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Your Doctor Says Universal Coverage Is Good for You

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Your Doctor Says Universal Coverage Is Good for You

By Jonathan Cohn
The New Republic
April 1, 2008

For most of the twentieth century, no single group represented a bigger obstacle to universal health care than organized medicine. It was state medical societies that blocked the very first efforts in California and New York, back during the late Progressive Era. (Back then, reformers called it “compulsory insurance.”) And it was the threat of similar opposition that is widely believed to have dissuaded Franklin Roosevelt from including health insurance as part of the Social Security Act in the 1930s.

Later, the American Medical Association spearheaded the fight against Harry Truman’s universal coverage proposal, blasting it as “socialized medicine.” It also fought Medicare until, thanks to Democratic gains in the 1964 election, Lyndon Johnson was able to pass the measure without the group’s support.

As a general rule, physicians supported these positions–although, of course, opinion was not always unanimous. But the practice of medicine has changed a lot in the last few decades. During the 1980s and 1990s, many physicians became closely acquainted with managed care via the private insurance industry–and decided it was just as arbitrary, overbearing, and impersonal as they always feared the govenrment might be.

What’s more, physicians–like everyone else–have become more aware of the myriad drawbacks to our patchwork health insurance system. They see it as practitioners, when their uninsured or underinsured patients go without recommended care; they see it as business managers, when they have to struggle with the cost of benefits for their own employees; they even see it as individuals, since even a physician can find him or herself without the right coverage, depending on the circumstances.

So given all of these changes, are physician attitudes about health care reform changing? Perhaps, if a new study from the Annals of Internal Medicine is correct.

It’s based on a survey sent to 5,000 physicians nationwide and conducted by a pair of Indiana University researchers. In the survey, the researchers asked respondents “do you support or oppose government legislation to create national health insurance?” The results: 59 percent said they supported it “strongly” or “generally,” which is ten points higher than in 2002.

Interestingly, the survey also asked whether respondents supported “achieving universal coverage through more incremental reform.” Support was actually slightly lower; just 55 percent said they “strongly” or “generally” supported it.

I’m not an expert on surveys, so I can’t comment intelligently on the study’s methodology. But one result certainly seems right to me: The fact that support for universal coverage was highest among psychiatrists, pediatricians, emergency physicians, internists, and family doctors. Radiologists were the least sympathetic, followed by anasthesiologists and surgical sub-specialists.

It seems right because it’s consistent with what I’ve observed in my reporting–and the way the different physician types practice medicine. If you’re a specialist, then your contact with patients tends to be intermittent. You focus on the task at hand, whether it’s repairing a ligament or fixing a cataract, and then move on.

If you’re a generalist, though, you develop close relationships with your patients and become invested in their well-being. You’ll notice, for example, when your patients miss follow-up visits and skip medications because they’re worried about the bills.

For a near-perfect illustration of how this plays out, just look at the two doctors who made a name for themselves politically over the last few years. There’s Bill Frist, the heart transplant surgeon. He’s a strongly conservative Republican who opposes universal coverage and, while he was in the Senate, championed market-based approaches to reform. And then there’s Howard Dean, the family doctor. As both governor of Vermont and a candidate for the presidency, he fought for universal coverage.

To read more about the study, see this release from Physicians for a National Health Plan, which is very pleased with the results–and rightly so.

Twice as many physicians support National Health Insurance as oppose it

Support for National Health Insurance among U.S. Physicians: 5 Years Later

By Aaron E. Carroll and Ronald T. Ackerman
Annals of Internal Medicine
April 1, 2008

Conclusion

In 2007, almost 60 percent of physicians supported government legislation to establish National Health Insurance – a 10 percent increase in support since 2002. This increase represents over 80,000 physicians, distributed across every medical specialty, who have changed their minds in support of National Health Insurance over the past five years. The largest increase was seen among physicians who “strongly support” National Health Insurance; now almost twice as many physicians support it as oppose it. This study, involving over 2000 physicians nationwide, is the largest study done to date of physician views on health care financing reform. Today, a significant majority of physicians support government legislation to establish National Health Insurance.

https://pnhp.org/docsurvey/annals_physician_support.pdf

For more information, read the full press release from Physicians for a National Health Program at this link:
https://pnhp.org/news/2008/march/most_doctors_support.php

Comment:

By Don McCanne, MD

The debate over physician support of national health insurance is over. A majority of physicians are clearly in support, and that support continues to grow.

