Posted on April 2, 2008

Your Doctor Says Universal Coverage Is Good for You


By Jonathan Cohn
The New Republic
April 1, 2008

For most of the twentieth century, no single group represented a bigger obstacle to universal health care than organized medicine. It was state medical societies that blocked the very first efforts in California and New York, back during the late Progressive Era. (Back then, reformers called it “compulsory insurance.”) And it was the threat of similar opposition that is widely believed to have dissuaded Franklin Roosevelt from including health insurance as part of the Social Security Act in the 1930s.

Later, the American Medical Association spearheaded the fight against Harry Truman’s universal coverage proposal, blasting it as “socialized medicine.” It also fought Medicare until, thanks to Democratic gains in the 1964 election, Lyndon Johnson was able to pass the measure without the group’s support.

As a general rule, physicians supported these positions—although, of course, opinion was not always unanimous. But the practice of medicine has changed a lot in the last few decades. During the 1980s and 1990s, many physicians became closely acquainted with managed care via the private insurance industry—and decided it was just as arbitrary, overbearing, and impersonal as they always feared the govenrment might be.

What’s more, physicians—like everyone else—have become more aware of the myriad drawbacks to our patchwork health insurance system. They see it as practitioners, when their uninsured or underinsured patients go without recommended care; they see it as business managers, when they have to struggle with the cost of benefits for their own employees; they even see it as individuals, since even a physician can find him or herself without the right coverage, depending on the circumstances.

So given all of these changes, are physician attitudes about health care reform changing? Perhaps, if a new study from the Annals of Internal Medicine is correct.

It’s based on a survey sent to 5,000 physicians nationwide and conducted by a pair of Indiana University researchers. In the survey, the researchers asked respondents “do you support or oppose government legislation to create national health insurance?” The results: 59 percent said they supported it “strongly” or “generally,” which is ten points higher than in 2002.

Interestingly, the survey also asked whether respondents supported “achieving universal coverage through more incremental reform.” Support was actually slightly lower; just 55 percent said they “strongly” or “generally” supported it.

I’m not an expert on surveys, so I can’t comment intelligently on the study’s methodology. But one result certainly seems right to me: The fact that support for universal coverage was highest among psychiatrists, pediatricians, emergency physicians, internists, and family doctors. Radiologists were the least sympathetic, followed by anasthesiologists and surgical sub-specialists.

It seems right because it’s consistent with what I’ve observed in my reporting—and the way the different physician types practice medicine. If you’re a specialist, then your contact with patients tends to be intermittent. You focus on the task at hand, whether it’s repairing a ligament or fixing a cataract, and then move on.

If you’re a generalist, though, you develop close relationships with your patients and become invested in their well-being. You’ll notice, for example, when your patients miss follow-up visits and skip medications because they’re worried about the bills.

For a near-perfect illustration of how this plays out, just look at the two doctors who made a name for themselves politically over the last few years. There’s Bill Frist, the heart transplant surgeon. He’s a strongly conservative Republican who opposes universal coverage and, while he was in the Senate, championed market-based approaches to reform. And then there’s Howard Dean, the family doctor. As both governor of Vermont and a candidate for the presidency, he fought for universal coverage.

To read more about the study, see this release from Physicians for a National Health Plan, which is very pleased with the results—and rightly so.