Most Doctors Want A National Health Plan

Six in ten U.S. physicians support a national health plan to achieve universal coverage.

A 2002 poll among American doctors was updated in 2007 to determine how physicians’ feelings about national health insurance (NHI) may have changed in the 5 year period.

In 2002, 49% favored a national plan. In 2007, 59% supported such a plan.

The chart on the left details findings by physician specialty. Not surprisingly, more generalist doctors favor a national health plan compared to specialists, although there is still support for national insurance by a plurality of specialists and the support has grown over five years.

Psychiatrists, long supporting mental health parity in American health financing, are at the vanguard of NHI support. Pediatricians, emergency doctors, and internists make up the over-50% crowd in support of NHI.

The emergency physicians’ support for NHI has dramatically grown since 2002, probably due to the fact that these clinicians are at the forefront of caring for the uninsured. They see firsthand that uninsurance and underinsurance often drives consumers to the ER. A recent study at Harvard published in Health Affairs found that overcrowding in emergency rooms has led to those with the most urgent conditions being at-risk.

Jane’s Hot Points: Physician support of national health insurance is nothing new. For over twenty years, Physicians for a National Health Program (PNHP) has focused its mission on achieving a single-payer system in the U.S. Today, PNHP has more than 15,000 members throughout the U.S.

That more physicians are joining the ranks of people in search of universal coverage moves the concept way past the tipping point in the U.S.

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  1. Universal Healthcare, Single Payer System or National Health Insurance……different names for the single most important outcome i.e provide quality healthcare to all US Residents. Not state of the art healthcare only to some, not experimental robotic surgeries to others ….but healthcare across the board. Overtime, we will develop a population that lives longer than Sardinians, Okinawans and other centenerians

  2. I was looking to start my own blog on healthcare finance and found this one. What I find most interesting about these discussions is that the people doing the discussing are generally not healthcare finance people. How come no one asks us? I wonder if people really understand how much it costs a hospital to get paid for the services we perform.
    I have been in healthcare finance for the last 25 years (non-profit community) and I can tell you that if we had a single payer system (not a national health care plan) the cost of healthcare would drop dramatically. Currently we have to confirm to the rules of every insurance company (and even the same company may have different benefits and rules depending on the employers plan) and managed care plan and the uniform bill is anything but uniform. In reading your responses I think you should make a definite distinction between single payer system and a national health care plan. I know if we had a single payer system hospital and doctors offices could reduce there billing departments, registration, precert and case management staff. There would also be a corresponding drop of personnel on the insurance side of the equation as there would be one set of rules everyone would follow.

  3. Whether or not physicians are in favor of Universal Health Coverage will be relevant after such a system is implemented and matures over time. Without practicing in such a proposed system and fully understanding the pros ad cons thereafter, the assumptions will hardly build a case for a single payer system.

  4. Even though the url string above disappears on the right I found if you just highlight as far to the right as you can and copy, it will paste ok to open the link.

  5. I did some searching. This may help if it’s the proper study but Jane will have to comment. I enlarged the image and traced the study. Below is a link of the study (I think) summary which discusses how it was conducted.
    Here is link for full PDF:
    Comments now Eric?

  6. In the case of a national health insurance, I would imagine that there would be fewer physicians that would be against it rather than for it. I can see why there would be an increase in physician supported in the group of ER doctors because you are right in saying that they do see most of the uninsured patients, but I have a hard time believing that other doctors would want this to happen. The reason for my previous statement is that if we were to function under a single payer system, much of the competition would die down and physicians would be paid a much lower salary than what they are currently earning. While I am neither for nor against a national health plan, I do have some concerns with the quality of care that would be provided by such a system. It is often the case that we focus on the good qualities of socialized healthcare networks in other surrounding areas, but very little do we notice all their flaws. Also, if we take a look at the current government run healthcare system, otherwise known as the VA, it is not the best of systems. In fact, there are constant stories in the news that remind us of the low quality of care that VA patients receive. I would hope that, if our country did move towards a more socialized healthcare, the appropriate measures and precautions be taken. I do think that there are parts of our healthcare system that do work, and that trying to fix what we already have would not be a bad idea either. In terms of the chart that you provided, I would like more information about how the study was conducted. Were the doctors who were polled randomized? What types of questions were they asked? It just seems to me that six out of ten doctors is a bit extreme in terms on national health insurance support. If you could please direct me where I could view the study, I would greatly appreciate it.

