U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey

By Danny McCormick, Steffie Woolhandler, Anjali Bose-Kolanu, Antonio Germann, David H. Bor and David U. Himmelstein
Journal of General Internal Medicine
April 2009

We asked respondents (physicians engaged in direct patient care) to choose the single option they preferred: 1) “The current health care system, in which most people get their health insurance from private employers, but some people have no insurance”; 2) “A universal insurance program in which everybody is covered under a program like Medicare that is run by government and financed by taxpayers”; or 3) “The current health care system, with the addition of new tax credits for buying, or tax penalties for failing to buy, health insurance”.

9% – The Current Health Care System

42% – Single-Payer National Health Insurance Program

49% – The Current System With Addition of Tax Credits or Penalties

Conclusions: The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.


This study supports the findings of other surveys that confirm that almost all physicians want reform of our current health care system, but they remain divided over whether or not we should replace the private insurance system with a government-run, taxpayer-financed program.

One interesting subset of this study suggests an answer to the question as to whether or not the AMA supports single payer reform. Although official positions of the AMA are decided by their House of Delegates, this survey helps us determine if the views of AMA members are different from a cross-section of practicing physicians. AMA members support the current system with the addition of tax credits or penalties over single payer by a ratio of 55 to 36. Physicians who are not AMA members are evenly divided with a ratio of 46 to 45.

When the physicians were asked if they agreed that people without health insurance have access to the medical care they need, single payer supporters disagreed at a ratio of 5 to 1. Supporters of the current system with added tax credits/penalties were more evenly divided. There is a fundamental difference, even if with fuzzy divisions.

Please forgive me for a moment of introspection, which seems apropos here. When I retired from practice and set up my home office to work on health care reform, I put all of my framed certificates, awards and other documents in a box in the garage, except for one that I received on graduation from medical school: The Oath of Hippocrates. My desk faces it. Frankly, much of the rhetoric doesn’t particularly resonate with me. I mean… pessary for abortion? … mischief and corruption? … seduction of females, males and slaves?

But there are two lines in the Oath that I hold sacred:

“I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

“With purity and holiness I will pass my life and practice my art.”

I have been very thankful for having had the opportunity to have known and worked with physicians who share these values – roughly one-half of the physicians whom I’ve met through the years. And the single payer supporters in PNHP with whom I continue to work? All of them, 100 percent, understand the sanctity of the healing arts. That’s what we’re all about.