Most US doctors now support a national health plan

[fourier jr]

No surprise to me, but in case there was still any doubt that the current for-profit situation in the US isn't working...

Reflecting a shift in thinking over the past five years among U.S. physicians, a new study shows a solid majority of doctors — 59 percent — now supports national health insurance.

Such plans typically involve a single, federally administered social insurance fund that that guarantees health care coverage for everyone, much like Medicare currently does for seniors. The plans typically eliminate or substantially reduce the role of private insurance companies in the health care financing system, but still allow patients to go the doctors of their choice.

A study published in today’s Annals of Internal Medicine, a leading medical journal, reports that a survey conducted last year of 2,193 physicians across the United States showed 59 percent of them “support government legislation to establish national health insurance,” while 32 percent oppose it and 9 percent are neutral.

The findings reflect a leap of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted. At that time, 49 percent of all physician respondents said they supported NHI and 40 percent opposed it.

*snip*

Support for NHI is particularly strong among psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent) and family physicians (60 percent). Fifty-five percent of general surgeons support NHI, roughly doubling their level of support since 2002.

http://www.pnhp.org/news/2008/march/most_doctors_support.php

 

[Poop-Loops]

I can imagine it must be tough to think "Great, we now know what's wrong with Mr. Smith. Just a matter of a relatively-safe operation... oh... no insurance... "

 

[Schrodinger's Dog]

Not a surprise, I've met American physicians on line who were deeply disillusioned with the current system. Which is why I don't spend a lot of time taking people who think it is a terrible idea seriously. Kind of heard all the arguments from the people in the know already. It makes more sense, private and nationalised health is better, it is both on paper and in the real world. Since the US is ranked 38th or if you want to manipulate the figures to favour your country then 17th, I'd say the 16 national/privatised systems above you say it all really.

It's really only a matter of convincing stubborn capitalists, that nationalised HS isn't really socialism honest. So that they'll swallow a medicine that is good for the system.

 

[turbo]

I managed the network of a very large (by Maine standards) ophthalmic practice, and I can attest to the strangle-hold that the insurance companies have on private medical practices. Each insurance company has its own fee schedules, and if a doctor wants to be able to accept patients covered by an insurance plan, they have to agree to accept whatever payment the insurance company allows for each procedure. In addition, each insurance company has their own coding requirements, and if the coding experts in the billing office don't adhere to those coding requirements exactly, the insurance company will either refuse to pay or will only pay a portion of the claim. Then the billing department has to figure out why the insurance company bounced the claim, re-code, and resubmit. The more claims the insurance companies can deny, reduce, or delay, the more money they have on hand to invest - and this comes at the expense of both doctors and patients.

A single-payer health care system would all but eliminate this friction by providing a single standard system for coding medical procedures. If the coding specialists in medical billing offices had only one set of standards to adhere to, their jobs would be greatly simplified, and doctors would be paid in a timely fashion instead of being stalled by the insurance companies.

One more advantage this would offer: Much of Maine borders Canada, and somehow Canadian lumber companies find it profitable to buy logs in Maine, truck them into Canada, saw them into lumber, and truck the lumber back to Maine for sale. One of the advantages that the Canadian companies have over our companies is that they don't have to pay for and administrate their own health-care plans for their employees. This is especially important for smaller companies that don't have a lot of clout in the insurance market.

 

[ShawnD]

One more advantage this would offer: Much of Maine borders Canada, and somehow Canadian lumber companies find it profitable to buy logs in Maine, truck them into Canada, saw them into lumber, and truck the lumber back to Maine for sale. One of the advantages that the Canadian companies have over our companies is that they don't have to pay for and administrate their own health-care plans for their employees. This is especially important for smaller companies that don't have a lot of clout in the insurance market.

Couldn't the US company just not pay health benefits? Since small companies don't have bargaining power with insurance, a lot of them don't offer insurance. I work for a small company in Canada and I don't get any benefits. A lot of Americans are in the same position as me, and they rely on insurance outside of their work.

 

[mgb_phys]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.

It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learned from history.

 

[lisab]

Couldn't the US company just not pay health benefits? Since small companies don't have bargaining power with insurance, a lot of them don't offer insurance. I work for a small company in Canada and I don't get any benefits. A lot of Americans are in the same position as me, and they rely on insurance outside of their work.

Not only is it expensive to buy individual insurance, but insurance companies can refuse to sell it to you if you have an "pre-existing condition." These are things like diabetes, heart disease, or a previous bout with cancer.

