Growing Sentiment

A couple of months ago, I wrote that I favored transforming our complex hodge-podge of health care financing to a national single-payer system. It now seems as though a majority of physicians in the US  feel the same way, with 42% strongly supporting the idea. This is a remarkable evolution from the days when the American Medical Association vociferously opposed the creation of Medicare and Medicaid in the early 1960s. Why the shift?

The folks who commissioned the poll cite 4 major reasons:

  1. Complexity fatigue. Back in the day, Medicare was seen as a threat to the simple and straightforward fee for service relationship that physicians had with their patients. Doctors resisted the intrusion of the “government into the exam room.” Now, the exam room is crowded with so many players, each with its own rules and demands, that having only the government to deal with would seem like a relief. This certainly rings true to me.
  2. Many feel as if the handwriting is on the wall about movement toward a single payer, so they grudgingly agree that we might as well do it sooner than later. I would say that another way to look at this is that few can articulate another alternative that reduces administrative complexity and expands coverage.
  3. Shifting demographics. Merritt and Hawkins cite a generational shift, with younger physicians more inclined to support a single payer. I don’t have the data they cite to judge the validity of the explanation, but I suspect it is not just about age, but about the changing nature of physician employment. As more and more physicians are employed by health systems or other large organizations, I believe they feel more financially secure, and more insulated from the details of reimbursement which makes them more open to single payer.
  4. Changing assumptions. One of the most remarkable aspects of the recent debacle in Congress over attempts to repeal the ACA is that public opinion has changed in a fundamental way. It now seems that there is a widespread belief that the government does have a legitimate role in guaranteeing access to health care, and physicians agree.

Another sign that physicians’ attitudes are changing: record membership in Physicians for a National Health Program.

I think the time has come. What do you think?

2 thoughts on “Growing Sentiment

  1. Thanks for posting this Ira. Hope it provokes a robust discussion. I tend to favor single payer as well, though I like to point out that there are a wide range of single payer models in use across the globe, each with their own strengths and weaknesses. The system in Canada, for example, is quite different from that in the UK, though both would qualify as single payer.

    1. Thanks for your comment. You are of course right to point out that “single payer” can come in lots of forms. I think the most interesting thing about the recent Congressional “debate” is the apparent acknowledgement that government has a critical role in assuring universal coverage. That may be the biggest hurdle on the way to a single payer.

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