  7. Since there seems to be a general debate about which poll numbers are accurate, I decided to look at the Wall Street Journal’s web site. Sure enough, they have posted a WSJ/Harris poll taken in March 2008 about healthcare coverage on the national level. I certainly trust their numbers, as Harris and the Wall Street Journal are credited with effective polling techniques. Anyway, two of the results are:
    1. 60% of Americans think it is the government’s job to insure that all Amneicans have adequate health coverage. 31% oppose this.
    2. 45% of those polled trust the Democrats to reform and improve our healthcare system. 25% trust the Republicans.
    Thus, it seems that the voters seem to want healthcare coverage of some sort for all; this does not mean, of course, the elimination of private payers. I imagine that some sort of system similar to Medicare provided by private insurers would be acceptable.

  8. No adam, 29% favor and 39% oppose. How do you get to add the 31% not sures to the oppose column? Must be the Rush Limbaugh math.
    “Twenty-nine percent (29%) of American adults favor a national health insurance program overseen by the Federal Government. A Rasmussen Reports national telephone survey found that 39% oppose such a government-led initiative while 31% are not sure.”

  9. I know this must come as a shock to the denizens of liberal bastions like NYC, SF, LA, DC, and Boston. Like Pauline Kael once said (I paraphrase): I don’t know how Nixon could have won. Everyone I know voted for McGovern. Like Obama, you all are totally out of touch.
    The overwhelming majority (and 71% is overwhelming) does not want a government-run HC monopoly. I predict that, if the Dems manage to impose such as system, that will constitute the beginning of the end of the Democratic Party. America will never forgot or forgive such a wrenching and coercive change.

  10. Simple math my friend: 100% minus 29% (in favor) equals 71% who do not favor (ie, either oppose or are undecided).

  11. Adam, just so I’m not trying to confuse, distract, and muddle, where in the link you provided does it show “71% of Americans do not favor a government run system?

  12. Thanks Bret, your take is exactly right. Typically lefty tactic is that taken by Peter: introduce unrelated topic in order to confuse, distract, and muddle arguments and facts. The point is, 71% of Americans do not favor a government-run system at present. Even more incredible is the fact that only 16% thought health care quality would improve under government control.
    As the the doc’s: a single-payer system is sure to discourage medicine as a career among our best and brightest college students. It will all end up like the UK, where the bulk of new physicians must be imported from abroad.

  13. Statistically, this survey is a joke. For it to be representative of the larger physician population, the 2,193 respondents should have been chosen randomly. They were not. This sample of 2,193 physicians is instead a self-selected subset of the original 5,000 chosen from the AMA master file.
    And the conclusions of the author (a Board member of PNHP) defy common sense: There are about 800,000 physicians in the U.S. and this guy claims 59% of them (472K) support a nationalized health care system. If this is true, why does PNHP only have 14,000 (less than 2%) members?

  14. Public health insurance programs have expanded coverage for the
    poor, and government provide essential services to these vulnerable populations.
    Despite these efforts, many Americans do not have access to basic medical
    care. I believed that politicians should concentrate their energies on this point
    Income protection

  15. Well Bret, we are being forced to endure the present healthcare system BECAUSE healthcare lobbying/donations/contributions/after politics jobs are creating government policy that we have to abide by. As for, “People who refuse to partake would have to be fined, penalized, or even jailed”, sounds like income tax.

  16. Peter,
    The coercion Adam is talking about is a completely different beast than the one you are noting in the OpenSecrets link, and we’re not just talking about a matter of degree. While most Americans, including myself, have a distaste for the sheer volume of dollars being spent to lobby congress, there’s nothing fundamentally wrong with the concept of petitioning the Government this way. It’s a form of peaceful coercion, if you will. Creating a single-payer system (or the like) would require forcibly conforming everyone to the system including those that disagree with it and do not wish to participate. People who refuse to partake would have to be fined, penalized, or even jailed. This is the coercion by force that many Americans wish to avoid.
    The real question is how much of the $444.7M is being spent in support of a forcibly coercive solution?

  17. adam, how’s this for “a highly coercive effort”.
    “WASHINGTON—Corporations, industries, labor unions, governments and other interests spent a record $2.79 billion in 2007 to lobby for favorable policies in Washington, the nonpartisan Center for Responsive Politics has calculated. This represents an increase of 7.7 percent, or $200 million, over spending in 2006. And for every day Congress was in session, industries and interests spent an average of $17 million to lobby lawmakers and the federal government at large.”
    “CRP, which tracks lobbying spending on its award-winning Web site, OpenSecrets.org, found that, for the second straight year, health interests spent more on federal lobbying than any other economic sector—$444.7 million. The finance, insurance and real estate sector was second, spending about $418.7 million.”

  18. “Twenty-nine percent (29%) of American adults favor a national health insurance program overseen by the Federal Government. A Rasmussen Reports national telephone survey found that 39% oppose such a government-led initiative while 31% are not sure.”
    That rasmussen report with “overwhelming numbers”?