So, if you are trying to buy individual insurance and you're healthy, it'll simply cost you big bucks. But if you're already sick, good luck finding a company that will even sell it to you.

 

[ShawnD]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.

But why does the logging company care about your health care? Other companies like McDonalds or Walmart give literally no benefits unless you're a supervisor, so why would the expectation be any different for the logging company? Methinks there's more to this than just health care, like a stronger union on the Maine side or maybe lower taxes in whichever province turbo is talking about.

 

[Poop-Loops]

But why does the logging company care about your health care? Other companies like McDonalds or Walmart give literally no benefits unless you're a supervisor, so why would the expectation be any different for the logging company?

Because a logging company needs people who know how to drive trucks, forklifts, etc., people who have an actual skill and are harder to find. They want to keep these people.

If an angry McDonald's employee wants insurance, he can just be ignored until he quits or does something stupid and gets fired, and lo a new person will come to fill his shoes, because that is so-called "unskilled labor".

 

[ShawnD]

Because a logging company needs people who know how to drive trucks, forklifts, etc., people who have an actual skill and are harder to find. They want to keep these people.

True, but in turbo's previous posts he has stated that Maine has a pretty bad economy, and the median income was equivalent to something like 30k per year. When the economy is bad like that, people are willing to work for low wages and fewer benefits.

Of course that could be true on the other side of the border as well. Eastern Canada is sort of the welfare side of Canada, so they'll probably work for low wages as well.

 

[Poop-Loops]

True, but in turbo's previous posts he has stated that Maine has a pretty bad economy, and the median income was equivalent to something like 30k per year. When the economy is bad like that, people are willing to work for low wages and fewer benefits.

The economy isn't bad because people don't feel like working. It's bad because there is already a lack of good jobs. If you make pay-cuts, people won't buy as much crap any more. Meaning stores will lose money, meaning delivery (like trucking) and manufacturing will lose money since stores won't be able to afford it all, meaning there is now a lack of jobs.

Cutting health benefits means people are too afraid to do risky things with money, since if they get sick they NEED it for medicine or worse.

 

[turbo]

But why does the logging company care about your health care? Other companies like McDonalds or Walmart give literally no benefits unless you're a supervisor, so why would the expectation be any different for the logging company? Methinks there's more to this than just health care, like a stronger union on the Maine side or maybe lower taxes in whichever province turbo is talking about.

Apart from teachers, law-enforcement and relatively few manufacturing jobs, there is very little unionization in Maine. Unemployment is high, wages are depressed, and the collapse of the housing market makes it difficult for people to sell out and move to another area (if they are lucky enough to find another job). Another problem is that real-estate prices have historically been depressed in more remote towns. That was OK when it allowed a fellow to take a low-paying job and still hope to make the mortgage on a modest house, but it makes moving quite problematic, because the equity (even if the mortgage is fully paid-off) in such a house wouldn't amount to much more than a down payment on a house within driving distance of Bath or Portland, where there may be some jobs at the shipyard, dry-dock, or other heavy manufacturing facilities. Affordable universal health care for all would at least provide a bit of a safety net for people facing our bleak economic prospects. I'm glad my wife and I aren't starting over again, and that she has an employer (New Balance Athletic Shoe Co.) that values their skilled employees and provides them with affordable health insurance and contributes to their 401K plans, etc. If I hadn't been covered by her health insurance, some of the medical problems I've had would have been a real drain on our savings. As it is, some treatments recommended by my primary care physician and specialist have been denied by the insurance company.

 

[mheslep]

Not a surprise, I've met American physicians on line who were deeply disillusioned with the current system. Which is why I don't spend a lot of time taking people who think it is a terrible idea seriously. Kind of heard all the arguments from the people in the know already. ...

https://www.physicsforums.com/showpost.php?p=1660741&postcount=33"

 

[Schrodinger's Dog]

https://www.physicsforums.com/showpost.php?p=1660741&postcount=33"

Er, considering the OP is far from being anecdotal evidence, I'm hardly resting my case on it, am I? If I was trying to say that its bad just because a few physicians said so you might have a point (it just backs up my anecdotal evidence and shows the concerns are more endemic). But since I've given a half a dozen other reason on as many threads, I don't feel the need to cite all the other stuff as well.

In that case Drankin (no one was prepared to debunk The Economist either) so i was trying to say because he made it to the top that was evidence that anyone can or that it was somehow related to social mobility statistics. In that case yes anecdotal evidence is meaningless. In my case I'm not working on anecdotal evidence alone, there are some pretty convincing statistics and well as I said the OP as well.

