Physicians prefer two-tiered single payer with private insurance option – What?

The Physicians Foundation, survey completed October 2020

The Physicians Foundation’s 2020 Survey of America’s Physicians: COVID-19 And The Future Of The Health Care System finds physicians ranked a two-tiered system featuring a single payer option plus private pay as the best direction.

Q1 – Considering all relevant issues such as patient access, value and quality, health system efficiency, physician autonomy and compensation, and the COVID-19 public health response, what direction should the health care system take? Rank the options below 1-4, with 1 being the best approach.

Implement a two-tiered system (single payer available for all, with private pay/insurance option)

• 67% – Rank 1 or 2 (36% Rank this as first choice)
• 33% – Rank 3 or 4

Maintain/improve the current Affordable Care Act (ACA) influenced system

• 49% – Rank 1 or 2 (19% Rank this as first choice)
• 51% – Rank 3 or 4

Move to a market-driven system with Health Savings Accounts and catastrophic policies

• 45% – Rank 1 or 2 (30% Rank this as first choice)
• 55% – Rank 3 or 4

Implement single payer/Medicare for All system (government funded and administered)

• 40% – Rank 1 or 2 (19% Rank this as first choice)
• 60% – Rank 3 or 4

Q3 – In the near future (next two to five years) how important will each of the following steps be if the goal is to ensure high-quality, cost-efficient care for all?

Providing affordable health insurance coverage that ensures improved health care access

• 98% – Important
• <3% – Not important

Increasing the number of physician leaders in key decision making positions

• 96% – Important
• 4% – Not important

Establishing price transparency for medical services

• 95% – Important
• 5% – Not important

Clarifying the effect of Pharmacy Benefit Managers and the integration of insurance and pharmaceutical companies on drug costs

• 93% – Important
• 7% – Not important

Determining the impact of health systems/ hospital consolidation on health care cost and quality

• 93% – Important
• 7% – Not important

Reducing health inequity/inequality of access

• 92% – Important
• 8% – Not important

https://physiciansfoundation.org…

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Comment:

By Don McCanne, M.D.

Of the four choices of health care reform offered in this survey, the most popular amongst physicians was implementing “a two-tiered system (single payer available for all, with private pay/insurance option),” with 67% ranking this as their first or second choice, and the least popular was implementing “single payer/Medicare for All system (government funded and administered),” though 40% still ranked that as their first or second choice. Opinions were split on maintaining/improving “the current Affordable Care Act (ACA) influenced system,” and moving to “a market-driven system with Health Savings Accounts and catastrophic policies.”

Although there was very strong support for all of the policy features they asked about, it is reassuring that 98% agreed that “providing affordable health insurance coverage that ensures improved health care access” was important “to ensure high-quality, cost-efficient care for all.” Plus the 92% support of “reducing health inequity/inequality of access” was sort of reassuring as well, although the 8% who did not believe that this was important are likely in the wrong profession.

So there is agreement that we need to reform the system, but physicians seem confused as to how we do that. Their first choice of “a two-tiered system (single payer available for all, with private pay/insurance option)” is not a single payer system since single payer does not have two tiers and it does not include the option of private insurance since that would be a multipayer system. It is likely that this preference represents perpetuation of a market of private plans with the addition of a Medicare-like public option. This might represent Joe Biden’s position except that only half of physicians seem to support the Affordable Care Act – an essential element of Biden’s proposal.

The fact that both health savings accounts with catastrophic coverage and pure single payer/Medicare for All have split support suggests that physicians may be making their decisions based more on ideology than on rational policy. Having discussed these issues with many physicians from across the political spectrum, it seems that the impasse is inviolate. Here’s hoping that some of you can figure out how to break through.

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