PNHP

Health insurance in small firms

Health insurance in small firms

The Economic Burden of Providing Health Insurance

How Much Worse Off Are Small Firms?

By Christine Eibner
RAND Corporation
April 4, 2008
Technical Report

Conclusion

Health-insurance burdens borne by employers grew substantially between 2000 and 2005, regardless of firm size. While growth was highest for small firms (<25 employees), medium-sized firms (25 to 99 employees) did not face higher growth in health-insurance burdens than larger employers did. Our results suggest that targeting health reforms that build on the employer-based system solely to large firms may be unwarranted, given that large firms do not face lower health-insurance burdens than moderately small firms do. However, our results indicate that the growth in health-insurance burdens has been substantial regardless of firm size. As a result, it seems that all employers -- large and small alike -- may have difficulty shouldering health-insurance burdens if costs continue to rise. Although firms may pass insurance costs back to employees in the form of lower wages, employees may be unwilling or unable to afford these cost increases in the future. This may be particularly true at very small firms, at which employees appear to be sacrificing a larger share of their wages for a lower-quality benefit. News release:
http://rand.org/news/press/2008/04/04/

Technical report:
http://rand.org/pubs/technical_reports/2008/RAND_TR559.pdf

Comment:

By Don McCAnne, MD

This report provides extensive data documenting the increased burden of employer-sponsored health insurance, especially in small firms. Those interested in defining and quantifying the extent of this problem would be interested in downloading this report.

For most of us, the important bottom line is that employees, especially in small firms, are sacrificing a larger share of their wages for a lower-quality benefit.

Building on our current system would not get us where we need to be. We desperately need a single payer national health program.

Health care for all

Brattleboro Reformer
Editorial
Thursday, April 3

Regarding health care, in a recent survey of 26,000 American workers conducted by the AFL-CIO, nearly three-quarters of the people interviewed said they feared losing their health insurance if they changed jobs.

Ninety-five percent said they were unhappy with the cost of health care and 64 percent said they were unhappy with the quality of the care they received.

The numbers weren’t surprising. What was surprising is that these responses came from people who already had health insurance. Three-quarters of the respondents had some kind of coverage and nearly 80 percent of them were covered through their employers.

The focus of the health care debate usually falls on the uninsured. That more than 40 million Americans have no form of health insurance is a national scandal. But it’s a surprise that people who do have insurance are still feeling insecure about their coverage.

Of the people who responded to the survey who had insurance, about half said it did not cover all the care they needed at a price they could afford.

Prescription drugs were ranked first as the most unaffordable element of health care.

Another one-third of respondents said that their insurance companies had at some time refused to cover them for something that should have been covered by their policies. The amount of fighting that goes on between patients and their insurers to get the coverage that’s due them is considerable.

Again, these are the people who have health insurance. Too often, high deductibles and co-payments mean that even people with coverage are forced to choose between going to the doctor and paying for rent, utilities or groceries.

We now have a system where having a health insurance plan you can afford to pay for and afford to use when you are ill is entirely dependent on where, or if, you have a job. If you are unemployed, self-employed, or in any other situation where you don’t have health insurance and can’t afford it, you are left to the mercy of charity or underfunded state and federal health insurance programs.

Even the doctors know the system is broken. According to a survey released this week by the journal Annals of Internal Medicine, 59 percent of U.S. doctors now favor a national health care plan, while only 32 percent oppose it. This compares to 49 percent in favor and 40 percent opposed when a similar survey was done in 2002.

“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,” said Dr. Ronald Ackermann, one of the physicians who worked on the study.

Vermont has tried to take a tentative step toward solving the problem with Catamount Health, the state’s program for uninsured Vermonters. But it’s now apparent that the state will not have the money to fund even a modest expansion of coverage either this year or in years to come.

Our nation still spends more than any other nation on Earth for health care, yet 47 million Americans are uninsured and tens of millions more have inadequate insurance. And few in Montpelier or in Washington have the will to take a step toward what the rest of the industrialized world provides for its citizens – a national health insurance program.

