According to a study published yesterday in the New England Journal of Medicine, 63% of doctors support expanding health insurance coverage through both private and public options.   NPR reported on this survey with the headline, “poll finds most doctors support public option,” and immediately elicited comment from the American Medical Association, since the organization has equivocated on support of the public option in its public statements, while the study explicitly demonstrated support for the public option among AMA members (62%).  Not surprisingly Dr. James Rohack, the president of the AMA (who has previously made confusing comments about the public health insurance option implying that subsidized private plans could be considered a public option), challenged the meaning of the findings, “[the public option] means different things to different people, kind of like the Rorschach ink blot test.”  However, his attempts to obfuscate only further emphasize that the official positions of the American Medical Association do not represent the viewpoint of most American doctors (or apparently in some cases even AMA members).

While it is true that there are different versions of the public health insurance option described in the bills coming out of the House, the Senate HELP committee, and the framework envisioned by Jacob Hacker, the findings of this study are not up for interpretation.  A Rorschach test is purposely subjective so a clinician can interpret a patients’ psychological state.  Conversely, good researchers ask precise questions and describe their methods in detail so that their findings can be reproduced.  The reputation and influence of peer reviewed journals, like the New England Journal of Medicine, is dependent on publishing quality research.

The consistency and reliability of the research demonstrating doctors’ support for public health insurance similar to Medicare should relieve us all of the fear mongering around “socialized medicine.”  Ironically, conservative politicians fear “government bureaucrats standing in between them and their doctors,” while their doctors do not.  The evidence is crystal clear.

In 2003, Ronald Ackerman and Aaron Carroll asked 3188 randomly sampled physicians, “In principle, do you support or oppose government legislation to establish national health insurance?” At that time 49% supported this type of legislation and 40 % opposed.

In 2008, the authors repeated the study, this time with 59% agreeing and only 32% opposing national health insurance.  They also asked, “do you support achieving universal coverage through more incremental reform?” 55% supported and 25% opposed this type of proposal.

And now, with the study by Keyhani and Federman we have another question directly relevant to the current health care debate:

Respondents were asked to indicate which of three options they would most strongly support:

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.

63% of doctors chose option #1 – the public and private options. It is not clear to me how Dr. Rohack could be unsure what the public option means in this context.  It’s right there in the study’s methods.

These research findings are robust and consistent: doctors support national health insurance (i.e. Single Payer); but when asked specifically about a public health insurance option similar to Medicare and available to everyone below 65, they overwhelmingly support it.  There even seems to be a trend developing where a greater percentage of doctors support public health insurance.

Doctors are not afraid of government health insurance bureaucrats – we already have private insurance companies’ utilization reviewers to contend with.  The study’s findings may be a surprise to some, since doctors tend to be conservative as a whole, but the truth is that most doctors are sick of fighting with insurance companies.  The average physician spends 43 minutes per day and $65,000 per year on interactions with health plans; there have already been multimillion dollar class action lawsuits against Aetna, Cigna, Humana, Blue Cross Blue Shield, and others for underpaying doctors (among other charges), and ultimately we have yielded too much decision making capacity to managed care companies.

So when we talk about a public health insurance option, we mean a plan modeled on Medicare.  We do not mean a co-op; we do not include a trigger option; and we don’t want expanded coverage limited to public subsidies for private plans.  The data is there in black and white – in the shape of a bar graph, not an ink blot.

Aaron Fox, MD

NPA – NYC Local Action Network

Crosspost from: Be Active Blog

I loved Obama’s speech last night.

He had many excellent frames. I’ve been advocating for him to use George Lakoff’s frame’s of health care and he did just that.

A classic frame was talking about the public option like public colleges: “But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities. ”

Most importantly he brought health care from a policy issue to a moral issue.  He first brought up stories of people who can’t pay for their health care.  You can see another example, of a boy’s family who can’t pay for his cancer care here:
Nathan and Thomas’ Story

He then brought up Teddy’s letter on why a fellow American thought that his fellow Americans should have the same access to care that he did.

“On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of his own experience.  It was the experience of having two children stricken with cancer.  He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick.  And he was able to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can’t afford it. ”

Continuing he puts health care in the frame of the Family of Americans:

“That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling.  It’s not a Republican or a Democratic feeling.  It, too, is part of the American character — our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.”

Keep talking about health care as a moral issue.  It IS in our country’s character to get everyone health care.  Keep telling the stories of friends and family who were denied by insurance companies for life saving care.  We are here to end that, because that is not the way we live in America.

