A New England Journal of Medicine survey released yesterday reveals that 73 percent of doctors favor a public option as a component of health care reform.  Sixty-three percent favored a public option as part of a public-private mix of insurance options, while another 10 percent favored a single-payer system. 

            The survey, based on a sample derived of a comprehensive database of all U.S. doctors, showed solid support for a public option that cut across geography, specialty, and the business models of the practitioners.  In the ironic tidbit department, the database was obtained from the American Medical Association, which opposes the public option.  The AMA represents barely a third of all doctors, yet speaks as if it represents the entire sector in opposing this element of reform.  

            The doctors surveyed presume that a public model will resemble Medicare.  The survey revealed that doctors are, despite complaints, more or less comfortable with Medicare as a model—more comfortable than they are with a rat’s nest of private plans.  Each of these offers its own brand of interference and obstruction wrought by corporate bureaucrats who are incentivized to deny care whenever they can.  At least that’s how the docs seem to see it.  Even for those who are lukewarm to Medicare, it seems to be a case of a devil with which they can do business.  That’s right, a government less “evil” (in culture wars, we must have evil) than its private counterparts.  This, then, is news.

Not Government-Run, Government Financed

            Doctors get the distinction that a plan modeled on Medicare is not government-run, it is government-financed.  This term—government financed—was used by Victor Rodwin, a professor of health policy at New York University in an article yesterday in the New York Times.  The professor made the distinction in relation to the French health care system, but it applies perfectly to the public option as envisioned in the U.S. reform effort.  Rodwin went so far as to compare a Medicare-like financing mechanism to Social Security.

            Such a distinction is by no means news.  What is news is that a plurality of American obstructionists refuse to get it.  Financed, not run.  What does one have to do to beat this into their Beck-addled heads?  Perhaps lead with the term government-sponsored insurance.  That is to say, the government sponsors the insurance.  It offers the insurance.  It establishes an agency of record that administers the financing of the plan.  (Nah, all of the above would still require an audience imbued with the capacity to reason.)

            A nurse from Pennsylvania at the tea party on the Mall on Saturday—a nurse who offers end of life counseling—said she opposed end of life consultations (death panels) as proposed in the leading Democratic plan because she didn’t want bureaucrats offering the service; she wanted only medical professionals like herself to do it.  This lady, for example, obviously doesn’t get that the health care reform on the table is a financing mechanism.

  Postal workers will not be offering death panel advice, except perhaps during the holiday rush.  Neither will Timothy Geitner, nor anyone over at Agriculture, nor any foreign service or IRS employees (though I believe the IRS already has death panels but prefers to call them audits).  Nor will a government doctor, for that matter, because there will be no government doctors.  None. Zero. Zilch. Nada.

            Physicians get this, and they get it by an overwhelming majority.  Seventy-three percent support is beyond huge, it’s practically monolithic.  So take that, AMA. 

            Unlike the scenario spun by town hall thugs, doctors are not aligned with elderly patients in a last stand against Dr. Sam.  Doctors are aligned with centrist Democrats in favor of a system that they, more than anyone, know will not be perfect because Medicare is not perfect.  Nothing is perfect.  But German and French health care, based on models similar to the public option and single payer option respectively, are a lot more perfect than anything we have.  All of the French get benefits that are sweeter than Medicare.  And far fewer of them die “avoidable deaths” (it’s a technical term meaning the kind of death you die when you can’t get medical care.)

            Town hall thugs take note:  Want to live longer while spending a far smaller percentage of your GDP on health care?  Move to Europe.

            Doctors are aligned with principles of sensible change that are being drowned out by dupes fighting a proxy war for Big Insurance.  What can we do stop this drift toward failure?  Put physicians favoring a public option in front of microphones at Congressional hearings, one after another, until the holdouts turn blue and pass out from holding their breath.           

Survey Surprises

            The range of variation in physician support by specialty was surprisingly narrow. Primary care physicians and surgeons supported a public option at nearly identical rates.  In fact, there may be nothing else in the universe that these two disparate segments of medical practice hold in such agreement.  While salaried physicians favored the public option by a margin of 10 percentage points over fee-for-service-only physicians, fee-only doctors actually favored a single-payer plan by a point.  Go figure.

            The 10 percent of physicians who favored a public option only (essentially a single payer plan), stated just that—public option only.  They essentially want Medicare for all, just like in France.  (These are the cosmopolitan docs of the bunch.)  They can be counted upon, however, to go along with the public-private mix; that’s how the 73 percent composite favorable rating was attained.  Lumping them together with the mixed option proponents actually strengthens the mandate. 

            The survey was conducted on a sampling of 6,000 physicians by a reputable team that returned findings deemed worthy of publication in the New England Journal of Medicine (online only, so far).  Physician attitudes were measured from June through early September, so this study is fresh as a daisy.  The survey was funded by the Robert Wood Johnson Foundation, long a proponent of health care reform, but carried out in an independent manner befitting the grande dame of American medical publications.  The Journal, by the way, publishes a number of useful articles on health care reform in its online incarnation.  The survey can be found here.

UPDATE 9/15/09:  An article appearing in the Minneapolis Star Tribune on Wednesday, entitled “14-foot-tall vampire illustrates view of one physician’s group,” included the following statement:  “It [The American Medical Association] initially opposed the public option but recently came out in support of a House proposal that included a public-private option.”  This statement is not entirely true.

            According to Mike Lynch, Vice President of External Communications at the AMA, the group has never opposed the public option.  “The AMA has no official position on the public option,” said Mr. Lynch.  In addition, he maintained that this has been the AMA’s position on the public option throughout the debate.  According to Lynch, The AMA has not changed its position recently as asserted by the author of the Star Tribune article, Chen May Yee.

   The AMA does support HR3200, the bill that includes the public option, but Mr. Lynch stated that support for the overall bill does not constitute an endorsement of all of its provisions, including the one in question here.  Mr. Lynch stated that the AMA ambivalence about the public option is that it “is not necessarily the best way to ensure public access.”

            The AMA’s lack of a position on the public option strikes me as a rather finely parsed response to a critical aspect of the health care debate.  It reflects pure politics in that it is likely the association is attempting to prevent a schism within its ranks.  In so doing, it panders to its conservative base.  The American public deserves a statement from the AMA on this crucial aspect of HR3200. 

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(I'll be taking next week off to sample the wine, and, who knows, maybe the health care, in France.  See you the week of September 28th.)