Andy Slavitt stated there are few issues that weigh on the minds of Americans as much as making sure they and their families can get health care. And there are few areas where our politics serve us so poorly.
Talk to a mom of a chronically ill child or a young man working in a fast food job without benefits, or a dad who lost his job and his insurance. Talking to Americans about their health care is often a conversation marked by vulnerability, fear, and the fragility of middle-class life.
I traveled across the country last year to listen to Americans discuss their concerns about health care and the politics in Washington, and I became struck by how much we all have in common. Whether they are Democrats, Republicans, independents or none of the above, no Americans want to live in fear that a job change, a prior illness, the cost of their medication, the generosity of their insurance company or who wins next election will determine whether they have their access to affordable health care.
For the last eight years, we’ve been locked in a battle over the Affordable Care Act that seems like it won’t end. In 2009, the Democrats passed what they believed would be seen as a set of middle-of-the-road reforms, adding protection for those with pre-existing conditions and sliding scale premiums to help lower-income people buy private insurance. But it passed on a party-line vote and quickly became an outsized political lightning rod.
Today there is little will to address any weaknesses in the law, only to maneuver for enough votes to tear it down or preserve it. Meanwhile, more than 28 million Americans still lack insurance coverage, and many who have it can’t afford their deductibles.
If there is good news, it is that political tides change and every decade, we try again to achieve that goal of creating a more equitable, affordable health care system. And when the next debate begins, we should start with fresh thinking that can unite us in a common goal of putting the health of our nation over politics.
To that end, I will be chairing a new, and a new type, of organization launching Tuesday called United States of Care. It’s founded on the premise that no American should have to go without the care they need. Not defined by any single policy proposal, United States of Care is based on three core principles.
We believe all Americans should have access to a regular source of care for themselves and their families; no one should face financial devastation due to illness or injury, and we need to achieve these goals through policies that are fiscally responsible and have the political support to last.
These are principles that Americans believe in.
I’m proud to be joined in this new organization by nearly 60 prominent Americans — patient and disability advocates, clinicians, healthcare leaders, former elected officials from both parties, business leaders, and inventors. People like Elena Hung, the inspiring mom who brought her daughter Xiomara to Capitol Hill over last year and founded Little Lobbyists to educate policymakers about the needs of medically fragile children; Dr. Bill Frist, the heart and lung transplant surgeon and former Senate majority leader from Tennessee; and Dr. Atul Gawande, a public health expert and one of the principal chroniclers of our progress and problems in health care.
A new survey commissioned by United States of Care suggests Americans are ready for the work we’re undertaking. It finds that large majorities of engaged citizens in both parties (people who, among other things, follow the news and vote regularly) want every American to have access to affordable care. But translating this into political change will mean not only making the voice of the public heard, but taking on difficult issues like the cost of care; how we encourage healthy lifestyles; and the role of mental health, addiction, and poverty.
Some are skeptical that we will ever get past the current political stalemate. This will not happen overnight. Our first step is a national listening tour to hear from families and local experts and turn what we learn into real policy changes, beginning at the state level..
America is a global leader in so many aspects of healthcare, yet millions of Americans still can’t afford to fill prescriptions or get the care they need. Not surprisingly, our national health outcomes are declining.
We can’t sit back and bemoan the politics. If we expect our children and grandchildren to have a future where they can live up to their potential, change jobs without fear, benefit from the cures which are coming, and not bankrupt themselves or our nation, we must come get together now and put our health ahead of our politics.
Survey says: More doctors now favor single-payer health care!
Fifty-six percent of the 1,033 physicians who responded to Aug. 3, 2016, Merritt Hawkins survey said they either strongly supported or somewhat supported a single-payer system. Jenny Dean, in the Houston Chronicle, wrote that a majority of doctors questioned nationwide now support a single-payer health care system — an almost exact reversal of their stance nine years ago.
Fifty-six percent of the 1,033 physicians who responded to the Aug. 3 Merritt Hawkins survey said they either strongly supported or somewhat supported a single-payer system.
That compares with 58 percent of physicians who, in 2008, said they opposed such a system. Back then, only 42 percent supported the concept.
The survey findings were released Monday.
The stark turnaround took many back on Monday as doctors have often been among the most outspoken critics of single-payer health care, in which the government, rather than private insurers, covers health care costs.
“I expected it would go the other way. We’ve always heard the opposite,” said Phillip Miller, vice president of communications for Merritt Hawkins, one of the nation’s leading physician search firms that often surveys doctors on their practices and opinions about the healthcare climate.
The one-question survey asked, “What is your position on single-payer health care?” It was emailed to 70,000 nationwide across all specialties. Miller said the survey was purposely held to one question to measure gut reaction and did not delve into how such a system would work or be paid for.
He added that the return sampling of more than 1,000 doctors is considered a good statistical cross-section of opinion.
In the latest survey, 35 percent of respondents said they strongly opposed a single-payer system, while 6 percent said they somewhat opposed it. The margin of error was 3.1 percent. Three percent of physicians said they did not support or oppose the system.
The new Merritt Hawkins findings are not dissimilar to a LinkedIn study earlier this year that found 48 percent of the 500 doctors surveyed said they would support a single-payer system if it provided health insurance to everyone.
Still, the shift surprised Vivian Ho, a health economist at Rice University’s Baker Institute for Public Policy. She wondered on Monday if it was a more a practical matter rather than a philosophical one.
Doctors she has spoken to often talk of the administrative burdens, both from federal program changes and narrowing private insurance markets, which have taken a toll. Ho suspected many doctors, especially those in small practices, may now be turning toward what they hope would be an easier system to navigate.
The survey did not ask for reasons behind the replies, but Miller also suspects a growing weariness among doctors with the current uncertainty coming out of Washington, D.C., about possibly repealing and replacing the Affordable Care Act, known as Obamacare.
“Physicians are seeking some sort of clarity and support in which way the health system is going,” Miller said. “Doctors, like everyone else, have been living on a yo-yo.”
Dr. Deane Waldman, a retired cardiologist, and director for the Center for Health Care Policy at the Texas Public Policy Foundation said Monday that he, too, thinks the nation’s doctors may be changing previous positions out of desperation.
While cautioning against a single-payer system, which he believes would add even more regulation and bureaucracy, he said he understands why doctors may be changing their tune.
“They are just looking for relief,” Waldman said.
The Harris County Medical Society said in an email that while it “supports the idea that the problems of our current system can and should be fixed,” it does not believe a single-payer system would “address or change the forces that have resulted in skyrocketing health care costs in our society.”
There is little doubt that opinions remain in flux, both within the medical community and among the public.
A tracking poll for the Kaiser Family Foundation in June found a slim majority of people, 53 percent, were in favor of a single-payer health plan, up slightly from 2016 and substantially higher than the 46 percent who favored such a system in the years directly leading up to the passage of Obamacare.
Upheaval surrounding the nation’s health care shows little sign of calming. Late last week, the Trump administration announced the deadline for insurers to submit rate increase requests had been extended by three weeks, until Sept. 5. Previously it had been Wednesday.
Insurance companies have complained that it is exceedingly difficult this year to set rates and calculate risk with so many unknowns, including the on-again-off-again threat to withhold payments to insurers to help pay the out-of-pocket costs for low-income customers.
At the same time, congressional Republicans may not be done with trying to resurrect plans to repeal and replace Obamacare. The House narrowly passed its version of a replacement plan in May, but the Senate failed to pass a version late last month.
“The uncertainty has had a huge effect on physicians,” Waldman said. “It scares doctors, but it absolutely terrifies patients.”
So, what has changed? In its 2008 survey, opinions ran the opposite way — 58% opposed single-payer. What’s changed?
Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firm’s vice president of communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.
“Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create fewer distractions, taking care of patients — not reimbursement,” Miller said.
In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work.
A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over.
Last year was the first in which fewer than half of practicing physicians owned their practice — 47.1% — according to the American Medical Association’s surveys in 2012, 2014 and 2016.
Many doctors are today employed by hospitals or health care institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said.
There’s also a growing sense of inevitability, Miller said, as more doctors assume single-payer is on the horizon.
“I would say there is a sense of frustration, a sense of maybe resignation that we’re moving in that direction, let’s go there and get it over with,” he said.
Merritt Hawkins emailed its survey August 3 and received responses from 1,003 doctors.
The margin of sampling error is plus or minus 3.1 percentage points.
The Affordable Care Act established the principle that everyone deserves health coverage, said Shawn Martin, senior vice president for advocacy at the American Academy of Family Physicians.
Inside the medical profession, the conversation has changed to how best to provide universal coverage, he said.
“That’s the debate we’re moving into, that’s why you’re seeing a renewed interest in single-payer,” Martin said.
Dr. Steven Schroeder, who chaired a national commission in 2013 that studied how physicians are paid, said the attitude of medical students is also shifting.
Schroeder has taught medicine at the University of California-San Francisco Medical Center since 1971 and has noticed students’ increasing support for a single-payer system, an attitude they likely carry into their professional careers.
“Most of the medical students here don’t understand why the rest of the country doesn’t support it,” said Schroeder.
The Merritt Hawkins’ findings follow two similar surveys this year.
In February, a LinkedIn survey of 500 doctors found that 48% supported a “Medicare for all” type of system, and 32 percent opposed the idea.
The second, released by the Chicago Medical Society in June, reported that 56 percent of doctors in that area picked single-payer as the “best care to the greatest number of people.” More than 1,000 doctors were surveyed.
Since June 2016, more than 2,500 doctors have endorsed a proposal published in the American Journal of Public Health calling for a single-payer to replace the Affordable Care Act. The Physicians for a National Health Program (PNHP), which says it represents 21,600 doctors, medical students and health professionals who support single-payer, drafted the plan.
I will continue this discussion in the next few weeks. What do patients want for a better health care system?
Lastly, Happy President’s Day. Also, I try to stay away from politics, but as a former competitive skier and hockey player I am so tired of a number of our American athletes making this a time for political points in not wanting to shake the Vice President’s hand or promising not to go to the White House as a winning Olympic athletes. Get real people, you are all athletes supposedly representing our country. If you don’t want to represent our country, join the Russian athletes who were banned because of drug doping, etc.