WellPoint tanks

The 52-Week Low Club

MarketWatch (Dow Jones)
March 28, 2008

Wellpoint (WLP) Downgrade from Lehman. Sells down to $43.02 from 52-week high of $90.

http://www.marketwatch.com/news/story/story.aspx?guid=%7B54CC3830-623F-4C66-8CAF-E5DD58D401FF%7D&link=http://www.247wallst.com/2008/03/the-52-week–16.html&dist=msr_2

And…

Analysis Look to First-Quarter Financial Results of Insurers for Signs of Industry’s Health

Kaiser Daily Health Policy Report
April 3, 2008

According to Sheryl Skolnick, a health care analyst and senior vice president at CRT Capital Group, the health insurance industry has experienced a downturn for two years, and “it just took (WellPoint) imploding for us to figure it out.” She added that the current prices of health plans do not account for growth in medical costs. Skolnick said that health insurers will begin to reverse the downturn when they “create affordable health insurance plans that consumers really want to buy instead of affordable-but-barebones plans that do not offer consumers a compelling value” (Wisenberg Brin, Dow Jones, 4/2).

http://www.kaisernetwork.org/Daily_reports/rep_hpolicy.cfm#51337

Comment:

By Don McCanne, MD

WellPoint has been the leader in marketing innovative “affordable-but-barebones plans that do not offer consumers a compelling value.” So now the industry will need to reverse its downturn by creating “affordable health insurance plans that consumers really want to buy.”

It’s all very simple. Restore the health benefits in their plans, and then sell them at a competitive premium that will cause consumers to want to buy them. It must be a good idea since Senators Clinton, Obama and McCain each propose private health plan competition as the major component of their health reform proposals.

Before benefits are restored, one little glitch will have to be solved. In addition to the revenues that they will receive from their competitive premiums, they are going to have to figure out where they will get the money to pay for the health care benefits that consumers really want to have. Apparently the presidential candidates will let the market figure that out.

OECD paper on the economics of prevention

The Prevention of Lifestyle-Related Chronic Diseases: an Economic Framework

By Franco Sassi and Jeremy Hurst
Organisation for Economic Co-operation and Development
OECD Health Working Paper No. 32
March 25, 2008

Abstract:

This paper provides an economic perspective on the prevention of chronic diseases, focusing in particular on diseases linked to lifestyle choices. The proposed economic framework is centred on the hypothesis that the prevention of chronic diseases may provide the means for increasing social welfare, enhancing health equity, or both, relative to a situation in which chronic diseases are simply treated once they emerge. Testing this hypothesis requires the completion of several conceptual and methodological steps. The pathways through which chronic diseases are generated must be identified as well as the levers that could modify those pathways. Justification for action must be sought by examining whether the determinants of chronic diseases are simply the outcome of efficient market dynamics, or the effect of market and rationality failures preventing individuals from achieving the best possible outcomes. Where failures exist, possible preventive interventions must be conceived, whose expected impact on individual choices should be commensurate to the extent of those failures and to the severity of the outcomes arising from them. A positive impact of such interventions on social welfare and health equity should be assessed empirically through a comprehensive evaluation before interventions are implemented.

Paragraph 171 (page 61):

Tackling major risk factors for health, or chronic diseases linked to behaviours that are highly prevalent in a population, requires more than a single preventive intervention, however effective and broadly based it may be. Turning the tide of diseases that have assumed epidemic proportions during the course of the 20th century requires fundamental changes in the social norms that regulate individual and collective behaviours. Such changes can only be triggered by wide ranging prevention strategies addressing multiple determinants of health, strategies that are likely to develop incrementally, rather than through comprehensive planning. Although the contribution and cooperation of many agents is needed for the success of a prevention strategy, none of the agents potentially involved, at any point in time, is in possession of the information, the tools and the power required for the comprehensive planning of chronic disease prevention, and none of the agents is able to take a sufficiently long time perspective in its action to make such an approach possible. Social norms cannot be engineered. They set the boundaries and the rules for a complex interplay of conflicting interests which we have interpreted here, using the tools of economics, as market dynamics. At the same time, it is precisely that interplay of interests that progressively adapts and changes social norms.

http://www.oecd.org/dataoecd/57/14/40324263.pdf

Comment:

By Don McCanne, MD

“We are not going to control health care costs until we change from a health care system focused on treating disease to a system that focuses on prevention.”

