majority of doctors support single payer

During the dog days of summer, the Trump Administration has continued its attempts to dismantle the ACA, bit by bit. But in the process, they are inadvertently reinforcing  the foundations for more comprehensive reform supported not only by a majority of patients, but also now by a majority of their physicians.

Consider last year’s Kaiser Family Foundation’s analysis of the August, 2017 Merritt Hawkins survey of 1,033 US physicians which showed for the first time a plurality of US physicians favored movement to a Single Payer system. Compared to 2008, when 58% of physicians opposed such a shift, 56% now support it (42% “strongly”, 14% “somewhat”).

Merritt Hawkins attributed the shift to four factors:

1. Physicians are seeking “clarity and stability”. They believe “single payer” will reduce “distractions.”
2. There is a generational shift underway. “Younger doctors are more accepting.”
3. Physicians have become resigned that “we are drifting toward a single payer system” – so let’s get on with it.
4. There is a philosophical change occurring that increasingly embraces the societal value of universal coverage.

The Kaiser release also referenced a June 2016 American Public Health Association published proposal drafted by the Physicians for a National Health Program with now nearly 22,000 physician and medical student members. That proposal echoed some of the five Code Blue points – universality, single administration, local delivery, health planning, and inclusive transparency.

Specifically it also unveiled weaknesses in the incremental approach under the ACA including:

1. Not Universal: A CBO report predicting 27 million remaining uncovered by 2026.
2. Reporting Requirements: “Mind numbing” and time consuming requirements for documentation and reporting.
3. Administrative complexity”: Robs time with patients.
4. Limited comprehensiveness: A trend toward “skinny plans” which are little better than no coverage at all. Plus they push narrow physician and hospital panels.
5. Underinsurance: A tripling of deductibles and “punishingly high copayments” paid by consumer.
6. Failure to Control Costs: A decade of Republican attacks on ACA “has elicited ubiquitous gaming of risk adjustment and quality measure” incentives, spawning giant moves toward hospital and insurer consolidation.
7. Market-Based: “Any method of payment can create perverse incentives in a market-based system.”
   

You can’t cure crony capitalism with more capitalism – even if it comes from Bezos and Buffett.