Docs Like The Public Option

16 Sep

Disclaimer: Life is busy these days, so you may have noticed I’m blogging a bit less. Don’t worry. I’m still here. However, I have this whole “dissertation proposal defense” thing to do on October 2nd, and a health reform talk to deliver this Friday, so I’m a bit swamped. In the interim, my posts will be a little less frequent, and probably a bit shorter. Hopefully, that means that they’ll be more relevant and easier to read, and it will be easier for you to keep up-to-date.

So, the Robert Wood Johnson Foundation conducted a poll and found that physicians overwhelmingly support a public option approach to health reform. That is, they want to see a mixed public-private approach, rather than government simply providing subsidies to low-income individuals to purchase private insurance, or–and they really didn’t like this–a government only option (i.e., single-payer). Ezra Klein, not surprisingly, beat me to the punch in writing on this. In fact, I stole his graphic, which looks like he stole it from the New England Journal of Medicine, but I don’t know that for sure.

But the real question in this for me is: Why would doctors support the mix, rather than a public or private only approach? My first thought is one of inertia. The status quo includes a mixture of public and private insurance, and many doctors might simply be resistant to change.

What about those who support either a public only or private only option? In this case, docs favor the private sector over the public sector nearly 3 to 1. I certainly wouldn’t conclude from this that U.S. physicians are hungry for a single-payer system.

That brings us back to the “mixed” options. If it’s not just status quo deference, and it’s clear that physicians tend to have a preference for private insurance over public insurance, why else might they want the middle option with “some” public option? That is, why support any public option at all? My personal feeling, and I stress that this is not based on empirical evidence, is that I think it helps take the heat off providers.

If there were no public plans in place for America’s less fortunate and senior citizens, it would change the face of health care in this country. Private insurance would look vastly different, and doctors practices and incomes would also look quite different–and not in a way that they might like. Instead, Medicaid and Medicare are almost like private insurance carve outs. The government steps in and says, you won’t cover these people, so we’ll do it. If docs were required to accept Medicaid and/or Medicare patients, they might feel less inclined to support any public option at all. Instead, those who want to treat such patients are able to do so, and those who don’t want to treat them are free not to.

If suddenly everything were public only, this freedom might be threatened. I suspect that the 10% in favor of such an option, is the same 10% already providing the bulk of care to the Medicaid population.

If suddenly everything were private only, there would be mounting pressure for reform, because of the problems noted above. Reform is inherently risky–going back to status quo deference–so it is preferable to keep the public options in place, where they can be used to bleed pressure from the system as needed to avoid major reform. It certainly seems to have worked so far.

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Posted by on September 16, 2009 in Uncategorized


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