Doctors support universal health care: survey

Reuters
Mon Mar 31, 2008 5:14pm EDT

WASHINGTON (Reuters) – More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.

The survey suggests that opinions have changed substantially since the last survey in 2002 and as the country debates serious changes to the health care system.

Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine.

The 2002 survey found that 49 percent of physicians supported national health insurance and 40 percent opposed it.

“Many claim to speak for physicians and represent their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support national health insurance,” said Dr. Aaron Carroll of the Indiana University School of Medicine, who led the study.

“As doctors, we find that our patients suffer because of increasing deductibles, co-payments, and restrictions on patient care,” said Dr. Ronald Ackermann, who worked on the study with Carroll. “More and more, physicians are turning to national health insurance as a solution to this problem.”

PATCHWORK

The United States has no single organized health care system. Instead it relies on a patchwork of insurance provided by the federal and state governments to the elderly, poor, disabled and to some children, along with private insurance and employer-sponsored plans.

Many other countries have national plans, including Britain, France and Canada, and several studies have shown the United States spends more per capita on health care, without achieving better results for patients.

An estimated 47 million people have no insurance coverage at all, meaning they must pay out of their pockets for health care or skip it.

Contenders in the election for president in November all have proposed various changes, but none of the major party candidates has called for a fully national health plan.

Insurance companies, retailers and other employers have joined forces with unions and other interest groups to propose their own plans.

“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,” Ackermann said in a statement.

The Indiana survey found that 83 percent of psychiatrists, 69 percent of emergency medicine specialists, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians and 55 percent of general surgeons favor a national health insurance plan.

The researchers said they believe the survey was representative of the 800,000 U.S. medical doctors.

(Reporting by Maggie Fox; Editing by Will Dunham and Xavier Briand)

Most Docs Favor National Health Insurance

A recent survey shows 59% of U.S. physicians support national universal health insurance, up from 49% just five years ago

by Catherine Arnst
BusinessWeek
News Analysis
March 31, 2008, 5:02PM EST

Most U.S. doctors now support the idea of national health insurance, a shift from a half-decade ago, when less than half favored a national system, a new survey has found. According to a study published in the Mar. 31 issue of the Annals of Internal Medicine, 59% of the nation’s physicians support federal legislation to establish national health insurance, often referred to as a single-payer system. These plans usually involve a single, federally administered fund that guarantees health-care coverage for everyone, much like Medicare currently does for seniors, and eliminates or substantially lessens the role of private insurers. In a similar survey five years ago, only 49% favored it. Thirty-two percent of doctors oppose universal coverage, down eight points from the previous survey, while 9% are neutral.

As the 2008 election draws near, the country’s health-care system is once again top of mind for voters. The leading candidates have drawn up plans for addressing what they consider flaws in a system that has left 47 million people uninsured–although none is calling for a single-payer system (BusinessWeek.com, 9/17/07). Senator Hillary Clinton (D-N.Y.) proposes a mandate requiring everyone to purchase health insurance, with subsidies and affordable federal insurance available, while Senator Barack Obama (D-Ill.) stops short of mandates but does support affordable federal insurance. Obama leads Clinton in winning delegates who have pledged to back his bid for the Democratic nomination. The presumptive Republican nominee, Arizona Senator John McCain, backs tax credits for the purchase of health insurance, similar to what the American Medical Assn. (AMA) proposes.

The findings signal a sea change in the attitude of the medical establishment toward universal care. Throughout the 20th century, U.S. doctors have been among the fiercest and most influential opponents of national insurance, citing concerns of a meddlesome bureaucracy, a loss of independence, and lower reimbursements. Lobbying by the AMA and other professional groups scuttled efforts to introduce universal coverage by several Presidents, starting with Calvin Coolidge and continuing through Franklin Roosevelt, Harry Truman, Jimmy Carter, and Bill Clinton. Back in 1948, after Truman was elected in part on a platform of compulsory health insurance, the AMA urged its members to “resist the enslavement of the medical profession.” That attitude held constant for decades.

Current System Hampers Good Care

But with so many Americans uninsured, doctors are finding that the lack of universal coverage is making it more and more difficult for them to do their jobs. “Across the board, 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,” says Dr. Ronald Ackerman, associate director for the Center for Health Policy-Professionalism Research at Indiana University School of Medicine and a co-author of the study.

