Majority of Physicians Back Public Option in Health Reform

A national survey of psychiatrists and other physicians found that most of them support inclusion of a government-funded option in any legislative effort to overhaul the existing health care system dominated by the private health insurance industry.

The summer-long survey, to which 2,130 physicians responded, asked them which of three options for expanding health insurance coverage they supported the most: combining public and private options, expanding access to private options only, or covering everyone through a single public plan like Medicare does. A substantial majority of physicians (62.9 percent) said they supported a combination of public and private insurance plans.

The survey was conducted by Salomeh Keyhani, M.D., M.P.H., an assistant professor of medicine at Mount Sinai School of Medicine, and Alex Federman, M.D., M.P.H., an assistant professor of general internal medicine also at Mount Sinai. The findings were published in the September 14 New England Journal of Medicine.

While 27.3 percent of physicians said their first option was a system based on private insurance options, only 9.6 percent of respondents supported a reform plan that relied solely on a government-funded insurance, such as a nationwide expansion of Medicare. However, 58.3 percent of the physician respondents supported an expansion of Medicare to Americans as young as age 55.

While the survey report did not disclose the number of psychiatrists who participated, the authors pointed out that responses were consistent across physician specialties, practice settings, and regions of the country.

“Regardless of their preferred solution, the majority of APA members would want to see parity principles recognized, appropriate physician reimbursement, and voluntary participation in any reform plans that emerge from Congress,” said Irvin “Sam” Muszynski, J.D., director of APA's Office of Healthcare Systems and Financing.

In September APA's Board of Trustees voted unanimously to support America's Affordable Health Choices Act (HR 3200) as the basis for health care reform (see APA Board Takes Stance on Health Reform Proposals). That bill—approved by three House of Representatives committees and previously endorsed by the AMA and other groups—includes the most aggressive government-funded insurance program, or public option, of the major health reform bills advancing through Congress.

The APA Board's support was based in part on the bill's requirement that its proposed Health Insurance Exchange feature include the option of a public health insurance program. The bill clarifies that physician participation in a public plan would be voluntary and that no penalties may be levied against physicians who choose not to participate.

The survey and the APA Board's actions came as the Obama administration and its allies explicitly called for physicians to help educate their patients about the need for a health system overhaul and how it could benefit them.

“It's especially important that we have doctors speaking up in their communities for the change that our health system needs,” said Vivek Murthy, president of Doctors for America, a liberal advocacy group, during a September 17 White House conference call for physicians.

Previous surveys on physicians' views of health reform proposals asked about somewhat different national health insurance questions and received varying answers. One survey of 1,650 physicians published in the November 2003 Annals of Internal Medicine found, for example, that 49 percent of physicians supported legislation to establish national health insurance, but only 26 percent supported a federally funded national health insurance plan. A majority of psychiatrists in that survey supported national health insurance, but less than 50 percent of them backed the federal government as the sole payer of national health insurance.

“Doctors on Coverage—Physicians' Views of a New Public Insurance Option and Medicare Expansion” is posted at<http://healthcarereform.nejm.org/?p=1790>.▪