 

[mheslep]

...One more advantage this would offer: Much of Maine borders Canada, and somehow Canadian lumber companies find it profitable to buy logs in Maine, truck them into Canada, saw them into lumber, and truck the lumber back to Maine for sale. One of the advantages that the Canadian companies have over our companies is that they don't have to pay for and administrate their own health-care plans for their employees. This is especially important for smaller companies that don't have a lot of clout in the insurance market.

The fix for that is to eliminate the employer based health deduction and thereby get employers out of the health care business.

 

[mheslep]

no one was prepared to debunk The Economist either

No one could read the subscription only link to read it.

 

[turbo]

My evidence may be dismissed as "anecdotal", too, but when you talk to doctors who are in private practice - especially specialists with convoluted coding requirements for procedures that are not commonly done, you'll find out what the biggest drag on their business is. Let's say a surgical laser craps out and it is a vital part of their business. They've got to go to the bank to get the big $$$$$ to get another one right away. They have their practice and their billed receivables as collateral, but they often have to demonstrate to the bank that their receivables are in good order. In other words, if the insurance companies are stalling, refusing payment, etc and billed receivables show ages of 60 and 90 days out, the bank will not consider them worthy of collateral. A practice that can keep its receivables aged primarily in the 30 days or less class stands a better chance of getting the loan at a reasonable interest rate. Insurance companies drive up the cost of health care for everybody and negatively effect the quality of care available.

Most doctors, especially those in small private practices would benefit from the establishment of a single-payer system. The drag and friction caused by the insurance companies makes it expensive for them to operate and requires them to over-staff to keep up with the work load.

 

[Schrodinger's Dog]

No one could read the subscription only link to read it.

That's not true actually, many people could, those that could just chose to dismiss it. I think you'll find one or two people can read subscription material in The Economist. And besides how is someone like me supposed to find an article that the proletariat can read? I tried, unfortunately most of the articles were by subscription only. Anyway someone kindly supported it with a source that was readable by all, my apologies for not having the sources at my finger tips, but that doesn't mean I was relying on anecdotal evidence alone. Any more than when someone here puts up a scientific paper only they and a few others can read are relying on anecdotal evidence alone.

Anyway the point still stands, and Turbo I don't think you have to support anecdotal evidence when the OP has 59% of Dr's agreeing with you it just adds. If it's on its own then it doesn't mean much on its own.

 

[mheslep]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable.

That depends. If you're chronically ill (diabetic) then yes and that needs to be fixed. Otherwise try an HSA. For example, quote from https://www.ehealthinsurance.com" for 30 yr old male no family:
Humana, PPO, $5000 deductible, 0% coinsurance, $43/mo
Unicare, PPO, $2000 deductible, 30% coinsurance, $64/mo
Kaiser, HMO, $2500 deductible, 20% coinsurance, $110/mo

For comparison, avg cost of food, low cost plan, is $201/mo in the US, 2007 per USDA.

It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learned from history.

Private clinics have been opening in Canada at the rate of about one per week since the Montreal Supreme Court decision that stopped the govt. from blocking private care.
http://www.apatheticvoter.com/Newsletter_Articles/CanadianHealthcareSystem.htm
http://opinionjournal.com/editorial/feature.html?id=110010266

 

[mheslep]

Apart from teachers, law-enforcement and relatively few manufacturing jobs, there is very little unionization in Maine. Unemployment is high, wages are depressed, and the collapse of the housing market makes it difficult for people to sell out and move to another area (if they are lucky enough to find another job). Another problem is that real-estate prices have historically been depressed in more remote towns. That was OK when it allowed a fellow to take a low-paying job and still hope to make the mortgage on a modest house, but it makes moving quite problematic, because the equity (even if the mortgage is fully paid-off) in such a house wouldn't amount to much more than a down payment on a house within driving distance of Bath or Portland, where there may be some jobs at the shipyard, dry-dock, or other heavy manufacturing facilities. Affordable universal health care for all would at least provide a bit of a safety net for people facing our bleak economic prospects. I'm glad my wife and I aren't starting over again, and that she has an employer (New Balance Athletic Shoe Co.) that values their skilled employees and provides them with affordable health insurance and contributes to their 401K plans, etc. If I hadn't been covered by her health insurance, some of the medical problems I've had would have been a real drain on our savings. As it is, some treatments recommended by my primary care physician and specialist have been denied by the insurance company.