Ackerman and his team surveyed 2,193 doctors across the country in 2007 as part of the largest survey yet of physicians on the issue of health-care financing. The researchers found that support for national health insurance exceeded 50% for every medical specialty, except surgical subspecialties, anesthesiologists, and radiologists. Even in those groups, support levels increased from 2002. The researchers also asked doctors if they would support incremental reform, such as tax incentives to buy insurance, or state mandates that all employers offer insurance coverage. They reported that 55% would support incremental reform failing a national solution, but only 14% favored incremental reform instead of national health insurance.

Professional medical associations are also beginning to change their stance on national health insurance. In December, the American College of Physicians, with 124,000 members, endorsed a single-payer national insurance program for the first time. The AMA, with 250,000 members, has not gone that far, instead calling for tax credits and financial assistance so that individuals can purchase health insurance. The group does say, however, that coverage for the uninsured is one of its top priorities. And now, the new survey suggests AMA constituents view national health care as a way to address the insurance shortfall.

Arnst is a senior writer for BusinessWeek based in New York .

Majority of U.S. Doctors Back National Insurance Plan

HealthDay News
Forbes.com
03.30.08, 8:00 PM ET

A majority of American doctors now support the concept of national health insurance, which represents a shift in thinking over the past five years, a new survey finds.

Typically, national health insurance plans involve a single, federally administered social insurance fund that guarantees health coverage for everyone. In most cases, these plans eliminate or substantially reduce the role of private insurance companies.

A survey conducted last year of 2,193 physicians across the United States found that 59 percent support “government legislation to establish national health insurance,” while 32 percent oppose it, and 9 percent are neutral. In 2002, a similar survey found that 49 percent of physicians supported the concept, while 40 percent opposed it.

“Many claim to speak for physicians and reflect their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support the government creating national health insurance,” study author Dr. Aaron E. Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research, said in a prepared statement.

The new findings were included in a study published March 31 in the Annals of Internal Medicine.

Support for national health insurance has increased across all medical specialties, said study co-author Dr. Ronald T. Ackermann, associate director of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine.

“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,” Ackermann said in a prepared statement.

The strongest support for NHI is among psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent), and family physicians (60 percent). About 55 percent of general surgeons support NIH, roughly double their level of support in 2002.

About 47 million Americans lack health insurance coverage, and it’s believed another 50 million are underinsured. Health-care costs in the United States are increasing about 7 percent a year, twice the rate of inflation. Many doctors are concerned about these issues, according to background information in the study.

Last December, the 124,000-member American College of Physicians — the nation’s largest medical specialty group — endorsed a single-payer national health insurance program.

Health insurers are the issue

By Susanne L. King, M.D.
Berkshire Eagle, MA
Monday, March 31

Is it time for your annual health insurance renewal? Have you noticed that your premium has gone up, while the coverage you receive is less than the coverage you had last year? Have you noticed that you are paying more, but getting less; that before you can even use your insurance, you have to pay a sizable deductible; and that if you visit your doctor or buy medication, your co-payment has increased?

Welcome to the land of “cost-sharing,” an insurance euphemism for sticking you with the rising costs of health care, without touching insurance company profits.

Massachusetts state Senators Theresa Murray and Richard Moore have introduced legislation to attempt to address rising health care costs in our state. One provision of the bill would create a panel to review insurance company premium rate increases, and hold them to an annual 7 percent increase. If the legislation passes, you know the inevitable result: your deductibles and co-payments will rise even more, at the same time as CEOs like William Van Faasen of Blue Cross Blue Shield of Massachusetts will continue to take home $16.4 million in retirement benefits in a single year. Health insurance companies will continue to get returns for their investors that will maintain their place near the top of the Fortune 500.

We continue to hand over shocking amounts of our health care dollars to insurance companies to do nothing more than to administer our health care funds. Insurance companies provide no health care: they merely handle the money, deny coverage and care, and make huge profits while doing so. The current Massachusetts health care reform, and Murray’s proposed legislation to control health care costs, only perpetuate our dysfunctional system because they do not eliminate health insurance companies.

With true health care reform, as in a single-payer health care system, health insurance companies would be eliminated, and either the state or federal government would administer our health care funds. “Single-payer” simply means that one payer would be the administrator, eliminating the hundreds of insurance company payers we now have. Nationally, this would save over $350 billion per year in administrative costs alone, enough money to cover the 47 million uninsured in our country and provide more comprehensive benefits for all of us.