How many times have you heard that statement? It’s everywhere – in questions from audiences at community forums, in letters to the editor, in op-eds, in communications from advocacy organizations, in the ubiquitous blogs throughout the Internet, and everywhere else. It even appears in the health policy literature – often in the form of reducing spending through disease management by preventing the complications of obesity, diabetes, hypertension, and other disorders.

Before addressing this report, let’s acknowledge that everyone agrees that prevention of disease and injury is far better than treating it after it occurs. Efforts to promote prevention are crucial to maintaining and improving the health of the people of the nation.

Accepting the health benefits of prevention as a given, there are two other questions to be addressed as we sort out the proposals to reform the financing of our health care system. First, does the health care delivery system provide the appropriate infrastructure for providing the interventions that would prevent injury and disease? Second, assuming that it does, would these interventions be effective in controlling health care costs, making health care affordable?

So what answers does this OECD health working paper provide to these questions?

It is important to understand what this paper is. It is a highly technical discussion of the economic framework of the prevention of lifestyle-related chronic diseases. The issues are very complex. If you really want to understand the economics of prevention, I would recommend reading the entire paper (78 pages). At a minimum, you should read the conclusions, pages 57-63.

What will become evident is that the statement that we must change the emphasis from treatment of disease to prevention really does not have much applicability to the topic of reforming the financing of health care, when one of our most important goals is to ensure that health care will be affordable for present and future generations.

In answering the first question posed, the paper demonstrates that prevention is complex function involving the interaction of government and private sectors of our society. Although the health care delivery system plays a role in prevention, it is comparatively minor. Most interventions would occur outside of the health care delivery system.

For the second question, interventions within the health care delivery system can have only a very minor impact on total health care spending. Further, it is not at all clear as to whether that would reduce or increase our total national health expenditures.

It is important that both government and the private sector invest in prevention, simply to improve the health of our nation. But we must not allow ourselves to divert the national dialogue from the other important goals of financing reform to a non-productive debate over the theoretical cost savings from prevention.

This paper is important to policy advocates since it will arm you with the confidence to reply to questions about and proposals for prevention. It is also a paper that you can recommend to individuals who are locked into the concept that health care reform is all about prevention. You can show that that prevention is crucial, but that it alone does not adequately address the very important issue of making access to the health care delivery system affordable for everyone.

Health care changes sought

Majority of doctors want federal government to pay costs of medical treatment

By CATHLEEN F. CROWLEY, Staff writer
Albany Times Union
First published: Wednesday, April 2, 2008

Tired of seeing families go broke under the pressure of medical bills and fed up with insurance companies interfering in medical care, doctors say it’s time for a nationwide health insurance system.

A majority of doctors now think the federal government should pay for health care, according to a study in Tuesday’s Annals of Internal Medicine. Doctors and student doctors at Albany Medical College held a news conference on Tuesday to draw attention to the study and show support for a single-payer system.


Dr. Paul Sorum, an Albany Medical College professor of
medicine and pediatrics, speaks Tuesday, April 1, about a
study showing 59 percent of doctors favor a single-payer
national health care system. (Paul Buckowski / Times Union)

The number of doctors supporting a single-payer system today jumped significantly from the last time physicians were surveyed in 2002, according to the study. “They see how our fragmented and for-profit health care system no longer serves the interest of patients, medical professional or employers,” said Jessin Blossom, a third-year medical student and student leader of Physicians for a National Health Program.

The number of uninsured in the United States is 47 million and many others are under-insured, according to recent Census data. More than half of all personal bankruptcies are caused in some part by medical expenses, according to a 2005 Harvard study.

Under a single-payer system, the government pays for all health care and everyone is covered.

The Annals of Internal Medicine study, conducted by two doctors at the Indiana University School of Medicine, found that 59 percent of doctors supported a single-payer system, up from 40 percent in 2002. In the latest survey, 32 percent opposed it and 9 percent were neutral.

The study is based on survey responses from 2,193 doctors. The biggest supporters of a single-payer system are doctors in psychiatry, emergency medicine and pediatrics. The doctors who least supported it are radiologists, anesthesiologists and specialty surgeons.

“We are seeing families who have no health care for their children and no health care for themselves and going through the anguish of poor medical care,” said Dr. Jennifer Pearce, co-director of the Center for Childhood Cancer and Blood Disorders at Albany Med. “It’s not American. It’s not moral. And it’s not healthy.”

