A survey of Massachusetts physicians indicates they overwhelmingly favor a single-payer healthcare system, but only a slim majority says they believe their physician colleagues would support such a system.
When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians surveyed chose a single-payer system, compared with 25.8% who selected fee-for-service and 10.7% who picked managed care.
Despite the strong showing for a single-payer system, only 51.9% of those surveyed said they thought their peers would support it, a remarkable finding according to Stephanie Woolhandler, M.D., one of four physicians affiliated with Harvard Medical School and Massachusetts General Hospital in Cambridge who co-authored the study.
"It's a huge thing," Woolhandler says. "It's like a coin flip, that only half the people know the majority support it."
Their work was based on a mailed survey to a random sample of 1,787 physicians in the state, of whom 904 responded. Results were published Monday in the Archives of Internal Medicine.
Woolhandler and fellow internists Danny McCormick, M.D., David Bor, M.D., and David Himmelstein, M.D., embarked on the survey because the views of rank-and-file physicians about a single-payer system have not been well studied, Woolhandler says.
In a December 2000 referendum, Massachusetts voters narrowly defeated a plan to create a statewide universal healthcare coverage system, Woolhandler says. The state also has one of the highest levels of penetration of managed care plans in the nation, so there was widespread knowledge of both single-payer and managed care systems among physicians, she says.
On the split between physician support and physician knowledge of that support, Woolhandler says that organized medicine, particularly the American Medical Association, is partly to blame. The AMA has been outspokenly opposed to a single-payer system, although the AMA has encouraged open debate, she notes. The Archives of Internal Medicine, the journal of an AMA-affiliated society, published their study, "which is to their credit," she says.
Further, she says, "I think the press coverage of national health insurance is pretty scanty, so I think there is a bit of a disconnect between the way the press has reported on the position of organized medicine and the way the people down in the trenches feel and see the issue."
In addition, most respondents said they would give up some of their income in exchange for less paperwork and said they believe it is the government's responsibility to ensure healthcare is provided to citizens.
"Doctors really hate paperwork," she says. "If they're at their office, they want to be seeing patients and not pushing papers around, and they see the huge expense of paperwork. They're spending a huge part of their income on administration, and they'd like to save that money."
The study was funded by the Department of Medicine at Massachusetts General Hospital and by donations from some local physicians, Woolhandler said.
All four survey co-authors are members of Physicians for a National Health Program, a pro-single payer organization, Woolhandler said.