Expanding coverage as we have done in Massachusetts, without controlling administrative costs, is not a sustainable policy. Unfortunately both of the Democratic presidential candidates are proposing a Massachusetts-style health care policy for our country: Neither Clinton nor Obama propose true reform of our health care system.

There are those who say that single-payer health care reform is not politically feasible, and I would guess the presidential candidates believe this. What they are not considering are the polls that show strong majority support for single-payer health care, when people are fully informed about this option.

What do people want in health care reform? They want choice of doctors and hospitals, not of a bewildering array of health care plans. They want to be able to keep their doctors, and to know that the treatment he or she recommends will be paid for, without deductibles and co-payments. They want lower prescription drug costs. They want to know that the quality of their health care is the best. They want their health insurance to remain the same, whether they change jobs, work part-time, retire before being eligible for Medicare, or develop a major disease. And they want affordable health care.

Hard-working middle-income taxpayers are feeling the squeeze. They are not seeing 7 percent increases in their wages, even as their share of the cost of their insurance premiums is rising. Small businesses are floundering as they try to provide insurance for their employees. Towns and cities are crippled by health care costs for their employees and retirees.

The current Massachusetts health care legislation does not address any of these issues. We need to divorce health care insurance from employment and eliminate private for-profit insurance companies. Only a single-payer health care program will provide affordable, comprehensive, portable, and accessible coverage for everyone. The current Massachusetts health care reform is not a viable model for the nation.

Dr. Susanne King is a Lenox-based practitioner.

Doctor pulls for health-care cure

By TIM WILKIN, Staff writer
Albany Times Union
First published: Sunday, March 30, 2008

Dr. Richard Propp, formerly of Albany Medical College and active in Albany civic affairs, chairs the Capital District Alliance for Universal Health Care Inc.

The group advocates on behalf of adopting a universal health care system in New York and a national single-payer system in the United States.

Q: What would you like to see happen in health care?

A: I would like to see a very simple thing happen. I would like to see this country do the right thing on health care and think of people first. That is most embodied in (Michigan Congressman) John Conyers’ bill, H.R. 676, which is an expanded and improved Medicare for all.

Q: What is H.R. 676?

A: It would cover all necessary medical care, carried out in doctors’ offices and nonprofit hospitals, just like it is now. The only thing it socializes is the funding of health care, just like Medicare. It does not socialize the practice of medicine — that is one of the bugaboos that conservatives get concerned about.

Everyone will be covered and there will be no bills and no co-pays. So that immediately eliminates about $300 billion worth of indirect and direct overhead that is in our system now.

Q: Do you find resistance to this program?

A: Yes and a lot of the resistance is hard to understand. I guess if you follow the money you can understand it more. The strongest groups opposed to it are the private insurance companies and the pharmaceutical companies.

Q: Does the average person realize how serious health care is?

A: In August of 2004, I came across a paper (from Harvard Medical School) that showed that if you did not have insurance, your eight-year survival from diabetes, heart failure or high blood pressure was 50 percent higher than if you were insured. If you were 50 and uninsured, your eight-year mortality was about 18 percent. If you had health insurance, your eight-year mortality rate was 12 percent. That was alarming to me.

Q: Can you talk about the economy and how it relates to health care?

A: Right now the economy is flat. Wages are flat but health care premium costs are going up 10 to 20 percent a year.

Q: You are very concerned about this. How big of a problem is it?

A: This is a huge problem. Even right now the state government is considering whether to approve the GHI-HIP bid to go for-profit. And we are very concerned about that because that is 180 degrees wrong from what we are thinking. We even wonder if there is a conflict of interest.

Supposedly we are going to have a budget shortfall. The governor is already counting on $500 million a year from the sale of GHI-HIP to venture capitalists. We’re wondering if his people are sitting on the review board and he is counting on the money for his budget, is that a conflict of interest? Some people say yes, some people say no.

Blue Cross Blue Shield, when they went for-profit in 2002, the CEO went from a salary of $1.5 million in 2002 to a salary of $6 million in 2006. How many homes does he need?

Q: Where does that money come from?

A: It comes from the people who pay the premiums. That is not my idea of health care. How many more millions uninsured do we have in 2008 than we had in 2002? A couple million, 2 or 3 million more uninsured. That certainly did not solve the uninsured problem. Why would it? They want to insure people they can make some money off of.