“We did not come to fear the future.  We came here to shape it.  I still believe we can act even when it’s hard.  … I still believe we can do great things, and that here and now we will meet history’s test.  Because that’s who we are.  That is our calling.  That is our character.”

Thank you President Obama, for speaking to our hearts.

I am sure both sides of the aisle will find something to complain about, but I was impressed with Obamas speech on health care before a joint Congress.

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated — by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles (…) The public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

First of all, after all what we have been hearing (mostly rumors), it is great to hear such a strong support for a public option. I think the way he presented his plan makes anyone still saying “No” look out of touch with reality and, honestly, morally challenged- and like your main concern is the insurance companies’ , not Americans’, well being. Maybe it takes working in healthcare and dealing with insurance companies on a daily basis (as a doctor and as an employer) to realize that they will not change their basic ways unless forced.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false — the reforms I’m proposing would not apply to those who are here illegally.

This was met by the “You lie” comment that apparently came from Joe Wilson, and made him (and the right side of the aisle) look really mature! But the way the debate has been going, why am I not surprised? This is the level opponents of health care reform are operating on. Apparently Wilson called to apologize… oh well….

Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens.

I must also say that I was impressed by the way he called out Sarah Palin and her consorts, and not surprised but saddened that most Republicans sat on their hands, and thus seemed to disagree with the inappropriateness of such lies. There was a piece on NPR this morning where they elicited seniors’ reaction to the speech, and people actually believe these claims!

Last but not least, I had the pleasure of seeing the speech with a relative from Germany, a country with Universal Health Care…. she was impressed, too, but completely perplexed by how bad things over here have gotten. Go figure.

The debate surrounding health care reform is not over! We can demand meaningful reform and the New York Local Action Network continues to be heavily involved in NYC.

Here’s a clip of Dr. Manel Silva addressing a crowd in Jersey City gathered at a candle light vigil in support of health care reform (and from the signs, the crowd is clearly in support of a public health insurance option):

And Dr. Viraj Patel sharing a patients story at a vigil in Manhattan:

59% of physicians support national health insurance and 55% support achieving universal coverage with more incremental reform. We need to get out there and let the country know that doctors want a health care system that is fair and that is focused on the needs of our patients.

Is health care an economic or a moral issue?

Let’s imagine for a moment that we were talking about education instead of health care.

At the time of this discussion, over 10% of children have no access to any schooling and 5% additionally only get to go to school 1-2 days a week (inadequate schooling). For the other 85%, they have access to schools, but if they have a learning disability, they may not be able to transfer schools, many have to pay for their books, and a large proportion of the rest have to pay their teachers their lunch money or they can’t attend (and lunch is getting more expensive by the day). And then there are the children who can only get one lens for their glasses, not two, because they can’t demonstrate that two makes it easier for them to read.

The question before Congress is whether or not we should give these children access to quality schools and ensure that children can choose a school that’s right for them (within a certain area) and not be denied going to the school because they had a prior need for glasses or have dyslexia.

To enable all of these children to get a quality education is going to cost money – lots of money. And we don’t necessarily have the greatest evidence in the world that even educating these children will save money in the long term – we think it will, but we have no guarantees.

So should we do it? Is this an ethical dilemma or an economic one? How should the debate be framed?

Senator Reid recently raised this question as a rhetorical one in a town hall debate on health care (see: http://www.lasvegassun.com/news/2009/sep/01/harry-reid-reform-moral-issue-financial-benefits/)

He sees it as a moral issue with economic benefits. But he is a partisan Democrat acting on his party’s behalf… or so some critics will claim. Or at least the claim is that the current health reform effort is simply another attempt by the Democrat liberals to enlarge the government and the government’s control in our lives with increased spending.

It is highly unfortunate that the issue of providing health care to those who need it has become a partisan issue. It is not one. And the fact that it has taken that tone saddens me. It should sadden all of us that instead of working together to try and tackle one of the major ethical issues of our time we allowed the discussion to be distracted by partisanship. Our education system is not perfect, but we have worked out a system where every child has access to education – not because it is cost-effective but because it is the right thing to do for children. As a recent post on this same blog pointed out, we need to focus on how to get health care to those who need it – we need to “get out there and do something about it.” The current health care reform may also not be perfect, but we collectively need to keep our eye on the goal of ensuring quality care for everyone who needs it and stop getting bogged down in party rhetoric – both of the ‘single-payer only’ type and the ‘anti-government run health care’ type. This is a moral issue. I think all Americans agree to some extent on that. Let that be the starting point and let’s get to work.