Doctors Need a Say on Health Insurance

No one understands the burden of the large number of uninsured Americans and the need for health-care reform better than our nation's doctors. The women and men who care for patients every day should know what can work for those patients. Yet their opinions are rarely heard in a direct and unfiltered way.

The big, organized special interests in health care have plenty of political influence, and they know how to wield it. Indeed, conventional Washington wisdom for the past 15 years has held that if any two of the status quo's chief protectors opposed health-care change, it would not occur. That's why the beliefs of doctors you rely on back home—those immersed in meeting the daily needs of their patients—should be heeded.

Last spring, the Robert Wood Johnson Foundation commissioned medical researchers at Mount Sinai School of Medicine in New York to sample the views of individual physicians across the country on how health-insurance coverage should be expanded. Our aim was to give voice to the huge cohort of physicians on the front lines of patient care.

The researchers randomly selected family doctors, internists, and specialists from every practice setting and region of the country. The findings, reported last week in the New England Journal of Medicine, are unequivocal. A strong majority of physicians—63 percent—supports a mixed menu of public and private insurance programs for patients to choose from.

A minority of doctors—27 percent—supports a private-only plan. And only 10 percent favor an entirely public health-insurance system. Interestingly, nearly six out of 10 physicians support covering more uninsured Americans by expanding Medicare to people ages 55 to 64.

The consistency of physician opinion is striking. The results were similar regardless of the area where the doctors live and work, the nature of their practices, their membership in the American Medical Association, and the prevailing political tendencies of their neighbors.

No matter how you slice the data, large majorities of doctors support health-care reform that includes both public and private insurance—whether they are from the more conservative Southern, Western, and rural states or the more liberal, heavily urban, coastal population centers. In no locale or physician demographic did support for both public and private insurance choices fall below 58.9 percent. If this were an election, it would be a landslide.

We have a good sense where our fellow physicians are coming from. They are clinicians, not politicians. Caring for their patients' health and peace of mind is their principal priority.

Doctors want patients to have reliable access to affordable, high-quality health care when they need it. They want to know that they will enjoy choice and flexibility in how they care for their patients. And they want to be fairly and promptly reimbursed for the necessary medical services they render. The majority of survey respondents found these attributes in both private insurance and Medicare.

Neither of us believes that doctors should be involved in the minutiae of policy-making—any more than we believe policy makers should be involved in the patient-physician relationship. But as physicians, we know our colleagues realize that the burden of reform will fall directly on their shoulders every time they look at their crowded waiting rooms. Their clinical relationships with their patients—local, personal, and private—will ultimately define whether and how reform works for their patients and for them.

The public, in turn, trusts physicians on the subject of reform. Gallup reported in June that nearly three-quarters of Americans—73 percent—are confident that doctors will recommend the right thing when it comes to reforming health care.

Hippocrates, the father of Western medicine, wrote nearly 2,500 years ago: "Whomever I visit, rich or poor, I will concern myself with the well-being of the sick." Nothing about that has changed for physicians; this is what matters most to them and their patients. Our prescription for Washington is to follow doctors' orders and not let ideology stand in the way of what's best for the health and well-being of the American public.

As appeared in the September 22, 2009 edition of The Philadelphia Inquirer.