Tuesday, April 1, 2008

Majority U.S. Physicians support single payer national health insurance

A new survey [Annals of Internal Medicine] of US physicians has found that 59% support legislation to establish a single-payer national health insurance. A previous survey completed in 2002 found that 49% supported a single-payer program. The 10% increase in support during 5 years parallels the increase in uninsured Americans from 43.6 million in 2002 to 47 million in 2006, the last year for which a US Census Bureau estimate is available.

The survey, done by two Indiana University researchers, found that a majority of physicians in every specialty support single-payer universal coverage except surgical subspecialists, anaesthesiologists and radiologists.

The American Medical Association, which represents an estimated 19% of US physicians, has steadfastly opposed a single-payer model. The organization is perceived to represent all US physicians, but its diminutive membership and lack of leadership in addressing the crisis of the uninsured would seem to make it irrelevant. Because no countervailing organization has emerged to represent the other 81% of US physicians, the AMA could make a large difference in the debate by acknowledging these new survey findings endorsing a national health program. I think it would then reverse its membership decline, but I also think it highly unlikely the AMA will change its position.

The leadership of the Canadian Medical Association wants to move away from a single-payer system, and the procedural specialists are leading the way. The current president, an orthopaedist, and the president-elect, a radiologist, both advocate for privatization. This reflects the US survey findings, suggesting that highly paid specialists feel constrained by a publicly funded system.

In Canada, physicians face a dilemma. How can we prevent the discontented procedural specialists from taking us down a path that will be destructive to our single-payer, equitable system? Some of their grievances and frustrations are legitimate. Yet their ability to obtain operating room time, new equipment, and high remuneration should not undermine access to care for our patients, the majority of whom would find premiums for private care a serious financial burden or even unaffordable. Furthermore, we know from experience in Australia and the UK that private clinics flourish at the expense of the public system. We need to establish dialogue within the profession, but we also shouldn’t play nice indefinitely lest we find ourselves with a CMA that no longer reflects the values of most Canadian physicians.

Randall White, M.D.

No comments: