Is the public plan option supported by doctors?

by Emily P. Walker, Washington Correspondent, MedPage Today

A solid majority of physicians favor creating a new public insurance option that would operate alongside existing private plans, according to a survey published online in the New England Journal of Medicine.

Is the public plan option supported by doctors? About 63% of doctors, across a smattering of specialties and in various geographic regions, support a public insurance option. That figure is in line with national consumer polls that have shown the majority of Americans support a public plan.

While most physicians’ groups have voiced a collective opinion on the issue, the opinions of individual doctors are less clear.

“Given the enormity of the current effort to reform healthcare and its potential effect on the future of generations of Americans, policymakers need to hear the views on the whole range of physicians on the key elements of reform,” wrote Salomeh Keyhani, MD, and Alex Federman, MD, MPH, from the Mount Sinai School of Medicine in New York.

To examine individual perceptions, Keyhani and Federman collected data from 2,130 physicians from the American Medical Association’s Masterfile and stratifed the responses of those doctors into four groups: primary care doctors, medical specialists, surgical specialists, and other specialties.

Physicians were asked which options they most support: a public option only; private options only; or a mixture of private and public insurance options.

The majority of physicians (63%) said they support a mixture of public and private plans — a cornerstone of the plan President Barrack Obama outlined in his recent address to Congress.

Meanwhile, 27% of respondents said they favored offering private insurance plans only, but creating subsidies to help low-income people afford insurance.

Just 10% favored a healthcare system in which a public, government-run plan was the only insurance option, which would mean private insurance companies would no longer exist in their current form.

Primary care physicians were the most likely to support a public option, while those in fields with less patient contact, such as radiologists and anesthesiologists, were less likely to support a public option, although 57% of those specialists still supported a public option.

Doctors who own their own practices were less likely than non-owners to support a public plan (58% versus 67%; P<0.001).

Physicians who are paid salary only tended to support adding a new public plan more than physicians who are paid through billing insurance companies or the government (69% versus 59%; P<0.001).

Support of the public plan was fairly universal across geographic regions as well, but the biggest majority of support came from those practicing in the Northeast (70%).

Among AMA members, about 62% of respondents supported the public plan.

“Support of the public and private options was consistent across a wide range of physicians, including those from the traditionally conservative southern regions of the United States, those with a financial stake in their practice, and members of the AMA, despite that group’s history of opposition to reform efforts” the article’s authors concluded.

The AMA — which has fought past reform efforts, including the creation of another public program, Medicare — has offered its support for legislation in the House, which would create a public option. The data from the new survey suggest that view is consistent with individual AMA member views.

The plan outlined by the Senate Finance Committee does not contain a public insurance option. It would set up state-by-state cooperatives, which would allow patients to pool together to purchase insurance, and to have an ownership stake in their insurance plan.

There are no plans in Congress that would establish a single-payer system.

The study authors point out several limitations to their survey, including a low response rate of just 43%, however, they add there were no significant differences between the characteristics of responders and non-responders.

The study authors reported no relevant conflicts of interest.

In a second Perspective, also published Monday online in NEJM, researchers sought to gauge physicians’ personal attitudes about healthcare reform.

For that survey, researchers led by Ryan Anteil of the Mayo Medical School mailed an eight-page questionnaire about moral and ethical beliefs in medical practice. Physicians were asked to respond to how much they agreed with the following statements:

* “Addressing societal health policy issues, as important as that may be, falls outside the scope of my professional obligation as a physician.”
* “Every physician is professionally obligated to care for the uninsured and the underinsured.”
* “I would favor limiting reimbursement for expensive drugs and procedures that would help expand access to basic healthcare for those currently lacking such care.”

The survey also asked for physicians’ moral perceptions on using cost-effectiveness data to determine which treatments are offered to patients.

Of the 991 returned surveys (a response rate of 51%), 78% of respondents said that addressing societal health policy issues is in the scope of professional obligation of a physician.

About 73% said physicians are obligated to care for the uninsured and underinsured.

Most respondents (67%) said they would favor limiting reimbursements for expensive treatments to expand access. Not surprisingly, surgeons and sub-specialists were more likely to oppose cutting payment for pricey procedures than were primary care doctors.

A little more than half (54%) said they were morally opposed to using cost-effectiveness as a factor in deciding which treatments a patient should receive.

As would be expected, there were differences between physicians who described themselves as “conservative” or “liberal” on social issues.

Liberals agreed more strongly that doctors have an obligation to address societal issues, and that physicians are obligated to care for the uninsured and underinsured, and that cutting reimbursements for expensive procedures should help pay for reform.

Conservatives, however, tended to object more strongly than liberals to using cost-effectiveness data in making clinical decisions.

The authors say the data suggest that efforts to mobilize physicians can increase their sense of professional responsibility, but “also that such efforts may encounter considerable opposition from some quarters of the profession, particular to elements of reform that impinge on physicians’ decision-making autonomy or threaten to reduce reimbursement for the costly interventions they provide.”

