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Doctors Support the Public Option

doctorsgraph.jpgThat's the conclusion of a national poll conducted by the Robert Woods Johnson Foundation. The survey included more than 5,000 doctors spread across an array of specialties, and asked two sets of questions. The first gauged support for a public health-care system, a system with public and private options, and a solely private system. The second measured attitudes towards Medicare. The results should be generally cheering to reformers.

Doctors overwhelmingly support either a public option or a public system. Indeed, when you add the two groups together, it's more than 70 percent of respondents. There were some differences across specialties, but not a lot: about 75 percent of primary care doctors favored a public option or public system, while about 67 percent of surgeons felt similarly.

Next, the survey asked about opening Medicare up to individuals between 55 and 64. Support overwhelmed opposition by more than 2 to 1. The public sector didn't fare so well when doctors were asked to directly compare their experience with Medicare and private insurers, however. Private insurers got higher marks for ease of paperwork, speed of reimbursements and adequacy of payments. In fact, they got much higher marks for adequacy of payments. Medicare, however, won out for the ease with which patients got treatments and the autonomy it offered doctors. Overall, 41 percent of physicians preferred private insurers and 21 percent favored Medicare. All in all, a pretty good showing for the public plans, both existing and proposed.

Perhaps the most surprising data point in the poll is that the traditional conservatism of the American Medical Association appears to be crumbling: There was virtually no difference between their membership and other respondents to the poll. That might explain why they backtracked so quickly on their opposition to the public option earlier this year. The other interesting factoid is that the survey was conducted in waves over the summer, but despite the tumult, there were no significant differences between the various groups of respondents. Doctors, it seems, know what they think. And they think a public competitor to the private insurance industry is a good idea.

By Ezra Klein  |  September 14, 2009; 5:34 PM ET
Categories:  Health Reform , Polls  
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Shouldn't we trust the folks having to deal with insurance companies every day that a public option is necessary?

Posted by: parkerfl1 | September 14, 2009 5:55 PM | Report abuse

"Medicare, however, won out for the ease with which patients got treatments and the autonomy it offered doctors. Overall, 41 percent of physicians preferred private insurers and 21 percent favored Medicare. All in all, a pretty good showing for the public plans, both existing and proposed."

Doctors prefer private insurers by double the amount of medicare and that's a pretty good showing for public plans? Are the percentages mixed up?

Posted by: jps677 | September 14, 2009 5:57 PM | Report abuse

They don't like Medicare because it pays them less. But given that the problem with our system is that it's too expensive, I don't really consider that a bad thing. And the fact that a huge margin of doctors wants Medicare opened to more people says a lot.

Posted by: Ezra Klein | September 14, 2009 6:00 PM | Report abuse

I wonder... HOW did they ask the question about supporting a public option? Did they distinguish between creating a new publicly-run health program and the current publicly-run Medicare program?
I would think that would change responses.

Posted by: SS306 | September 14, 2009 6:22 PM | Report abuse

@SS306 - that thing up there where the words "national poll" looks different - that's one of them there hypertext links. Click on it, you get to a summary page, and can download the whole report.

"1. Public and Private Options: Provide people under age 65 the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans.

2. Private Options Only: Provide people with tax credits or low income subsidies to buy private insurance coverage (without creating a public plan option).

3. Public Option Only: Eliminate private insurance and cover everyone in a single public plan like Medicare."

By the numbers, some doctors who prefer dealing with Medicare to private insurers preferred public choice to single payer, and some doctors who prefer dealing with private insurance to Medicare preferred the public choice to private-only.

Posted by: BruceMcF | September 14, 2009 7:58 PM | Report abuse

The survey indicates a wide range of physician specialties. In my spouse's field (infectious disease) and for family physicians/internists the percentage supporting Medicare is much higher. These are the general practitioners that most people come in contact with day to day. These generalists don't do expensive procedures and therefore are compensated much less than the surgeons, dermatologists, gastro-ent. specialists, etc. But, there are more of them. Politically, thats a plus for the Democrats.

