Physicians views on Single Payer

This is not new data, but I am just trying to get as much information into this blog as I can. So here we go, first from Archives of Internal Medicine in 2004, by Himmelstein and Woolhandler of PNHP:

Single-Payer National Health Insurance: Physicians' Views

Danny McCormick, MD, MPH; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH; David H. Bor, MD

Arch Intern Med. 2004;164:300-304.

Results Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single-payer system. Most respondents would give up income to reduce paperwork, agree that it is government's responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system.

Conclusions Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.

A response from Dr. Palmisano of the AMA

The Danger of Single-Payer Health Insurance
Donald J. Palmisano
Arch Intern Med. 2004;164(20):2281-2282.
EXTRACT FULL TEXT

Dr. Palmisano cites Dr. Ian Bogle in his "Outgoing speech as Chairman of the British Medical Association Council." Available at: http://www.bma.org.uk/ap.nsf/Content/ARM03chcouncil.

and a survey published a year earlier to make his case: "Support for national health insurance among US physicians: a national survey." Ann Intern Med. 2003;139:795-801.

Regarding the former, England has a National Health Service, not a single payer system, though I always urge us to learn from the faults of other systems. We are not doomed to repeat the mistakes of others (unless we're stupid).

Regarding the second study, which Dr. P argues "found that only 26% supported a single-payer system," here is the results section of the abstract:

Results: Sixty percent of eligible participants returned a survey. Forty-nine percent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it. Only 26% of all physicians supported a national health insurance plan in which all health care is paid for by the federal government. In analyses adjusting for differences in personal and practice characteristics, physicians in a primary care specialty, physicians reporting that at least 20% of their patients had Medicaid, and physicians practicing in a nonprivate setting or in an inner-city location were statistically significantly more likely to support governmental legislation to establish national health insurance.

The editors' notes from the journal:

With the exception of family practitioners, anesthesiologists, and surgical subspecialists, more than half of physicians in major specialties supported national health insurance. Support was highest among pediatricians, psychiatrists, and general internists.

With all due respect to the authors, these questions were as clear as mud. I am very engaged and strongly favor single payer, but I don't know how I would have answered these questions. I'd suggest: "Would you favor expanding Medicare to all citizens?" for instance.

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