The overhead due to the insurers you have described hear and elsewhere sounds bad. The question is how did it get that way.
Given Maine's history of the government trying to run the health system, I would think you'd be more cautious about having .gov run the entire thing. In '93 the Maine legislature got in the insurance business w/ its 'community rating' plan and went about telling the insurers what and how to do.

Health Care News,2004
http://www.heartland.org/Article.cfm?artId=15674

“Just over 10 years ago,” he said, “we had well over 90,000 Maine consumers in the individual market. Today there are fewer than 30,000. From a competitive market with more than 10 carriers, we now have a monopolistic market with only one, Anthem, writing new individual policies.”

“We know that Maine has the highest tax burden of all 50 states,” wrote State Senators Paul Davis (R-Sangerville) ... “But do you also know that Maine has some of the highest health insurance [premium] rates?

 

[ShawnD]

Private clinics have been opening in Canada at the rate of about one per week since the Montreal Supreme Court decision that stopped the govt. from blocking private care.
http://www.apatheticvoter.com/Newsletter_Articles/CanadianHealthcareSystem.htm
http://opinionjournal.com/editorial/feature.html?id=110010266

Private clinics are covered by UHC.

 

[Economist]

No surprise to me, but in case there was still any doubt that the current for-profit situation in the US isn't working...

Full scale doctor support is in no way proof that it's a good idea. In fact, I'm somewhat suspicious of what they say (no matter which side they're on in this debate) given the fact that they're so financially/professionally involved. To give a counter example, most economists think we already have to much government intervention and third party payments (read not enough profit and consumer payments). However, I don't think anyone should find that convincing just because 1 group of individuals within a discipline have a similar view.

 

[turbo]

Full scale doctor support is in no way proof that it's a good idea. In fact, I'm somewhat suspicious of what they say (no matter which side they're on in this debate) given the fact that they're so financially/professionally involved. To give a counter example, most economists think we already have to much government intervention and third party payments (read not enough profit and consumer payments). However, I don't think anyone should find that convincing just because 1 group of individuals within a discipline have a similar view.

It's a business decision that an economist should be able to appreciate. When you (as a private-practice physician) have to over-staff your medical practice to keep up with all the tricks and traps used by the medical insurance companies, and you have to pay more to borrow money from the bank because the insurance companies drive up the age of your receivables with their denials and delays, you've got trouble. Insurance companies drive up the cost of medical care and reduce the quality of medical care. Nobody knows this better than doctors and their staff. Despite the natural resistance to making such a sweeping change, doctors know that the financial performance of their practices will improve if a single-payer system is put in place.

 

[mheslep]

Private clinics are covered by UHC.

There's no blanket 'are covered' by the UHC. They can be, if your Ca. Medicare people send you to one.

 

[Moonbear]

In talking with physicians about this story, it seems it's not really as clear-cut as the survey and headlines would like people to think. It's not about simply having a national health care plan, but the form it takes and who is running it. A patient with an insurance plan that refuses to pay for care the doctor deems necessary or that gives the patient no choice to change doctors if they are uncomfortable with their current provider is no better off than one with no insurance at all.

 

[Schrodinger's Dog]

In talking with physicians about this story, it seems it's not really as clear-cut as the survey and headlines would like people to think. It's not about simply having a national health care plan, but the form it takes and who is running it. A patient with an insurance plan that refuses to pay for care the doctor deems necessary or that gives the patient no choice to change doctors if they are uncomfortable with their current provider is no better off than one with no insurance at all.

Well that's a bad system, in most countries you have the right to change doctors, for whatever reason you see fit, even practices, if you're not happy with a Dr then you can just go somewhere else. Problem solved, health insurance or not, you can go private, you can go to another HS provider.

 

[Moonbear]

Well that's a bad system, in most countries you have the right to change doctors, for whatever reason you see fit, even practices, if you're not happy with a Dr then you can just go somewhere else. Problem solved, health insurance or not, you can go private, you can go to another HS provider.

In the US, you can run the gamut from excellent health insurance with low co-pays (or no co-pays for preventative care) and the flexibility to go to any provider you like, to HMOs where you're locked into a provider network and can have long waits to see providers and might have costly co-pays, to medicare where you're stuck with whatever one physician is willing to take you on a plan that seems to go out of it's way to deny claims based on incomprehensible coding systems that turns into more charity on the part of the physician than an actual healthcare plan. Of those, medicare is the one that's currently government run, so not a lot of people with decent health insurance think switching to something like medicare is a good plan, including the physicians.

