Most U.S. doctors now support the idea of national health insurance, a shift from a half-decade ago, when less than half favored a national system, a new survey has found. According to a study published in the Mar. 31 issue of the Annals of Internal Medicine, 59% of the nation's physicians support federal legislation to establish national health insurance, often referred to as a single-payer system. These plans usually involve a single, federally administered fund that guarantees health-care coverage for everyone, much like Medicare currently does for seniors, and eliminates or substantially lessens the role of private insurers. In a similar survey five years ago, only 49% favored it. Thirty-two percent of doctors oppose universal coverage, down eight points from the previous survey, while 9% are neutral.

As the 2008 election draws near, the country's health-care system is once again top of mind for voters. The leading candidates have drawn up plans for addressing what they consider flaws in a system that has left 47 million people uninsured—although none is calling for a single-payer system (BusinessWeek.com, 9/17/07). Senator Hillary Clinton (D-N.Y.) proposes a mandate requiring everyone to purchase health insurance, with subsidies and affordable federal insurance available, while Senator Barack Obama (D-Ill.) stops short of mandates but does support affordable federal insurance. Obama leads Clinton in winning delegates who have pledged to back his bid for the Democratic nomination. The presumptive Republican nominee, Arizona Senator John McCain, backs tax credits for the purchase of health insurance, similar to what the American Medical Assn. (AMA) proposes.

The findings signal a sea change in the attitude of the medical establishment toward universal care. Throughout the 20th century, U.S. doctors have been among the fiercest and most influential opponents of national insurance, citing concerns of a meddlesome bureaucracy, a loss of independence, and lower reimbursements. Lobbying by the AMA and other professional groups scuttled efforts to introduce universal coverage by several Presidents, starting with Calvin Coolidge and continuing through Franklin Roosevelt, Harry Truman, Jimmy Carter, and Bill Clinton. Back in 1948, after Truman was elected in part on a platform of compulsory health insurance, the AMA urged its members to "resist the enslavement of the medical profession." That attitude held constant for decades.

Current System Hampers Good Care

But with so many Americans uninsured, doctors are finding that the lack of universal coverage is making it more and more difficult for them to do their jobs. "Across the board, physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy," says Dr. Ronald Ackerman, associate director for the Center for Health Policy-Professionalism Research at Indiana University School of Medicine and a co-author of the study.

Ackerman and his team surveyed 2,193 doctors across the country in 2007 as part of the largest survey yet of physicians on the issue of health-care financing. The researchers found that support for national health insurance exceeded 50% for every medical specialty, except surgical subspecialties, anesthesiologists, and radiologists. Even in those groups, support levels increased from 2002. The researchers also asked doctors if they would support incremental reform, such as tax incentives to buy insurance, or state mandates that all employers offer insurance coverage. They reported that 55% would support incremental reform failing a national solution, but only 14% favored incremental reform instead of national health insurance.

Professional medical associations are also beginning to change their stance on national health insurance. In December, the American College of Physicians, with 124,000 members, endorsed a single-payer national insurance program for the first time. The AMA, with 250,000 members, has not gone that far, instead calling for tax credits and financial assistance so that individuals can purchase health insurance. The group does say, however, that coverage for the uninsured is one of its top priorities. And now, the new survey suggests AMA constituents view national health care as a way to address the insurance shortfall.

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