Are physician attitudes toward a universal healthcare system changing? The results of a survey recently released by the University of Indiana (UI) and published in the Annals of Internal Medicine seem to indicate that may be the case.
More than 2000 physicians responded to the UI survey, with 59 percent of the U.S. physicians saying they support legislation to establish national health insurance. That's up from a 2002 survey by UI which showed 49 percent favored such legislation. At the same time, the number of doctors opposing universal coverage has dropped from 40 percent to 32 percent.
"Discussing this with a number of dermatologists and other specialists, I've found that any doctor would really be the happiest with the system that pays the most. That's the bottom line," he says.
In practice for 20 years, Dr. Gottesfeld doesn't actually think universal healthcare will come to pass, but says physicians' willingness even to consider the idea shows an evolution in ideology.
"I'd be really amazed if national healthcare went through, given the politics of the whole thing. But it shows how things change with the times. Physicians were originally very anti-Medicare. Now, Medicare pays more than most of the other companies, so it's the most popular one," Dr. Gottesfeld tells Dermatology Times.
But just north of Dr. Gottesfeld, in the southwest corner of Georgia, Melina F. Greenfield, D.O., says not all doctors face that same dilemma.
"Where I am, in a little niche of Albany, Ga., we do not have any HMOs. We have all private insurance. When I worked in Ohio, Medicare was the best payer. Here, Medicare is kind of middle-of-the-road, if not lower. Seventy or 80 percent of Medicare might have been considered decent reimbursement when I was in Dayton, but not here in Georgia. So we are in an area that tends to pay more," she says.
Dr. Greenfield, a medical/surgical dermatologist and an associate clinical professor at the Georgia campus of the Philadelphia College of Osteopathic Medicine, says that besides concern that a single-payer system might not yield the same reimbursement, she has another practical concern. What would it cover?
"I don't know that I'm with that 59 percent majority. I would be afraid, as a dermatologist, that a government-run, single-payer system might consider a lot of our services as unnecessary. Acne is not a life-threatening disease. Might we have politicians sitting around a table asking why they should spend money on psoriasis?
"The state programs we have here for lower-income patients allow us to see acne patients, but they will only cover three or four acne drugs. We can see the patient, but they tie our hands behind our backs on what we can prescribe. My concern is that a government program would starting cutting out diagnostic codes the powers-that-be may deem unnecessary."
Dr. Greenfield also expresses concern that a single payer would take away her ability to negotiate when she felt she was not being reimbursed appropriately.