THE PLANK 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 dissauded Franklin Roosevelt from including health
insurance as part of the Social Security Act in the 1930s.
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.
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"
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
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.
Edit: Readers drdannyu, wandreycer1, sullydog, and others offer some great personal perspectives on this in the comments thread. Check it out.