Doctors support national health insurance, claims press

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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.

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7 Comments

  1. If they’re stupid enoughto belong to the AMA, they’re certainly stupid enough to favor a complete government takeover of their business.

  2. I do think we need reform but single government payer healthcare is NOT IT!!! Look at Canada and UK …it’s a disaster!!! Besides it will take away any control doctors and patients have over their healthcare. Sorry, to burst your bubble but when it’s estimated that 50 cents of every healthcare dollar is lost to fraud and waste the solution is NOT to THROW More money at it!!! Why not some catastrophic coverage ONLY and have tax credited HSA’s instead?? It will force patient/ consumer self regulation and more prudent and logical decision making with market forces decreasing costs to be more reasonable without expanding unreasonable demand and as far as liability reform goes …don’t get me started!!!!

  3. The survey must have been sent to doctors who are members of the communist party or doctors who are living in homes who care for Altzheimer victoms. I don’t beleive for one second that 51% of physicians support goverenment run health care. Call it what it is, socialized medicine. It is very true that health care reform is needed. The reform should be to repeal managed care and return to the pre 1993 system! This was before Clinton’s task force on health care destroyed medicine. It should be called the communist manifesto on health care. No physician with half a brain in their head would support government care. The publication of this survey is politically motivated, and deadly inaccurate.

  4. Any doctor in favor of even a continued increase in third party medicine, especially governmental, has not practiced long enough to see what it has done to “Medicine, that most estimable of professions.” (Voltaire) Those doctors have always favored a solution to the problem which incrementally for 50 years has caused the problems: enormous expense, abuse of the system by both doctors and patients, and deterioration of personal medical care. They want computerized billing of the third party from lists of many thousands of 5 digit numbers, rather than, say, 10 or 12 items on the medical statement sent directly to the patient with an offer to assist in reimbursement directly to the patient. Yeah, that’s anachronistic, but it worked. So did professional courtesies to colleagues and their families, the clergy, and discounting or cancellation of bills when indicated.

  5. Obviously a poor propaganda survey.

    If any of these groups or even the government were truly concerned about the uninsured, as a first step, they could simply advocate to change the IRS regs where health care costs were a fully deductible expense without having to itemize and be subject to a 7% “floor”. This would provide immediate relief for the uninsured and place them on a tax equal footing with those that have tax advantaged plans through their employers.

  6. I cannot believe the percentages quoted! The questions were poorly worded. The government cannot do anything efficiently, even though I believe we have the best government in the world. We absolutely cannot have more government involvement in healthcare. Academic types are the ones who appear to favor more government involvement in healthcare. Remember the early 1990’s? “Managed care” came out of the mouths of academicians not clinicians didn’t it? I have practiced in a university setting and as an employed physician at a large hospital. Both provided excellent care, but worked like big overspending, inefficient government. For a while, I practiced oncology with a nationwide, for profit, practice management company. (Oh, the horrors of for-profit medicine the ivory tower academics would complain.) Medical care through that for-profit, publically-traded company was provided more-efficiently, more patient-friendly, and much cheaper than at either the private nonprofit hospital or the academic medical center. The way I saw it, the patients, the insurers, and the country’s economy all benefited from the private enterprise medical system.

  7. Doctors are like wives whose husbands beat them yet they turn back to them for ‘love’ – we have a system that worked when it was free-market ‘capitalism’ and became dysfunctional as socialism was phased in. The cure we want for our current problems – more socialism!

    Same with most government programs – look at welfare, gun control, the ‘war on drugs’ and all manner of other government programs; they cause problems then we want to solve the problems with MORE of the same interventions.

    The really funny part is that “more of the same” has personified in Obama, and calls itself “change.” Now THAT’S irony.