They prefer Medicare even though it does pay less because its much less hassle (more physician autonomy) and the predictability of payment is much greater. (They like Tri-Care, the military's single payer system even more.) Remember that the insurance company's "approved" amounts (usually 50-60% of physician charges) frequently don't get paid in full, or are denied for the widely known reasons.

For what its worth, here in conservative South Carolina, a good number of physicians in private practice that I personally know are in my wife's camp: "the health insurance companies should be shut down." And thats the printable part of their opinion.

If a strong public option or a option for Medicare is passed, you'll have 85-90% satisfaction rates here in South Carolina, as elsewhere in the nation. If Obama and his aides don't understand and act on that fact, they might as well resign themselves to one term and a Republican resurgence in 2010 and 2012. They will be condemned for something they didn't do, which would have substantially helped those who are doing the condemning.

Even the densest Tea Bagger after having the Public Option available for a year will realize that this is a good thing. More choices for health care coverage. More accessibility to doctors. They will vote accordingly. If these ardent opponents of "socialized medicine" don't have it in front of them as a reality, it will always be the nasty, awful, horrible projection that the Republicans say it is. The Republicans know this. Does Obama?

Posted by: opal22 | September 14, 2009 8:14 PM | Report abuse

Shouldn't we have been asking these front-line troops this question to begin with? 63-27 for including the public option. Sounds like a convincing majority to me.

Posted by: Eugene6 | September 14, 2009 8:52 PM | Report abuse

In our tiny country the Netherland Antilles we have a health insurance system that works pretty well. It's part private part public. The highest paid employees get their own private insurance, and the middle and lower wage makers take part in the government programs. Insurance companies are in the business of making money , big money. Sectors where they'll be losing money will be dropped. That's where the public option comes in . This is a simplified explanation, in reality it is a little more complex.
But what we look at in the USA is the incredible amount of people without coverage. The richest country in the world has one of the worst health care system. Something drastic has to be done. Is it Socialism ? Yes in part. Because it is going to better the social welfare of the masses.
The Doctors understand the need for the public option.They deal daily with sick people . Some of those without coverage , paying from their pockets , and in case of serious illness will run in to bankruptcy .
Politically speaking I agree totally with Opal 22. If this is not passed it's going to be a disaster.
People here, and in Europe are watching this debate, not understanding what the big deal is about it. Public health care has been engraved for so long in their memory, that for them it is incomprehensible to see people fighting against it.

Posted by: Maxon475 | September 14, 2009 9:02 PM | Report abuse

Obama repeatedly claims there's billions of dollars of waste, corruption, mismanagement in Medicare and Medicaid.
So, why on earth would anyone claim these are good programs? And, why would we want more waste, corruption and mismanagement?

Posted by: ohioan | September 14, 2009 10:00 PM | Report abuse

Here's what I want to know: how many of those physicians who say they want a public option are thinking of the public option as an extension of Medicare (with Medicare rates, and participation required) vs. thinking of it as having to fend for itself in negotiating rates and participation untethered from Medicare.

I'd bet a lot more physicians would like the first kind of public option than the second.

Posted by: jdhalv | September 14, 2009 10:08 PM | Report abuse

Private insurers got higher marks for ease of paperwork, speed of reimbursements and adequacy of payments.

I'm honestly stunned at the ease of paperwork comment. With thousands of insurers many with several different networks ease of paperwork isn't better in private its better in medicare. As a proponent of private plans they're wrong.


Overall, 41 percent of physicians preferred private insurers and 21 percent favored Medicare.

And Ezra why did you not title your post:

Private insurers favored by almost two to one by doctors.

Posted by: visionbrkr | September 14, 2009 10:34 PM | Report abuse

Listen to your doctors. Doctors want a public option more than 2 to 1. Why do Insurance Companies fight so hard to block it? Sounds like Fox and the corporate press are trying to get between the patients and their Doctors.

Single payer, public option will save billions of health dollars.

Posted by: thebobbob | September 15, 2009 12:04 AM | Report abuse

Almost 70% of doctors support a public option.

And the Republicans intend to cost the taxpayers more money to cover the poor, without a public option.

