Blog | Tuesday, September 5, 2017

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 U.S. 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 Affordable Care Act 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?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.