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Physicians warm to single payer healthcare [PODCAST]

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The Hospital Finance Podcast

In this episode, Phil Miller, VP Communications at MerrittHawkins, discusses the results of a recent physician survey that gauged perceptions of single payer healthcare.
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Mike Passanante: Hi! This is Mike Passanante. And welcome back to the Hospital Finance Podcast. Today, I’m joined by Phil Miller who is Vice President of Communications at Merritt Hawkins. And he’s here to discuss the results of a new survey they’ve published which looks at physician perceptions towards a single-payer healthcare system.

Phil, welcome to the show.

Phil Miller: Thank you very much. Good to be here.

Mike: So Phil, can you briefly explained why this survey was initiated and who you surved?

Phil: Sure! Merritt Hawkins is a physician search and consulting firm. For about three decades, we’ve been serving doctors to find out their motivations, practice patterns, sort of how they live, what they think. That allows us to better recruit them on behalf of our clients.

And this is one of a variety of surveys we’ve done of physicians that we sent out in early August sort of in the midst of the health reform discussion. We just wanted to see what their thoughts were in terms of a single-payer system.

Mike: And why don’t you tell us about those survey results because I think they were pretty unique.

Phil: Sure! We offered a one-question survey. We wanted to keep it very simple in order to encourage response. Physicians are probably the most highly surveyed group out here—at least one of them. So, we let them know it was just one survey. And we asked what we thought was a neutral question which is: “What is your position on single-payer healthcare for the United States?”

We gave them five categorical responses: strongly support, 42% indicated that they strongly support the single-payer; somewhat support, 14% indicated somewhat support for single-payer; neither support nor oppose, 3% were in that category; somewhat opposed, 6% indicated they somewhat oppose single-payer; and strongly oppose, 35% indicated they strongly oppose.

So, essentially, the majority, 56%, are saying they either strongly support or somewhat support single-payer. And a fairly robust minority, 41%, are saying they either somewhat or strongly oppose it.

Mike: So, not quite an event split, but certainly skewing towards the side of supporting it.

Phil: Correct.

Mike: And these results contrast pretty sharply with a similar survey you conducted in 2008—almost 10 years ago, but things have clearly evolved. Why don’t you tell us about that?

Phil: We did ask a similar question in a larger survey of physicians that we conducted in 2008 on behalf of Physicians Foundation which is a not-for-profit organization composed of about 20 state medical societies and others. And they asked us to query physicians on a wide-range of topics. And we did ask a question about single-payer.

At that time, 58% were opposed to the concept; 42% were in favor. So, as you mentioned, almost an inversion of those findings over the last basically decade.

Mike:  And in the release of the survey results, you noted four reasons for this change in sentiment. Let’s talk through each of them.

Phil: Okay. The first is that physicians are seeking clarity and stability I think like the general public in terms of the direction where healthcare is headed. So they have been on a yo-yo like the rest of us.

Will the ACA go through? We needed a supreme court decision to sort of certify that? Will it be repealed? We’ve all been sort of going through that process as well.

And it just creates for the whole system a sense of uncertainty and instability for physicians. Who will my patients be? Who’s going to be insured? Who will not be insured? What will my payer mix be? What sort of organization will I be working for?

It’s hard to plan year over year and take stock of your career when the ground rules are shifting or may shift.

So, I think a number of physicians just want to resolve this whole issue and have it done with one way or another and just bring some clarity and stability to the future.

The second, I would say, trend causing this shift would be simply a generational matter. Younger doctors, younger people in general seem to be more open to change. We have surveyed physicians on behalf of the Physicians Foundation on things like the ACA, electronic health records, accountable care organizations. Younger doctors all seem to embrace these things, these sort of agents of change, at a higher rate than older doctors.

So, as the younger doctors come up, their practice characteristics tend to be different. They are more likely to be employed by a hospital or some other entity than older doctors. And for them, the issues of payment, because they’re on a salary, where the reimbursements are coming and so forth, are a little more certain because they are employees.

So, for them, I think single-payer seems to make more sense than it may for older doctors who tend to be more opposed to it.

The third factor that we pointed to you would be the feeling among doctors of resignation rather than enthusiasm. I think many physicians, 14% said they somewhat support it. And I think we’re probably talking about that group. They simply see the writing on the wall. We have 133 million patients out there covered by some government payer Medicare/Medicaid, CHIP, et cetera, the VA. That’s a pretty substantial number.

So, it just seems like we’re moving in that direction, the writings on the wall. “Let’s get it over with. I’m not crazy about it, but it’s going to happen. Let’s just do it.”

And the fourth would be a general philosophical evolution among doctors and I think among the general public that, as a society, we should try to cover as many people as we can. And I think that is still an emerging concept, but one that the ACA with all of its various shortcomings, I think was an important landmark because it did establish this notion that we do have to cover more people. We can’t have 45 or 50 million people uninsured, at risk. And we should do better.

So, people look at single-payer and whatever its drawbacks might be. They can say, “Well, at least we’re going to cover everybody.”

So, between those four things, I think you have seen a shift among physicians who, in the past, you could safely say they were not for single-payer. But now, I think more of them are embracing the concept—maybe not with enthusiasm but they are turning towards it.

Mike: And as we talked about just a few minutes ago, while there is a skew in the survey towards a single-payer or at least maybe resignation towards the idea that there may be a single-payer in the future, there still is a sharp divide on that issue as the survey showed.

So, how do you think that will change moving forward?

Phil: As we showed, 35%, over a third, are strongly opposed. And I think you’re going to have a third of the people at least probably strongly opposed indefinitely. And I think what it will come down to is whether we have continued confusion and dysfunction in the healthcare system.

If we ping-pong back and forth between what systems we’re going to have, how we’re going to, in particular, reimburse providers, physicians, hospitals and others, if we just can’t seem to get our act together, then I think you’re going to see more acceptance, whether it’s enthusiastic or again resigned for single-payer just because the clarity and the finality of it, we’re used to it with Medicare and Medicaide. So let’s just do it.

I don’t think it’s going to be enthusiastically embraced by all doctors. There’s going to be a significant number that don’t like it. And they may choose to do something else—retire if they’re an older doctor. But if we can’t come up with something better, I think more and more doctors will turn to single-payer as the answer.

Mike:  Well, this was certainly an interesting survey and interesting contribution to the overall discussion. And it clearly showed some changes in perception. So, we appreciate you doing that and appreciate you coming on the show to share it with us today, Phil.

Phil: It’s a pleasure! Any time!

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