The providers’ perspective 

The idea of national insurance grows more popular with doctors.

In 1995, most doctors responding to the Arkansas Times first Best Doctors questionnaire said they disapproved of single-payer health plans, like those in Canada and Great Britain. In those countries, citizens pay into one system through taxes and all receive services from that system free. (They may also go to private doctors.)

Foes say it would lower the quality of American medical care and stifle advances. Specialists, because their pay would likely be reduced under the system, are among the opponents.

Only 19 percent of the doctors responding to the 1995 survey favored a single-payer approach. Eighty-one percent disapproved.

Things have changed in the past 18 years. Insurance premiums have skyrocketed. In 2005 it was estimated that there were around 47 million Americans (16 percent of the population) with no health insurance; the number has certainly grown. Results from the Times' 2008 survey suggest the single-payer system has gained more support in a medical community beset with paperwork.

Nearly a quarter of the 164 doctors who chose to answer the question “What sort of reforms, if any, would doctors support to widen access to affordable medical care in Arkansas?” indicated support for a single-payer system. One in three doctors would like to see either single-payer or a universal coverage, which would require government support.

Answers could be roughly sorted into six strategies: single payer or universal coverage, increased government funding of programs like ARKids and Medicaid, insurance company reform, tort reform, increasing the number of family practice doctors and preventive care, and state-mandated insurance coverage. Some answers did not fall into those categories.

A total of 54 doctors fell into the single payer/universal category; 39 of those doctors specified “single-payer,” “European” or “socialized medicine,” and the rest “universal coverage.” Another 11 doctors advocated expanding government programs such as Medicaid and ARKids by raising income eligibility limits.

One doctor wrote: “Single payer system, everyone eligible, no restrictions for pre-existing conditions. Insurance shouldn't be tied to employment. I worked in Australia for 5 years — the benefits of the single-payer system for patients and doctors were tremendous.”

Two doctors volunteered opposition to single-payer, one of them warning: “I know socialized medicine from ‘inside,' as patient and as provider. I will do anything I can to convince fellow citizens that ‘social medicine' is bad news, mostly for the patients.”

A total of 14 doctors said insurance companies need to lower their premiums for the working poor and small business owners. “End the profit-mongering of insurance companies,” one doctor wrote. “We need reforms in insurance companies overcharging government entities for procedures — such egregious practices as charging $5 for one Band-Aid!” another commented. Criticism of the price of drugs charged by pharmaceutical companies and calls for caps often accompanied demands for insurance reform.

Twelve doctors said the nation needs more primary care doctors, and most of those said primary care doctors need to be better compensated. One doctor explained: “Better distribute the doctors, make more primary care docs available to all Arkansans, decrease the number of specialists, and close UAMS if they keep emphasizing production of specialists over primary care doctors in a state so badly in need of generalists.” Another wrote: “What people without insurance who don't qualify for governmental programs, e.g. Medicaid, need is access to primary care. Any emergency room physician or nurse will tell you that their emergency room is overrun with individuals who don't need an emergency room or hospital.” And another: “Multiple studies show that primary care docs give equal or better results with lower costs and fewer interventions.”

Tort reform was proposed by 10 doctors. “The entire system needs to be reformed starting with the lawyers/medical malpractice expenses which contribute to higher costs of medical care,” one doctor wrote. “This is the single greatest, controllable health care cost and is TOTALLY unjustified and unjustifiable,” another said.

Ten doctors called for tax credits for individuals and businesses based on their premiums and to doctors for seeing uninsured patients. Another four called for tax increases — on liquor, cigarettes and “luxury items” or a small income tax — to pay for government programs.

Nine doctors cited the Massachusetts plan, which requires all residents of that state to buy health insurance, as a solution.

Several doctors took Congress to task for considering a 10 percent cut in Medicare reimbursements. (Congress rejected the proposal.)

Other suggestions: Three doctors called for a lottery, and three supported tax-free medical savings accounts. Two said something should be done about end-of-life care, one of them writing: “I like the 80-80-80 approach and it goes like this: If you are 80 years old or older, and have an 80 percent chance (or greater) of not living another 80 days, you are referred to hospice care unless you can afford continuing heroic measures on your own. This solution would change everything.”

One called for the removal of government “intervention, i.e., Medicaid and Medicare, etc. and have a more market-driven system.” One advocated stopping medical care to aliens “who bleed the system. Send them home.” Another took the Times to task for our wording of the question: “You guys always call this an ‘access' problem … that makes us look bad. The question is how do we make it affordable. Our office has never refused a patient and most haven't. Best solution: High deductible insurance that lets me charge cash prices underneath. Prices I determine per pt.” More transparency in hospital costs and continuing sample drug distribution were suggested. One doctor questioned whether some people who aren't insured could be if they weren't spending their income on “cell phones, TVs and automobiles.”

One doctor wrote simply: “Stop the war!”



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