Q: How many people in New York are uninsured?

A: 2.7 million people out of 19 million are uninsured and another equal number are under-insured as they get hit with a bad disease.

Q: How alarming is this to you — if something does not happen, things will get worse?

A: Well, it is alarming. The thing that is upsetting is the gurus of health care say that as un-insurance creeps into the middle class, which it’s doing, and the recession gets worse, as it is doing, you will have so many people uninsured or under-insured that the government will have to do something and yet, at the national level, there doesn’t seem to be that sense of urgency and the policies they are projecting are about 180 degrees from the right thing.

Telling poor people they have to buy insurance, to my way of thinking, is not humane policy-making.

National health plan support up

59% of doctors say yes in poll

By JULIE M. McKINNON
Blade Staff Writer
Toledo Blade
Tuesday, April 1, 2008

Nearly 60 percent of U.S. doctors want government legislation to establish national health insurance, while another 14 percent instead support incremental reform, according to a study to be published today.

A 10 percent spike in the percentage of doctors supporting national insurance – to 59 percent last year from 49 percent five years earlier – shows more are ready for a system overhaul, said Toledo physician Dr. Johnathon Ross, past president of Physicians for a National Health Program.

“What this means is the usual block of anti-reform is breaking up,” he said. “These doctors are looking in the eyes of sick [uninsured] patients every day.”

With an estimated 47 million Americans lacking health insurance, doctors realize it is increasingly difficult for patients to get coverage despite some efforts to improve the system, said Dr. Aaron Carroll, lead author of the study to be published today in the Annals of Internal Medicine.

“It’s frightening, and it’s getting worse. It’s not getting better,” said Dr. Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research.

He added: “It probably will take a big step to fix things, not these small incremental steps.”

National health insurance typically involves having a federally administered fund guaranteeing health coverage for all, as Medicare does for those at least 65 years old and some disabled people. Incremental reform, meanwhile, involves taking steps such as mandating that consumers buy coverage from private insurance companies and offering tax incentives.

Health insurance has surfaced as a major concern among voters this election year. None of the three leading presidential candidates is proposing national health insurance, although they do offer up incremental reform to some degree.

Hillary Clinton and her Democratic rival, Barack Obama, would both give Americans the chance to buy guaranteed group insurance like that offered to federal employees, as well as expand eligibility for Medicaid and the State Children’s Health Insurance Program.

Mrs. Clinton calls for mandated coverage for all, while Mr. Obama would require that children be insured but not adults.

Republican John McCain, meanwhile, opposes mandated coverage but has outlined various health-care reform measures. Insurance reforms, he maintains, would make health-care coverage more affordable by fostering competition and elimination.

The American Medical Association also proposes reforms that build on the existing system to provide coverage to the uninsured, including providing tax credits or vouchers to those who need financial help. Association officials declined to comment yesterday on the study’s findings because they had not yet seen complete results, a spokesman for the nation’s largest doctors group said.

Of 2,193 doctors surveyed by Indiana University researchers, 55 percent said they would support achieving universal coverage through incremental reform.

Fourteen percent of doctors who opposed national insurance instead were in favor of just incremental reform, according to the Indiana University survey.

Overall, 32 percent of doctors surveyed opposed national health insurance and 9 percent were neutral. Forty percent of doctors surveyed in 2002 opposed national health insurance, and 11 percent were neutral.

What was most surprising about survey results was that support for national health insurance was up among all groups of doctors except pediatric subspecialists, whose approval remained relatively high at 71 percent, said Dr. Carroll of Indiana University.

Support for national health insurance is particularly strong among psychiatrists at 83 percent. It was lowest among radiologists at 30 percent, according to the survey.

Dr. Quentin Young, a Chicago legend, to retire

Phil Kadner
Southtown Star
April 1, 2008

His patients have included Martin Luther King Jr., Mike Royko, Studs Terkel and members of the Chicago 7 conspiracy trial, but after 61 years in private practice, Dr. Quentin Young is hanging up his stethoscope.

Young, a physician in Chicago’s Hyde Park community who from 1972-81 was chairman of the Department of Medicine at Cook County Hospital, was King’s doctor during the civil rights leader’s ill-fated stay in Chicago.

He was with him when King was hit in the head with a rock while marching through Gage Park and also visited King in his Chicago home when he came down with a respiratory infection.