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  • family practitioner

    If the question is put simply in yes or no terms, ie do you support a public option, then I would say yes. However, as the cliche goes, “the devil is in the details.”

    I would not support one if it is basically another version of medicaid.

    I would also not support one if it is modelled after medicare, unless the problems with medicare, ie running out of money, are acknowledged and addressed.

  • Doc99

    It’s difficult to reconcile the NEJM poll with this one.

  • docguy

    i have yet to speak to a doctor who is favor of this so If it’s really 60% did they just ask people who are in a little bit of favor or a lot of favor or maybe people who were in the room with them at the time.

    I am in the doctors lunch room at my hospital every single day and no one is in favor of this.

    Also I noticed a study that said that 45,000 people die each year because they don’t have insurance and it’s from a group that wants to make sure that there is socialized medicine. Well I’m amazed their study proved that. sarcasm implied.

  • Doc99

    Most Americans now favor the status quo. Moreover, I have a difficult time reconciling the poll cited by NEJM with this poll from Investors Business Daily.

  • ninguem

    “About 63% of doctors, across a smattering of specialties and in various geographic regions, support a public insurance option. ”

    “The majority of physicians (63%) said they support a mixture of public and private plans”

    Author contradicts herself in her own article. The question that got the 63% response was whether physicians favored giving the public a CHOICE of a public plan like Medicare (“like Medicare” was the wording in the question) or private plans.

    Favoring a CHOICE of A or B does not mean the respondent favors one or the other. Yet everywhere the state-run media ran headlines that “Physicians favor public option”.

    Journalistic incompetence, or bias.

  • docguy

    the media has decided what they want so they pull out crap polls and studies that go along with what they want the end result to be,

    case in point, the headline on right now about the crap study that proves that not having health insurance kills you from the association to socialize medicine.

  • Russ


    This NEJM cover-up of its political ties is proof that NEJM cannot be believed.


    RE: General Questions and Comments: The Regressivity of Taxing Employer-Paid

    Thursday, September 17, 2009 8:36 AM

    From: “Guth, Lindsay”


    Dear Mr. XXX,

    Thank you for your feedback.

    Perspective articles are opinion-oriented — not research-oriented — so relevant affiliations are not against our policy for these articles.


    Lindsay Guth
    Perspective Researcher
    New England Journal of Medicine
    P: 617-487-6539
    F: 781-207-6529

    —–Original Message—–

    From: NEJM, Customer

    Sent: Friday, September 04, 2009 10:56 AM

    To: NEJM Editorial; NEJM, Comments

    Cc: Johnson, Louisa

    Subject: FW: General Questions and Comments: The Regressivity of Taxing Employer-Paid

    Dear Colleague,

    I am forwarding the customer comments appearing below which pertain to your area. I have responded to this customer advising that their comments have been forwarded to the appropriate area within the company.

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    —–Original Message—–

    Sent: Thursday, September 03, 2009 6:53 PM
    To: NEJM, Customer
    Subject: General Questions and Comments: The Regressivity of Taxing Employer-Paid

    To the Editors:

    about this –

    The Regressivity of Taxing Employer-Paid Health Insurance

    Did the NEJM feel the need *not* to identify the two authors as the founders of the MD single-payer group “Physicians for a National Health Program?”

    Why? Reputable publications fully disclose their writers’ major memberships.

    Very, very disappointing.

    This supports the claims that NEJM is very biased to one political group.

  • Doc Stone

    I think only a minority of docs say they want more public insurance–but the ones that I know who do are also the most prone to whine and complain about medicare and medicaid. There is no accounting for human irrationality.

  • Anonymous

    Ninguem – It’s not a contradiction. The question was whether the doctors support a public OPTION, not a public system (single-payer). That is the same thing as supporting a CHOICE between public and private plans. OPTION = CHOICE in this context. So yes, according to this particular poll, “Physicians support a public OPTION.” In this debate, to support the public option is to support the inclusion of a public plan into the bill, not a statement of preference of one vs. other.

  • J87630


    The IBD poll and the NEJM poll ask two fundamentally different questions: The former asks whether docs support Congress’ plan while the latter asks specifically about a public option. First, the IBD poll doesn’t specify which plan, given that there are multiple proposals in both the house and the senate, and doesn’t ask doctors specifically what in the plans they support or oppose. There is both liberal opposition and conservative opposition to various proposals in each of the plans (i.e. anyone who supports single payer could easily express opposition to the Congressional plans.) The NEJM poll is equally problematic in that it asks only about a theoretical “public option” removing it from the context of the much maligned Congressional plans. And the third question from the IBD poll borders on a push poll. While I agree the disparity is unusually large, the differences in the poll’s themselves likely account for at least some of the difference.

  • ninguem

    Anonymous September 18, 2009 at 7:19 pm
    That’s the most laughable twisted corruption of the English language that I have ever heard. You’re either a reporter or a lawyer.

    Those with a brain fully understand the press is doing their best to twist the poll into the lie that physicians prefer a public plan over private. Given a choice of one or the other, there was a 3-1 preference for private, even in this poll.

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