Physician Opinion Tips in Favor of National Health Insurance

By Charles Bankhead

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 Ackerman, 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,â€? 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 Ackerman.

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.

Primary source: Annals of Internal Medicine
Source reference:
Carroll AE, Ackerman RT “Support for national health insurance among U.S. physicians: 5 years later” Ann Intern Med. 2008; 148: 566-567.

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