“I stretched a 15-minute visit for a cold into an all-afternoon affair just so I could talk to the man,” Young recalled. “It was a unique opportunity.”

I have done the same whenever I’ve had the chance to talk to Young, a liberal renegade who has lived by the credo: “If the majority agrees with you, you are probably in the wrong.”

Young, for the first time in his 20-year fight for national health insurance, finds himself in the majority.

A survey to be published today in the Annals of Internal Medicine, a medical journal, indicates that a majority of U.S. physicians (59 percent) support national health insurance, 32 percent oppose it, and 9 percent are neutral.

The findings, according to a news release, reflect a 10-percentage-point increase in physician support for national health insurance since 2002, when a similar survey was conducted.

Surveys were randomly mailed to 5,000 doctors, and 2,103 were returned.

Psychiatrists (83 percent), pediatric subspecialists (71 percent), emergency medicine physicians (69 percent) and general pediatricians (65 percent) seemed to be the most enthusiastic about national health insurance, while those practicing radiology (30 percent) and anesthesiology (38 percent) registered the lowest amount of support for such a program.

Young, 84, is a founding member of the Chicago-based Physicians for a National Health Program and believes the results signify an important shift in the public debate.

“People trust their doctors,” Young said. “If their doctor tells them that national health insurance is not a good thing, they tend to believe that’s probably true. If their doctor now starts saying it is something that would be good for the country, then average people will be more likely to support it.”

The survey, conducted by researchers at Indiana University, is being touted as the largest ever among doctors on the issue of health care financing reform.

An estimated 47 million Americans have no health insurance, and another 50 million are believed to be underinsured.

At the same time, health insurance costs are rising at a rate of about 7 percent a year, twice the rate of inflation.

Employers are struggling to pay health insurance premiums for their employees, often reducing coverage or asking workers to pick up more of the cost.

Local governments, such as Cook County and the state of Illinois, find themselves cutting other costs to meet the public’s health care needs.

The amount of money budgeted for Medicaid in Illinois is now larger than the amount of money budgeted for public education, although about half of that cost is picked up by the federal government.

Young contends that while other industrialized countries control medical costs through single-payer universal health care plans, the profiteers here (primarily health insurance companies) continue to drive up costs. Because their primary motive is to make money, not to provide the best health care for patients, insurers’ decisions often are detrimental to policyholders.

Yet many Americans still believe health care here is better than anyplace else in the world. But they seem to be living in denial, ignoring the fact that health care here is not going to remain as it is.

Costs will continue to rise. Employers, facing a potential recession, are going to have to cut their costs.

Health insurance companies will continue to make a profit through higher premiums and by taking control of patient treatment out of the hands of family doctors.

Young, who is giving up his medical practice, will devote all of his energies to reforming health care.

“I tell people that I will refuse to die until there is national health care,” he laughed.

Phil Kadner can be reached at pkadner@southtownstar.com or (708) 633-6787.

Physician Opinion Tips in Favor of National Health Insurance

By Charles Bankhead
Staff Writer
MedPage Today
Published: March 31, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor

Listen to Study Co-Author Dr. Aaron Carroll

INDIANAPOLIS, March 31 — A majority of U.S. physicians support national health insurance, according to findings from a nationwide survey.

Almost 60% of 2,200 physicians surveyed said they favor government legislation to establish a national health insurance plan, Aaron Carroll, M.D., and Ronald Ackermann, M.D., of Indiana University, said in a letter published in the April 1 issue of Annals of Internal Medicine.

The results represented a 10-point swing in physician opinion since a similar survey was conducted in 2002 and seem to leave practicing physicians and organized medicine staring at each other across a wide philosophical chasm.

In the 2002 survey, 49% of respondents favored national health insurance. Given that the U.S. has about 800,000 physicians, the 10-point swing means that 80,000 physicians have changed their minds about national health insurance in the past five to six years.

The American Medical Association, the largest body in organized medicine, has traditionally battled the concept of a government-run national health insurance plan.

In a statement, Edward Langston, M.D., who chairs the AMA’s board of trustees, noted that the Indiana survey does not define national health insurance.

Also, he cited an AMA proposal to expand “coverage and choice through tax credits that would provide the most money to those who need it most: lower-income Americans. Our plan gives individuals choices so they can select the appropriate coverage for themselves and their families, and it promotes fair rules that include protections for high-risk patients and greater individual responsibility.”

