Support for government health insurance has increased by 10% since the last survey in 2002, claimed a PNHP press release. However, sampling methodology was quite different in the earlier, more rigorous survey, and question #2 was dramatically changed. In 2002, the question read: “Do you support or oppose a national insurance plan where all health care is paid for by the federal government” [emphasis in original]. Only 26% supported this option (only 9% “strongly”), while 60% opposed it (27% strongly). (Ann Intern Med 2003;139:795-801)
Doctors least likely to support government payment for care were male, “non-minority” specialists in private practice in rural areas, whose practice was less than 20% Medicaid. Authors Ackermann and Carroll were “surprised to find that fewer than 50% of family practitioners supported government legislation to establish national health insurance,” and suggested this might be explained by the fact that FPs were more likely than internists or pediatricians to have a rural practice.
The bias of the authors seemed apparent in the 2003 abstract. “Background:… National health insurance would remedy this situation [of 40 million uninsured], and many believe the success of reform efforts in this direction may depend on physician support…. Conclusions: A plurality of U.S. physicians supports government legislation to establish national health insurance. This support may be relevant to the success of future efforts to reform national health care.”
AMA Board of Trustees chairman Edward L. Langston, M.D., said it was difficult to draw conclusions from the 2007 survey because of “possible confusion over its terminology” (AM News 4/21/08).
The survey was “pure propaganda,” stated Greg Scandlen of Consumers for Health Care Choices, noting that the sample was self-selected, and the contents of the cover letter unknown. “It might have been calculated to infuriate physicians who believe in freedom, resulting in these doctors discarding the survey.” He compared it with a Commonwealth Fund survey a few years ago, which purported to show that employers supported an employer mandate. Scandlen found that the survey permitted only two choices: an employer mandate or single payer (Consumer Power Report #122, 4/3/08).
Desperation resulting from being mugged by managed care is one suggested explanation for the results.