Pearce said she couldn’t think of a doctor at Albany Med who doesn’t support a single-payer system. The dozen doctors who attended Tuesday’s news conference said they believe a single-payer system will be cheaper, easier and provide better health care.

“About 30 percent of our time in medicine is spent in the forms, appeals and the paperwork involved with the thousands of different insurance plans,” Pearce said. “A lot of our time, effort and intelligence is wasted.”

Paul Sorum, a primary care doctor and chairman of the Capital District Chapter of Physicians for a National Health Program, believes the government would be less intrusive than private insurers.

“There would be far less interference in the day-to-day decision making under a single-payer system rather that the private insurers who are increasingly reaching in to the examination room to decide what kind of care is best for you,” Sorum said.

The government would have rules, too, he said.

“But the rules would be simple, uniform, transparent,” he said. “They would be public and well-known.”

Cathleen F. Crowley can be reached at 454-5348, or by e-mail at ccrowley@timesunion.com.

National health care? Even doctors want it

Editorial
Des Moines Register
April 2, 2008

When it comes to reforming health care, special interests have run the show in Congress. Crafting Medicare reforms that benefit insurers and drug companies. Snuffing out proposals to allow Americans to import cheaper prescription drugs from other countries. Stonewalling the creation of a taxpayer-financed system of health insurance to cover all Americans.

Among the most powerful special interests on health care: insurance companies and physician groups. Both have opposed national health insurance that would provide coverage to all Americans similar to the way Medicare covers seniors.

Well, the times they are a changin’.

According to a new study published in the Annals of Internal Medicine, a majority of American physicians now support national health insurance. A survey of nearly 2,200 doctors found that 59 percent think government legislation should establish national health insurance – a jump from 49 percent in 2002.

“More and more physicians are realizing they’re seeing more uninsured patients, said Dr. Aaron E. Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research and lead author of the study. “Even those patients with insurance are having more difficulty getting care. Doctors in general are fed up waiting for the system as we have it to get better.”

Physicians embrace a credo that they must provide care to everyone. But then there’s the reality of needing to secure payment for their services, even though millions of Americans don’t have insurance to help pay the bill for that care. And doctors are tired of the paperwork burden of dealing with thousands of different private insurance programs.

The shift by doctors toward supporting creation of a national health-insurance system is an important finding, because the organizations that represent them continue to march to a different drummer in the halls of Congress. The American Medical Association, for example, has long opposed a taxpayer-financed system of health care.

It appears the special interests may no longer be representing their members. It’s time for the doctors themselves to speak up. And Congress to listen.

Editorial: National health care? Even doctors want it

Editorial
Des Moines Register
April 2, 2008

When it comes to reforming health care, special interests have run the show in Congress. Crafting Medicare reforms that benefit insurers and drug companies. Snuffing out proposals to allow Americans to import cheaper prescription drugs from other countries. Stonewalling the creation of a taxpayer-financed system of health insurance to cover all Americans.

Among the most powerful special interests on health care: insurance companies and physician groups. Both have opposed national health insurance that would provide coverage to all Americans similar to the way Medicare covers seniors.

Well, the times they are a changin’.

According to a new study published in the Annals of Internal Medicine, a majority of American physicians now support national health insurance. A survey of nearly 2,200 doctors found that 59 percent think government legislation should establish national health insurance – a jump from 49 percent in 2002.

“More and more physicians are realizing they’re seeing more uninsured patients, said Dr. Aaron E. Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research and lead author of the study. “Even those patients with insurance are having more difficulty getting care. Doctors in general are fed up waiting for the system as we have it to get better.”

Physicians embrace a credo that they must provide care to everyone. But then there’s the reality of needing to secure payment for their services, even though millions of Americans don’t have insurance to help pay the bill for that care. And doctors are tired of the paperwork burden of dealing with thousands of different private insurance programs.

The shift by doctors toward supporting creation of a national health-insurance system is an important finding, because the organizations that represent them continue to march to a different drummer in the halls of Congress. The American Medical Association, for example, has long opposed a taxpayer-financed system of health care.

It appears the special interests may no longer be representing their members. It’s time for the doctors themselves to speak up. And Congress to listen.

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 .