This “AMA proposal for covering the uninsured builds on what’s great in our system — world-class medical innovations and research, and doctors dedicated to the health of their patients,” said Dr. Langston.

“Many claim to speak for physicians and represent their views,” said Dr. Carroll. “We asked doctors directly and found that, contrary to conventional wisdom, most doctors support national health insurance.”

The findings came from a random sample of 5,000 physicians from the AMA Masterfile. The survey instrument consisted of two questions:

* In principle, do you support or oppose government legislation to establish national health insurance?
* Do you support achieving universal coverage through more incremental reform?

For both items, respondents could express their support or opposition on a five-point scale.

The survey also elicited information about membership in physician organizations and demographic, personal, and practice characteristics.

About 500 questionnaires were undeliverable, 197 were returned by physicians no longer in practice, and 2,193 were completed (51% response rate) and returned to Drs. Carroll and Ackermann.

Overall, 59% of respondents expressed support for legislation to establish a national health insurance program (28% “strongly” and 31% “generally”). Additionally, 32% opposed national health insurance (17% strongly and 15% generally), and 9% of respondents had no opinion.

By medical specialty, the survey showed that some form of national health insurance was favored by:

* 83% of psychiatrists
* 69% of emergency physicians
* 65% of pediatricians
* 64% of internists
* 60% of family physicians
* 55% of general surgeons

About 55% to 60% of physicians representing medical subspecialties, pathology, and obstetrics and gynecology also favored national health insurance.

Specialties whose physicians opposed national health insurance were surgical subspecialties (about 45% support), anesthesiologists (40%), and radiologists (30%).

The results also showed that 55% of physicians favored an incremental approach to universal coverage (14% strongly, 41% generally), whereas 25% opposed incremental reform (14% strongly, 10% generally). Additionally, 14% of respondents expressed support for incremental reform but opposed national health insurance.

The survey was not designed to explain physicians’ answers, so Dr. Carroll could only speculate about potential reasons. He suggested that specialties that strongly support national health insurance probably are at the forefront of caring for uninsured patients and dealing with the nuances, quirks, and restrictions of managed care and private health insurance.

Conversely, opposition to national health insurance could come from specialties that have less contact with uninsured patients or who stand to take a major financial hit from enactment of universal coverage.

As for the incongruity between the survey results and organized medicine’s opposition to national health insurance, Dr. Carroll speculated that an organization’s membership might not be representative of the general physician population.

The insurance industry elephant

U.S. Refuses to See Insurance Elephant

Dr. Bill Roy
The Wichita Eagle
March 30, 2008

More good people are spending more good effort and more good money trying to make our inequitable and tattered health care system sustainable than can be measured or imagined. And the “system” per se is getting into deeper and deeper trouble, because Americans refuse to see the elephant in the room — the health insurance companies.

No country can long afford a health care system run by private health insurance companies. They take 15 to 30 percent for their fees (and add 15 percent to the administrative costs of physicians and hospitals); refuse to insure the sick, disabled, chronically ill and elderly; and generally distort the health care delivery system for their own profit.

Paradoxically, only a few health insurance companies are really bad guys. Rather, they behave the way insurance companies behave, just as the aforementioned elephant behaves as elephants behave.

They spend money to get the youngest, healthiest enrollees they can get. So they don’t insure just anybody. And if they do err, they increase next year’s premiums, for example, for the 15-person employee group that has a new diabetic or too many babies.

They underwrite, the ultimate art of evaluating risks. They refuse to accept bad risks, or they boost premiums up front to protect themselves from marginally higher risks.

Insurance companies are necessary for a functioning capitalistic economy. They work very well for expensive, infrequent losses, which they have done for centuries. But not for paying for the billions of treatments and pills of health care — which they accidentally have been designated to do for just a few decades.

Our states, God bless them, are trying to reform health care within their jurisdictions. But they usually end up using tax dollars to pay insurance companies for “managing” the care of the medically needy.

They also try to coerce or induce better health habits for their citizens. But even these public health efforts are modest and difficult, as evidenced by the Kansas Legislature’s struggle to pass a public smoking ban. At best, they just postpone the costly medical care associated with the end of life.

And states are hemmed in. Almost anything states want to do costs money that must be raised by taxes. And any great disparities in taxes among states are noted by business and industry, which head for the state or national border.

