ERIK STEELE

Health care reform — what do physicians think?

Posted Sept. 27, 2012, at 4:10 p.m.
Dr. Erik Steele
Dr. Erik Steele

Physicians agree on — maybe — two things. First, they agree they don’t agree on anything. Actually, some probably disagree about that. Second, they usually agree that everyone who disagrees with them is wrong. It should therefore come as no surprise that physician opinions about health care reform cover more territory than a bad rash.

That is reflected in physician opinions about President Obama’s Affordable Care Act, or ACA, in particular. Talk to five physicians and you get five opinions that sometimes overlap, sometimes don’t, and are almost always strongly held. And as we know, opinions are like bacteria — everyone has them and some of them are nasty. That’s why a Florida urologist who probably had a big prostate clouding his thinking put a sign on his office door telling Obama supporters to seek care elsewhere.

The difficulty understanding what physicians think about all of this is compounded by the fact there are few really good surveys of them on these issues, and results of them seem contradictory. One of those — a survey of 2,694 physicians commissioned by the Jackson Healthcare System — found 55 percent felt the ACA should be scrapped, but one-third of respondents felt the act did not go far enough and a single-payer health system was needed. That means some of those who felt the law should be scrapped did so because they thought it went too far, and others thought so because it did not go far enough.

On the other hand, a 2009 survey of 2,130 physicians found 62.9 percent supported universal insurance through public (government-sponsored) and commercial options. They differed on how to achieve that universal insurance, with 25 percent supporting commercial insurance as the only option, and less than 20 percent supported government-sponsored insurance as the only option.

Despite this diversity of opinion, general patterns of physician perspective have emerged. Perhaps two-thirds support some kind of insurance for all Americans, because most recognize that lack of insurance puts their patients in jeopardy. Just as there seems to be an emerging consensus among physicians, there is also one among their professional associations (such as the American Medical Association and the American Osteopathic Association) that all Americans need access to comprehensive, affordable health care, and that some kind of insurance is required to ensure that access. That evolution is part of what brought the AMA from its position in the 1960s opposing the formation of Medicare to its position in 2011 in support of the ACA.

In fact, the AMA’s website suggests continued advocacy on the issue; it has a banner running across its website policy page detailing some of the impact of the ACA since its implementation: 3.1 million Americans under age 26 insured under their parents’ insurance plans, 54 million Americans who have had expanded coverage of preventive health care, 5.1 million Americans on Medicare who have paid less for prescriptions, etc.

This growing consensus among physicians that all Americans must have access to ongoing, affordable health care has probably been driven, I believe, by the tremendous suffering that lack of insurance causes our patients. We cannot escape seeing it every day. Our experience is reflected in a painful avalanche of studies that has now proved beyond a doubt that lack of insurance kills thousands of Americans each year — friends, colleagues, family members, and other fellow Americans. You cannot watch this parade of preventable misery walk through your ER or office each day and not be moved to conclude that something must be done.

Despite the range of opinions among physicians, here’s my prediction: If most Americans are not insured in another five years, a large majority of physicians will support any means necessary to make that happen, even a single government insurance plan such as Medicare for all. We don’t agree on much, but most of us agree we cannot sit by and watch millions of our patients suffer, and thousands of them die each year, for lack of comprehensive, affordable care.

Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

 

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