  19. Relevant?
    “The American College of Physicians (ACP) has endorsed the single payer health plan as “one way” to accomplish universal health care. This is a significant step toward convincing our elected officials and the American people of the virtues of establishing the government as the sole provider of health insurance (this is not socialized medicine, as the cons would have you believe). The single payer system has long been endorsed by the Physicians for a National Health Plan (PNHP). PNHP is a relatively small group of progressive and realistic physicians (of which I am a member) who realize that our current health care system is a disgrace. In a country where most believe that our system is “the best in the world,” it is absolutely incredible that we rank behind over 30 countries, including Costa Rica, in outcomes.
    The ACP is the second largest group of physicians in the US, having approximately 120,000 members. The ACP has a track record of being more of a patient advocate group and less of a self-interest group than the AMA. Endorsement of this plan by the ACP should help establish the plan as a reasonable alternative to our present failure. It is important to point out that the ACP is not what would be regarded as a progressive organization.
    While the ACP stopped short of endorsing single payer as the only way to accomplish universal health care, they noted that single payer systems have the advantage of being “more equitable, have lower administrative costs, have lower per capita health care expenditures, have higher levels of patient satisfaction, and have higher performance on measures of quality and access than systems using private health insurance.” The ACP has published a position paper, delineating the strengths and weaknesses of various approaches to universal health care:
    The ACP concluded, by studying the health care systems of 6 industrialized countries, that single payer healthcare is the most equitable, efficient, and economical of all systems. The support of a large, prestigious organization like the ACP should alter the playing field, and aid in shifting the momentum toward the establishing an equitable health care system in the US: something that has been sorely lacking in “The greatest country in the world.””

  20. Peter- you will see that I do not mention the AMA anywhere… the AMA was not the point of Jane’s original post, nor my comments.
    Her conclusions, however, imply that the membership total of 15,000 for PNHP signifies a tipping point.
    To a certain extent, your comment bolsters my point that so called ‘organized medicine’– the groups given the access to power to lobby government, perhaps do not really represent the total group at all?

  21. Wikipedia, Re: AMA
    “Physician membership in the group has decreased to lower than 19% of practicing physicians. In 2004, AMA reported membership totals of 244,569, which included retired and practicing physicians along with medical students, residents, and fellows. The medical school section (MSS) reported totals of 48,868 members, while the resident and fellow section (RFS) reported 24,069 members. Combined they account for almost 30% of AMA members. [4] If every other member of the AMA was a fully qualified practicing physician then the AMA would represent 19% of America’s practicing physicians (There are currently approximately 900,000 practicing physicians in America). However, MedPage Today estimates that the AMA only represents 135,300 “real, practicing physicians” as of 2005 (15.0% of the United States practicing physicians). [5] When asked about this, Jeremy Lazarus, MD, a speaker in the AMA House of Delegates, stated that membership was stable, avoiding commenting on the low overall numbers (2005 AMSA annual meeting, AMA vs. PNHP healthcare debate, Arlington, Va.).”
    So how relevant is the AMA?

  22. Jane– rhetorical question (perhaps not a hot point, but an important one nonetheless): if 6 in 10 physicians, of the about 600,000 – 800,000 in the US want a single payer system, does it strike you as odd that PNHP has only 15,000 members?
    Even more important, and perhaps the first law of reading the medical literature: who are the authors and could there be any bias there?
    And, lo and behold– one of the authors of this ‘study’ just happens to be on the national board of the PNHP. hmmm.
    Next step in looking at medical literature— check the methods… well, on this front, you cannot really find them easily, BECAUSE IT WAS ONLY PUBLISHED AS A 1 PAGE LETTER TO THE EDITOR!
    But, it appears that 5000 questionnaires were sent out— to whom? random? to PNHP members? We do not know…
    What were the questions? Unsure, but apparently there were only 2 questions: 1. In principle, do you support or oppose
    government legislation to establish national health insurance? And 2.
    Do you support achieving universal coverage through more incremental
    That’s it.
    Next step in the process– look at the results: Under 50% of those were returned– what are the characteristics of the respondents vs. non-respondents?
    We do not know at all…
    Conclusions– and for the ‘casual’ readers of the medical literature (like almost all reporters), this is where they begin and end… even though it is the most subject to bias and wishful thinking… and, if you perform the other steps, perhaps you can draw your own—
    Would you now believe that the ‘study’ demonstrates that nearly 60% of US physicians favor a single payer system?
    And back to your ‘conclusion’, Jane: “That more physicians are joining the ranks of people in search of universal coverage moves the concept way past the tipping point in the U.S.”
    Knowing the facts of this ‘non-study’, do you think that you can make a genuine claim that having an organization with less than 3% of a group’s possible members in spite of 20+ years of regular access to the op-ed pages around the country, and supporters in the media, that we are past some mythical ‘tipping point’?
    I look forward to your sincere reply.