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Sunday Forum: Doctors support the public option
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Three of four doctors support health-care reform with a public option. Eight of the 10 largest physician organizations support House Bill 3200, which includes a public option, or something like it.
A recent survey of physicians published in the New England Journal of Medicine indicated that 73 percent of physicians support either a public and private blend of health insurance or a simple government single-payer system. This is consistent with previous studies.
In a second survey of physicians published in the same issue of the Journal, 78 percent "agreed that physicians have a professional obligation to address societal health-policy issues. Majorities also agreed that every physician is professionally obligated to care for the uninsured or underinsured [73 percent], and most were willing to accept limits on reimbursement for expensive drugs and procedures for the sake of expanding access to basic health care [67 percent]."
I was one of the physicians at the White House on Oct. 6 for a "doctors for reform" event in the Rose Garden. My main job is to practice intensive-care medicine, but I was there to represent the Pennsylvania chapter of Doctors for America.
I have been working actively with Doctors for America since its inception, organizing physicians at the grass roots to speak out on health reform. One of the huge tasks we envisioned was to be the voice of progressive physicians and to advocate for health reform against a wave of opposition from the American Medical Association and some other physician organizations.
We knew that three of the largest doctors' groups, the American College of Physicians representing internal-medicine practitioners, as well as the American Academy of Family Practice and the American Academy of Pediatrics, favored a progressive overhaul of the system (including the possibility of adopting a German or French approach), but we were worried about the others.
I am happy to say that our fears were unfounded, as, one by one, most physicians' membership organizations, including the AMA, and most doctors individually have indicated their support.
Unfortunately, this unprecedented wave of physician advocacy for fundamental reform has not yet found its way into the public's consciousness. At Doctors for America, we often get e-mails from angry physicians and citizens who suggest we must not be "real doctors" or that we are out of touch with what physicians think.
A physicians-only Web site, Sermo.com, recently broke ties with the AMA over the association's conversion to reform. When progressives post on the site, we are routinely castigated and bullied by those who feel we are breaking with their perceived conservative orthodoxy. I have been called "a stain on the profession" and many other epithets for advocating the practical, moral and professional case for reform.
While this is disheartening, I am cheered by the willingness of most of my colleagues to step up this time and advocate for our patients (and those who can't afford to be our patients) rather than pursuing blinkered self interest.
The most recent addition of support for HB 3200 came from a unanimous vote by the board of the American Psychiatric Association, the ninth-largest physician membership organization in the country, as it joined the seven largest in support of health reform in general and HB 3200 in particular. Also advocating reform are the American Osteopathic Association, the American College of Surgeons and the American College of Obstetrics and Gynecology.
Only a quarter of physicians remain opposed to reform, and surveys of young physicians and women physicians show they are significantly more likely to identify themselves as liberal or progressive than their colleagues. As the older, more male cohort of physicians moves into retirement, the politics of physicians will shift even further.
Some of this shift represents an acknowledgement that as physicians, we have a higher duty than to simply advocate for ourselves and the patients in front of us. In 2004, the Charter on Medical Professionalism was published and subsequently adopted by more than 50 physician organizations. The starkest message in the document tells us to "promote justice in the health-care system, including the fair distribution of health-care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion or any other social category."
The opinion still held by many that we don't represent "real doctors" because we advocate for fundamental health-care reform and a strong public option is disappointing -- and just wrong. Even if we spot a 20-point margin of error to the surveys, the majority of physicians still want health reform!
So, while you may see anti-reform doctors on television in marked disproportion to their actual numbers, remember that your doctor probably wants universal access to health care and serious health reform to reduce costs and improve quality. The vast majority of us see it as part of our duty as physicians.
First Published November 8, 2009 12:00 am