Basically, until someone proposing national health care spells out some details of how it will function, it's really hard to know whether it's going to be on the good end of the spectrum where patients will get the care they need and doctors will get paid for providing that care with minimal hassle, or if it'll be on the bad end of the spectrum where patients will get stuck with physicians they don't like or won't get the care they need while physicians fill out mounds of government paperwork just to be told the claims are denied because they forgot to check box 26b-a-2 on page 37 of the form.

You have to keep in mind that we're a nation of people who don't trust government, somewhat by design, so while there are good models of nationalized healthcare in the world, we tend not to trust our politicians very much to choose one of those or implement it correctly, especially when they have probably never experienced the hassles of bad insurance plans or not having the money to pay for something out of pocket if they wanted/needed it.

 

[Schrodinger's Dog]

Indeed I'm looking at it from the perspective of a NHS looking back. And of course the US is different. But I think on a state by state basis, ie try it out see if it works given each individual states needs, it might work? Slowly and progressively to see what works and what doesn't. Obviously centralised by the government is not going to work. I don't think anyone is going to trust that, your country is too large to have one single system work.

That said your system seems very confusing. If it was centralised on a state by state basis, I guess the only people who lose out are those companies that aren't nationalised, but of course no one is talking about making the system solely nationalised, that is not what works in practice. Combination of both, seems to be better than one or the other. Those who want to pay above and beyond get above and beyond, those who can't or won't pay are covered by taxes. Now that sounds horrible, but when you're paying twice what any other country in the world is by GDP or close to, you're already paying more in taxes than the cost of a private healthcare plan. You just don't feel it because it comes out of your stealth taxes.

 

[Moonbear]

Indeed I'm looking at it from the perspective of a NHS looking back. And of course the US is different. But I think on a state by state basis, ie try it out see if it works given each individual states needs, it might work? Slowly and progressively to see what works and what doesn't. Obviously centralised by the government is not going to work. I don't think anyone is going to trust that, your country is too large to have one single system work.

Yes, it might have more of a chance at a state level than a national level to begin implementation. Thinking about that, predominantly rural states would probably be good starting points. Afterall, you can't really make the choice of providers any worse than what's already offered (not that providers are necessarily bad, but that they are few and far between, so people don't have much choice regardless), the populations are poorer so can't really afford out-of-pocket expenses if they don't have insurance, etc. It would probably not take so well starting out in states with large urban populations...while the urban poor would benefit, the suburban rich would fight it tooth and nail.

 

[ShawnD]

There's no blanket 'are covered' by the UHC. They can be, if your Ca. Medicare people send you to one.

There isn't 1 clinic in my entire country that is unwilling to accept payment from UHC, because they would go out of business immediately. If one clinic asks for your health card and charges you nothing, and the one next door only accepts cash/credit and charges $130 per visit (that's what visiting Americans are charged), guess which one goes out of business the fastest. Non-UHC clinics in Canada are comparable to finding a Walmart that will only accept cash; no credit or debit. They simply do not exist.

Yes, it might have more of a chance at a state level than a national level to begin implementation.

Not only that, but having it vary from state to state allows people to vote for the system they want. 50 states with 50 different systems, at least somebody will be happy somewhere. 1 country with only 1 system is just asking for trouble.

 

[mgb_phys]

That does pose the problem of 'health tourism' unless you are going to insist on a minimum residency requirement in each state before you get benefits (which Canada does).

 

[mheslep]

That does pose the problem of 'health tourism' unless you are going to insist on a minimum residency requirement in each state before you get benefits (which Canada does).

That right there would prevent insurance reaching several million of the of the US 46million uninsured figure that is so often quoted. A large portion of that figure are illegal aliens and hence would not be covered under Canadian rules.

 

[mheslep]

so while there are good models of nationalized healthcare in the world,

Where do you have in mind?

 

[mheslep]

There isn't 1 clinic in my entire country that is unwilling to accept payment from UHC, because they would go out of business immediately. If one clinic asks for your health card and charges you nothing, and the one next door only accepts cash/credit and charges $130 per visit (that's what visiting Americans are charged), guess which one goes out of business the fastest. Non-UHC clinics in Canada are comparable to finding a Walmart that will only accept cash; no credit or debit. They simply do not exist.

Thats not the issue. Of course private clinics will take payment from anyone or any source. The issue is whether or not CHC agrees to pay the clinic for you, or not.

 

[devil-fire]

Frontline just did a show on the health care systems in other countries, http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Americans generally pay too much for too little of something many other countries consider to be a basic human right.