There is NO political, ethical, moral, or economic downside to pushing a public option by whatever Congressional mechanism necessary.

Posted by: Lee_A_Arnold | September 15, 2009 1:15 AM | Report abuse

Ezra - Doctors favor private insurer reimbursement almost 7 to 1 over Medicare. And they favor private insurers overall by a 2 to 1 margin. Yet they also favor opening Medicare up to people 55-64, according to the survey. I find this a bit of a puzzle. Do you know how the question about opening up Medicare was asked? Did it apply only to people who were uninsured? Any thoughts on what looks like an odd result to me?? I couldn't find the wording of the question anywhere....

My guess is Docs would like Medicare a whole lot less if employers dropped coverage of the 55-64 group and shifted it over to Medicare and they accepted Medicare reimbursement for that large cohort of people.

Posted by: mbp3 | September 15, 2009 8:10 AM | Report abuse

For-profit health plans need to be eliminated from our health care system. They don't provide the actual health care nor do they provide any revenue independent of our health insurance premiums - so we, the people, pay for 100% of all health care delivered in the U.S. Any profit made by for-profit health plans goes to stockholders and other nonhealth costs. Unlike other companies who put profits back into their businesses, profits don't go into health care in the way of lower premiums or adequate compensation to providers. Every other nation built their health care systems around the moral or social obligation position that no one should suffer or die because they don't have the money to pay for health care. We, on the other hand, have allowed a system to develop (like an untreated tumor) that lets people suffer or die if they don't have the money to pay for health care. Doctors, patients, hospitals, taxpayers subsidize the wealthy for-profit health insurance companies when people in need of care are treated but doctors and hospitals don't get compensated for that care. The U.S. health system does not represent the American values we supposedly have - that all are created equal, all are deserving of life, liberty, fairness, justice. We have a health system that says some of us are more equal than others. If you have a funding source for your care, you are more equal than those without money. So for those of you who say we have the best health care in the world, I say, "yes, we do - but just for some of us. And we pay substantially for those who don't - both financially and morally." Americans despise freeloaders and often these so called freeloaders are blamed for the runaway costs in health care. The real freeloaders are the for-profit health plans who are merely unnecessary middlemen who take money from us, the people, and deny and restrict our care and inadequately compensate doctors and hospitals who actually deliver the care. All other industrialized nations that allow private health insurance to exist, have forbidden them to be for-profit. They are non-profits and heavily regulated so that the public good comes first ahead of windfall profits made from human suffering. We should at least do that much. Single payer would be most efficient, but at minimum take out the incentive to make money from human suffering and heavily regulated private health plans; require them to be non profit and be transparent in how they spend their money.

Posted by: chrzcatt | September 15, 2009 8:16 AM | Report abuse

Regarding doctors reporting on private insurers vs Medicare for ease of payments, that result seems to be in direct contradiction to reality, so the doctors' "self-reporting" seems a bit uninformed in this regard:

from the AMA

Contracted payment rate adherence

On what percentage of records does the payer’s allowed amount equal the contracted payment rate?

Aetna - 70.78%
Anthem - 72.14%
CIGNA - 66.23%
Coventry - 86.74%
Health Net - not reported
Humana - 84.20%
UHC - 61.55%
Medicare - 98.12%

Since they support Medicare expansion at a 2:1 ratio, it is likely that they also support single-payer in a similar ratio (there are polls that have them supporting it at 59%).

Posted by: tegrat | September 15, 2009 5:59 PM | Report abuse

It is not clear what is meant by a "public system"? Is this single-payer publicly funded and privately delivered model, the Bismarck model, or the Beveridge model (NHS)?

Certainly responses are going to be quite different for each.

Posted by: tegrat | September 15, 2009 6:02 PM | Report abuse

tegrat - Your comment includes an assumption: That receiving payments = to contracted rate is more important than receiving a higher $$ amount payment. Medicare pays it's contracted rate without question, but private insurers' rates are much higher. So i don't think the AMA and RWF surveys are necessarily inconsistent.

Posted by: mbp3 | September 15, 2009 8:59 PM | Report abuse

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