Friday, October 2, 2009

Where Doctors Stand on Health Reform

Yesterday a reader of my blog wrote to ask how many physicians supported Obamacare. He had read the White House claimed 500,000 of America’s 900,000 licensed physicians stood behind President Obama. What did I think?

I don’t know the exact number. Neither does the Obama administration. As the old adage goes, where you stand depends on whether you sit – whether you are young or old, salaried or in private practice, Democrat, Republican, or Independent, primary care physician or specialist, threatened or non-threatened, ideologue or realist.

It also depends on what comes out of the Senate Finance Committee and other Congressional committees.

What we know so far from the Senate Finance Committee proposal is this:

• Paying doctors and hospitals for high-quality care, rather than for volume of care, will be central to slowing the growth of health costs.

• Paying specialist less who order the most tests and treatment is one approach, and this is not popular among many doctors.

• The bill would give bonus Medicare payments to primary care doctors, and cut payments to medical specialists. Primary care doctors often have less training than specialists and tend to make far less money. Some experts warn of a shortage of primary care docs as young physicians choose higher-paid specialties.

• Another provision would make it more difficult for doctors to own a share in hospitals — not surprising given long-running opposition from Max Baucus and Chuck Grassley, the committee’s chairman and ranking Republican.

• The Finance bill wouldn’t block scheduled cuts to Medicare payments to physicians. The House health-care bill does block those cuts, which was key to winning support from the AMA and other doctors’ groups. The AMA hasn’t taken a position on the Senate Finance bill.

You could estimate the numbers who favor or resist Obamacare by the numbers who prefer both public and private options (the status quo), the private option only (the marketplace), or the public option only (single payer).
Here ‘s how those numbers break out .
Public and Private Option Private Only Public Only
All physicians 62.9% 27.3% 9.6%
Primary care 65.2% 23.9% 10.8%
Subspecialists 64.7% 25.0% 10.1%
Surgeons 59.4% 33.2% 7.3%
Other specialists 57.4% 33.7% 8.8%

NEJM,”Doctors on Coverage, Physicians’ Views on a New Publicn Insurance Option and Medicare Expansion, September 14, 2009."No one knows what lurks in the minds of physicians.” Doctors will wait to see what lurks in the final bill Congress produces.

Doctor Reece is noted author, blogger, speaker, and health reform expert. His latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For more information on speaking fees and arrangements, call 860-395-1501


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