So one can easily believe that the American people are deaf, blind and dumb — or just fatalistic — when they fail to respond constructively to reports like the one issued last month by the Centers for Medicare and Medicaid Services.

The centers project our nation’s already bloated health care spending will nearly double by 2017 to $4.3 trillion, or nearly 20 percent of annual total value of all goods and services. Without substantial changes, about half would be paid by Medicare and Medicaid; the rest falls more directly on the private sector.

If elected president, John McCain offers essentially no change, just the old GOP sleight of hand with the tax code. Both Barack Obama and Hillary Clinton intend to nurse the health care system as it sinks into death by making more money available to be wasted.

Neither intends to go to something like Medicare for all (minus Medicare Advantage), which would cover everyone and control costs to the extent possible in the face of more effective and costly medical services.

Meanwhile, we’ll bump along spending about 1 ½ times the amount spent by similar nations without getting more medical care, and with a less healthy populace that does not live as long as people in nations with government-administered (but usually privately provided) universal care.

(Bill Roy is a retired physician and former member of Congress who represented northeast Kansas.)

http://www.kansas.com/205/story/356501.html

Comment:

By Don McCanne, MD

Wake up America! There’s an insurance industry elephant in the room!

Most doctors support national health insurance, new study shows

EMBARGOED UNTIL:
March 31, 2008
5:00 PM EST

CONTACTS:
Aaron E. Carroll, MD
Ronald T. Ackermann, MD
Todd Main, PNHP, (312) 782-6006

Support for National Health Insurance Among U.S. Physicians: 5 Years Later

Reflecting a shift in thinking over the past five years among U.S. physicians, a new study shows a solid majority of doctors — 59 percent — now supports national health insurance.

Such plans typically involve a single, federally administered social insurance fund that that guarantees health care coverage for everyone, much like Medicare currently does for seniors. The plans typically eliminate or substantially reduce the role of private insurance companies in the health care financing system, but still allow patients to go the doctors of their choice.

A study published in today’s Annals of Internal Medicine, a leading medical journal, reports that a survey conducted last year of 2,193 physicians across the United States showed 59 percent of them “support government legislation to establish national health insurance,” while 32 percent oppose it and 9 percent are neutral.

The findings reflect a leap of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted. At that time, 49 percent of all physician respondents said they supported NHI and 40 percent opposed it.

Support among doctors for NHI has increased across almost all medical specialties, said Dr. Ronald T. Ackermann, associate director of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine and co-author of the 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,” he said.

Support for NHI is particularly strong among psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent) and family physicians (60 percent). Fifty-five percent of general surgeons support NHI, roughly doubling their level of support since 2002.

Doctors have often expressed concern about lack of patient access to care due to rising costs and patients’ insufficient levels of insurance. An estimated 47 million Americans currently lack health insurance coverage and another 50 million are believed to be underinsured. At the same time, health care costs in the United States are rising at the rate of about 7 percent a year, twice the rate of inflation.

The health care issue continues to rank high among voter concerns in the 2008 elections, placing third in a recent poll after the economy and Iraq.

The current study by the Indiana University researchers is the largest survey ever conducted among doctors on the issue of health care financing reform. It is based on a random sampling of names obtained from the American Medical Association’s master list of physicians throughout the country.

In addition to measuring attitudes toward NHI, the survey also asked doctors about their views about “more incremental reform,” often interpreted as state- or federal-based programs requiring or “mandating” that consumers buy health insurance from private insurance companies, legislative measures providing tax incentives to businesses to provide coverage for their employees, or similar steps.

Fewer physicians (55%) were in support of “incremental” reform. Moreover, virtually all those opposed to national health insurance also opposed incremental reform to improve access to care. In fact, only 14% of physicians overall oppose national health insurance but support more incremental reforms. Ironically, many medical organizations and most politicians have endorsed only incremental changes.

Dr. Aaron E. Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research and lead author of the study, commented: “Many claim to speak for physicians and reflect their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support the government creating national health insurance.”

Other signs indicate that attitudes among doctors are changing. The nation’s largest medical specialty group, the 124,000-member American College of Physicians, endorsed a single-payer national health insurance program for the first time in December.

****

“Support for National Health Insurance among American Physicians: Five Years Later,”
Aaron E. Carroll and Ronald T. Ackermann, Annals of Internal Medicine, April 2008.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.