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Doctors favor single-payer system
By Dr. BRIAN O'MALLEY
August 06, 2008
The many adverse changes physicians have faced since the takeover of health care by Wall Street and the market have transformed the once-conservative profession. Recent surveys that serve as a barometer of that shift are reviewed here.
A 2008 study, the largest ever on physician attitudes toward health policy reform, asked about "government legislation to establish national health insurance." Published in the well-respected Annals of Internal Medicine, this was conducted by researchers at Indiana University. Their finding: By a nearly 2-to-1 margin (59 percent to 32 percent) physicians supported such a reform. This reflects a 10-point gain in support of single-payer reform since a prior similar study in 2002.
In the words of Dr. Ronald T. Ackerman, a co-author of this study, "Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy."
As long ago as 2004, a Harvard Medical School study of Massachusetts physicians, published in the AMA's Archives of Internal Medicine, found a remarkable 64 percent support for a national single-payer plan. By more than a 70 percent margin, they rejected a major role for the insurance industry in determining the delivery of health care. A study co-author commented that these views shouldn't surprise. "The plain fact," he said, "is Medicare works better for patients — and doctors — than most private insurance plans."
The American College of Physicians, the largest U.S. physician specialty society, in December 2007 endorsed a single-payer national health insurance program, reflecting its perspective that "universal health care insurance is necessary to ensure that everyone within the United States has access to needed health care services of high quality."
Another major medical society, the American College of Surgeons, approved a position paper that supports universal access to care, stating, "The achievement of universal health insurance coverage should be completed incrementally over the next decade, with some features perhaps being implemented on a state-by-state basis according to local priorities and needs."
Physicians for a National Health Program, a membership organization of more than 15,000 with many regional chapters across the country, has for years advocated and worked for a single-payer national health insurance program. PNHP members support the idea that "access to high-quality health care is a right of all people and should be provided equitably as a public service rather than bought and sold as a commodity." And it sets a goal of restoring "the primary mission of physicians, to act as professional advocates for our patients."
More and more practicing physicians find frustration in trying to provide competent, personal, cost-effective care. They leave practice. They advise their college-going children against careers in medicine.
Patients now bring a diverse assortment of health insurance plans, each with its own requirements and allowances. Physicians spend more and more time satisfying plan demands for pre-authorization of care. We no longer make the decision to have a CT or MRI scan, or a cardiac stress test. The plan must approve it. And the absolute anarchy of the prescription drug market, with its new "pharmacy benefit managers," creates a constant stream of uncompensated time demands on doctors.
Increasingly, physicians across the nation are recognizing that effectively covering everyone, with an improved version of Medicare, would go a long way to making our professional lives much more about what we trained to do — providing care to our patients — and less about running a business. The recent evidence presented here suggests that a diverse and substantial spectrum of current American physicians would support the establishment of a national health system to deliver universal care.
On Cape Cod, while we await the day the nation comes to its senses on this subject, we are working to establish a working demonstration model called Cape Care. Health providers, including physicians, have been central to this development. We envision an ongoing physician leadership role in the evolution of this innovative community health and care delivery system. And we actively welcome the participation of all health care providers in this effort!
Dr. Brian O'Malley, a Provincetown physician, is a leader of the grass-roots Cape Care Coalition.
Reprinted under Fair Use, in accordance with Title 17 U.S.C. Section 107