Category Archives: Health Care Debate

All items relevant to the debate over Health Care Reform in the U.S.

Three of Four Doctors Prefer Public Option

A new study by the Robert Wood Johnson Foundation, just published in the New England Journal of Medicine, shows that three of four physicians prefers Health Care reform that includes a public option. More than 62% of respondents opted for reform that includesa public option as an alternative, or in addition to, existing private health . Another 10%+ prefer a public-only, single-payer, system. Added together, this means that three of every four practicing physicians prefer a plan in line that proposed by President Obama.

Don’t just take my word for it. here is the text of the NEJM report:

Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion

Posted by NEJM • September 14th, 2009 • Printer-friendly

Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H.

In the past few months, a key point of contention in the health care reform debate has been whether a public health insurance option should be included in the final legislation. Although polls have shown that 52 to 69% of Americans support such an option,1 the views of physicians are unclear. Physicians are critical stakeholders in health care reform and have been influential in shaping health policy throughout the history of organized medicine in the United States.2

The voices of physicians in the current debate have emanated almost exclusively from national physicians’ groups and societies. Like any special-interest group, these organizations claim to represent their members (and often nonmembers as well). The result is a well-established understanding of the interests of physicians’ societies but little, if any, understanding of views among physicians in general. Faced with this absence of empirical data, we conducted a national survey of physicians to inform federal policymakers about physicians’ views of proposed expansions of health care coverage.

In April 2009, we obtained data on a random sample of 6000 physicians from the American Medical Association (AMA) Physician Masterfile, which includes current data on all U.S. physicians. We excluded physicians from U.S. territories because health care reform may not be as relevant to them, and we excluded physicians in training because of their limited experience with insurance; a sample of 5157 physicians remained. We categorized physicians into four groups: primary care physicians (in internal medicine, pediatrics, or family practice); medical subspecialists, neurologists, and psychiatrists; surgical specialists and subspecialists; and other specialties. The survey instrument we used was developed with the input of an expert panel, and we conducted cognitive testing and pilot testing to ensure its clarity and relevance. (More detailed information about our methods can be found in the Supplementary Appendix, available with the full text of this article at

NEJM Report Data

NEJM Report Data

Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support: public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans; private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan; or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare. We also assessed the level of physician support for a proposal that would enable adults between the ages of 55 and 64 years to buy into the current Medicare program — a strategy that the Senate Finance Committee has proposed.

Data were also collected on additional variables that might be associated with preferences for different expansion options, such as time spent on clinical duties each week, whether physicians owned their own practice, salary status, and type of practice. The survey has been in the field for approximately 2 months (June 25, 2009, to September 3, 2009). All available data were analyzed on September 4, 2009. A third survey wave was initiated on August 27, 2009.

The final sample included 5157 physicians, but 221 of them had an incorrect or incomplete address or were deceased. Of the remaining 4936 physicians, 2130 returned the survey — a response rate of 43.2%. Women made up a smaller proportion of respondents than of nonrespondents (26.8% vs. 31.2%, P<0.001), and the average age of respondents was 1 year older than that of nonrespondents. There were no significant differences associated with practice location (census division or urban vs. rural setting), practice type, or specialty group. There were no significant differences in the characteristics of respondents to different survey waves (for details, see the Supplementary Appendix).

Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%).

20090914_keyh_f1Physicians’ Support of Options for Expanding Insurance Coverage and Medicare.

Panel A shows the proportion of survey respondents who favored public options only, those who favored both public and private options, and those who favored private options only. Panel B shows the proportions of respondents (according to their medical specialty) who supported, opposed, or were undecided about the expansion of Medicare to include adults between the ages of 55 and 64 years. The proportion of support was consistent across all four specialty groups (P=0.08).


Overall, 58.3% of respondents supported an expansion of Medicare to Americans between the ages of 55 and 64 years (see Panel B of graph). This support was consistent across all four specialty groups, with proportions in favor ranging from 55.6% to 62.4% (P=0.08).

Physicians’ groups have strongly influenced efforts in health care reform throughout modern U.S. history2 and in so doing may have often obscured the collective views of individual physicians across the spectrum of specialties, interests, and regional affiliations. Given the enormity of the current effort to reform health care and its potential effect on future generations of Americans, policymakers need to hear the views of the whole range of physicians on the key elements of reform.

On one of the most critical elements — expansion of coverage — our study of a national sample of physicians showed that a clear majority support a combined public–private approach to expanding health insurance. We found that physicians’ support for including a public option in the reform package largely mirrors the support revealed in national public polls conducted throughout the spring and summer of this year.1 A similar proportion of physicians also supported the expansion of Medicare to help cover the near-elderly population. Support of public and private options was consistent across a wide range of physicians, including those from the traditionally conservative southern regions of the United States, those with a financial stake in their practice, and members of the AMA — despite that organization’s history of opposition to reform efforts.2 The AMA’s 2009 platform on health care reform originally endorsed an expansion of health insurance through private means.3 But the organization recently came out in support of a House proposal for reform that includes a new public option4 — a position that our data suggest is consistent with the views of its members.

Some limitations of our study deserve comment. First, our response rate was 43.2%, which is modest, though typical of the most recent national physician surveys and surveys in general. There were no significant differences between survey respondents and nonrespondents in important characteristics, such as specialty, practice location, and practice type. Second, physicians’ opinions about strategies for expanding health insurance coverage may have evolved during the period of data collection, given the intensive press coverage of the issues. However, we found no significant differences between respondents in the first and second waves of the survey. Finally, we did not ask physicians their views on other proposed solutions, such as insurance cooperatives.

