Poll Finds Most Doctors Support Public Option

by Joseph Shapiro
September 14, 2009 , NPR

Among all the players in the health care debate, doctors may be the least understood about where they stand on some of the key issues around changing the health care system. Now, a new survey finds some surprising results: A large majority of doctors say there should be a public option.

When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.

Most doctors — 63 percent — say they favor giving patients a choice that would include both public and private insurance. That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. Together, the two groups add up to 73 percent.

When the American public is polled, anywhere from 50 to 70 percent favor a public option. So that means that when compared to their patients, doctors are bigger supporters of a public option.

Doctors' Support For Public Option 'Broad And Widespread'

Enlarge Mario Tama/Getty ImagesDoctors and other supporters of health care overhaul attend a candlelight vigil in New York City in September 2009. The gathering was one of hundreds nationwide honoring those suffering under the current health care system.

Mario Tama/Getty ImagesDoctors and other supporters of health care overhaul attend a candlelight vigil in New York City in September 2009. The gathering was one of hundreds nationwide honoring those suffering under the current health care system.
The researchers say they found strong support for a public option among all categories of doctors. "We even saw that support being the same whether physicians lived in rural areas or metropolitan areas," says Federman.

"Whether they lived in southern regions of the United States or traditionally liberal parts of the country," says Keyhani, "we found that physicians, regardless — whether they were salaried or they were practice owners, regardless of whether they were specialists or primary care providers, regardless of where they lived — the support for the public option was broad and widespread."

Keyhani says doctors already have experience with government-run health care, with Medicare. And she says the survey shows that, overall, they like it. "We've heard a lot about how the government is standing in between patients and their physician," Keyhani says. "And what we can see is that physicians support Medicare. So I think physicians have sort of signaled that a public option that's similar in design to Medicare would be a good way of ensuring patients get the care that they need."

The survey was published online Monday by the New England Journal of Medicine. It was funded by the Robert Wood Johnson Foundation, a health care research organization that favors health reform.

AMA Doctors Also Support Public Option

The survey even found widespread support for a public option among doctors who are members of the American Medical Association, a group that's opposed to it. The AMA fears a public option eventually could lead to government putting more limits on doctors' fees.

"The American Medical Association has traditionally been probably the loudest voice for physicians across the United States," says Federman. "And part of our reason for doing this research was really to get at the real voice of physicians as opposed to the voice of one physician organization."

Keyhani and Federman belong to another, smaller group, the National Physicians Alliance. It supports a public option, and Keyhani has spoken publicly about her own support for a public option.

What Would A Public Option Look Like?

It's hard to know for sure what doctors mean when they speak about a public option, says Dr. James Rohack, president of the AMA.

"Because when I say public option, or you say public option, it means different things to different people, kind of like the Rorschach ink blot test — when you look at it, to some people it means one thing, to other people it means the other thing."

Politicians in Washington turn to the AMA for support and guidance, even though fewer than a third of practicing doctors belong to the lobbying group.

The AMA's own position on a health overhaul has, at times, been hard to pinpoint. In July, it praised the bill that came out of the House of Representatives. That bill included a public option. But the AMA made it clear that what it really liked was that it eliminated cuts in doctors' fees from Medicare.

"And so I think that's why we need to be very clear about what does the AMA articulate for," says Rohack. "It's to make sure that everyone has coverage that's affordable, that's portable and that is quality — that is, it covers the things you need to cover because you've got a medical condition or developed a medical illness."

U.S. 'Not Getting What We Pay For'

Many Experts Say Health-Care System Inefficient, Wasteful

By Ceci Connolly
Washington Post Staff Writer
Sunday, November 30, 2008; A01

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to worsen.

Senate Finance Committee Chairman Max Baucus (D-Mont.) has already warned that improving and expanding health care will cost money in the short run -- money that his Republican counterpart, Sen. Charles E. Grassley (Iowa), argues the government does not have.

Yet among physicians, insurers, academics and corporate executives from across the ideological spectrum, there is remarkably broad consensus on what ought to be done.

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One fundamental problem is how doctors are paid, he said. Under the current fee-for-service scheme, "the more you do, the more you make," Kaplan said. There is no incentive to keep people out of doctors' offices, hospitals, imaging centers and dialysis clinics.

More tests lead to more procedures, which often result in mistakes, complications, misdiagnoses or the use of untested therapies, said Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Mass. "The current system is very hospital-centric," he said. "We wait for people to get sick, and then we invest enormous sums to fix them up. We should build primary care as the core."

It is possible to change the incentives, Kaplan said. Partnering with Starbucks and the insurer Aetna, Virginia Mason devised a new strategy for dealing with back pain, the leading medical complaint of Starbucks' coffee-pouring baristas. Virginia Mason made big money on MRIs, but there is little scientific data that the scans resolve the problem.

So they flipped the process, trying physical therapy first. To make up for some of Virginia Mason's lost revenue, Aetna increased its payment for the therapy. Today, the majority of Starbucks employees with back trouble return to work within 48 hours without an MRI or a prescription, Kaplan said.

"We've shown that you can have superior outcomes at lower costs," Kaplan bragged. He acknowledged, however, that the success on back pain is "one small vignette" in a mega-mess.

Moving from pricey, high-tech solutions such as MRIs to older, low-tech approaches such as physical therapy requires solid data and a culture change, said Helen Darling, president of the National Business Group on Health, which represents large employers. Americans are attracted to innovations, regardless of cost or whether they have been proven to achieve results.

A whole-body scan that is covered by insurance may seem like a bargain, Darling said. "But one way or another we're all paying" for it in higher premiums, increased government expenditures and even false-positive results that lead to more costly, invasive procedures.