Nonetheless, it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage. A majority of physicians also support the expansion of Medicare. Support for the public option is consistent across physician specialties, practice settings, and regions of the country, and therefore should be carefully considered by lawmakers as they finalize legislation to reform health care and provide coverage for 47 million uninsured Americans.

No potential conflict of interest relevant to this article was reported.

Source Information

From the James J. Peters Veterans Administration Medical Center, Bronx, NY (S.K.); and the Department of Health Policy (S.K.) and the Division of General Internal Medicine (S.K., A.F.), Mount Sinai School of Medicine, New York.

This article (10.1056/NEJMp0908239) was published on September 14, 2009, at

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Posted by on September 15, 2009 in Health Care Debate


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Howard Dean Sets Record Straight on Palin “death panels” Remark

Howard Dean speaking at DNC event
Image via Wikipedia

Commenting on former-Gov. Sarah Palin’s recent creation of the term “death panels,” Gov. Howard Dean, former Chairman of the DNC published the following on his blog carried at

Former Governor Sarah Palin made some preposterous claims over the weekend which attracted mainstream media attention. She made up the term “death panel” and claimed that part of the health care reform bill now working it’s way through Congress required that families with children with disabilities, or elderly people who are infirm, could be judged by one of these death panels, which could control their fate and decide if they would die. GOP leadership repeated this outrageous claim across the airwaves on the Sunday morning talk shows. The mainstream media gave this claim credibility simply by repeating it.

My wife and I have practiced medicine for over forty years combined. There is no truth now, nor has there ever been any truth to the idea that the government encourages euthanasia or infanticide.

Our country is in trouble. Claims like these are routinely refuted by people who know better, but they are recirculated because they are sensational, and the MSM purports to take a balanced position without a thoughtful assessment of the facts. Fox News actually has people on in support of these outrageously false claims.

In fact, these kinds of claims are lies. There is no nice way to say it. This kind of stuff is far beyond the usual politicians’ tricks of shading words and imputing meanings that aren’t there. To quote a famous American who began the process of ending the McCarthy era in the fifties I address the MSM: “At long last, Have you no sense of decency?”

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Posted by on August 25, 2009 in Health Care Debate


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Health Care Myths and Facts – part 1

Health Insurance Reform Reality Check

8 ways reform provides security and stability to those with or without coverage

  1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
  2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
  6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
  8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick
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Posted by on August 14, 2009 in Health Care Debate


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Sen. Grassley & Republicans Attack Hospice Care

In response to wild rumors of “death panels” and other distortions,  Republicans have forced a minor provision out of the proposed legislation to reform health care coverage in the U.S. That provision was designed to authorize payment for counseling services to help seriously ill and aged sort through questions that face them upon checking into a medical facility.

Sen. Charles Grassley

Sen. Charles Grassley

Anybody who has been hospitalized in the last four or five years has seen, among the pages of crap you have to sign, questions about “extraordinary medical procedures” and suggestions about a “living will.” These very terms can be confusing and scary for older folks (my mom is 98). If there is a knowledgeable family member on hand, whom the patient trusts, these are not a big problem. However, many of our seniors are alone when a medical emergency occurs. The nurses doing the admission don’t have the time, or the training, to go over all these issues and are cautioned against giving patients any advice.

The stricken provision was to authorize payment for counselors trained to explain these issues and to consult with the patient, and any available family members or significant others, on how to make and implement a decision.

Here is a direct quote from Sen. Grassley, appearing at a public gathering yesterday (August 11, 2009) in his home stae of Iowa:

There is some fear because in the House bill, there is counseling for end-of-life,” Grassley said. “And from that standpoint, you have every right to fear. You shouldn’t have counseling at the end of life. [emphasis added]

How does this impact hospice care, you ask? Well, a great deal of what hospice workers do is just this kind of counseling. They the terminally ill, and their loved ones, find a way to talk meaningfully and openly about difficult issues and arrive at a decision that everyone can accept.  Since this is a major component of their work, and the Repubs (led by Glen Beck, Rush Limbaugh and that guy shaking a finger in Sen. Arlen Specter‘s face) are martialed against it, one has to question how the hospice movement can effectively survive.

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Health Care Protesters

Town Hall meetings all over the country have devolved into shouting matches and mass demonstrations. This is a sad state of affairs in American politics. We are witnessing the intentional stifling of debate. The saddest part is, much of this activity is not a spontaneous expression of individual feelings but is being perpetrated as a strategic campaign coordinated and funded by lobbyists.


Senators and Congressmen are out on summer recess but finding their local district offices likewise besieged by shouting crowds, not always made of constituent voters. At best, this is interfering with the real exchange of ideas and opinions with our elected representatives. At worst, it will allow a very small minority to control an important legislative decision just by virtue of being loud and nasty. [Look at this guy shaking a finger in anger right in the face of Sen. Arlen Specter. His mama would not be proud!]

This is not the way America is supposed to work.

Another sinister effort at distorting the legislative debate came to light last week when it was discovered that a Conservative lobbying firm, Bonner Associates, had sent fake letters to members of Congress in opposition to legislation addressing energy and climate-change issues. Bonner was in the employ of coal industry interests, but forged the letters to make them appear to have originated from members and officials  of African-American and Latino-American groups. Fraud!

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Posted by on February 12, 2009 in Health Care Debate


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