When I posed that question this morning, I intended primarily to call out the cable nets and others for letting the public debate veer so far off point that doctors had become irrelevant to it. But in reader responses to the post, I detected a thread of suspicion and wariness about the health care reform plan even among docs with progressive sensibilities. I don’t think that fully explains the absence from the public forum that I was noting, but it would surprise me if it doesn’t play a part.
Here’s a sampling of the responses from physician readers:
TPM Reader EW:
Great question! I can tell you in a very anecdotal way about my own experience and the experience of my colleagues. It is in no way scientific, but is more of a survey. I too have noticed a distinct lack of interest in the health care debate. I will not speak for my colleagues, but instead try to explain my own indifference.
1) I have no idea what they are talking about. As with the effort in ‘93, it has started off in a wonky, complex, and unintelligible mass of incomprehensible double speak. And that is before the Republicans have even further muddied the waters.
2) I don’t really believe it is going to happen.
3) Most of us believe that the healthcare system is horribly broken and on the way to ruin, but that the only real and effective way to fix the system is with a single-payer or similar model.
4) This follows closely from #3, but if you ask most doctors to give you an honest assessment of the biggest problem with healthcare these days, most would not mention the uninsured (or at least not directly). Most of us would say that the single biggest issue is incentives. …
So you see, we are not being quiet because we are lazy or otherwise not interested. We are just dubious that this thing is going to happen and even more so that it will happen effectively. …
TPM Reader CF:
[D]ocs (although by no means only docs) will bear much of the costs. I suspect the final bill will increase the number of citizens with health insurance which is a good thing in many ways. This will initially be paid for by the self employed, small businesses and high income earners. This describes most primary care docs.
Since even with a public option costs will soon climb to the point that serious political pressure will force direct cost controls such as decreased fees for service rendered - no protective assurances have been given physicians like they have been to Big Pharma.
A public option will not decrease the difficulties in dealing with multiple payers that plague the delivery of primary care. It only adds one more.
In summary, the current reforms will provide better access to medical care but won’t decrease my practice management headaches and will decrease my income. Consider this a lukewarm endorsement.
TPM Reader RS:
I’m not sure how much invaluable instruction my front line experience with the impediments to delivering quality health care offers, but here are some thoughts:
The current debate is just downright silly, and I am not surprised if there are few doctors who would want to respond to arguments against health care reform that are based so little on intelligent thought.
I agree that specialists tend to be more conservative politically than primary care docs, but I think all doctors are wary about the details of what health insurance reform will mean to patients and physicians and their relationships. There is probably universal agreement that the current system needs to be changed (with a majority agreeing that BIG change is necessary). A lot of doctors are probably just waiting for more details before they loudly support or condemn any specific proposal.
I am a family physician who is a strong supporter of Barack Obama and Democrats, and I believe a public option is a requirement for meaningful health insurance reform. It seems to me that would be the only way to control healthcare costs which are a major part of the problem. We should be loud about that specific point and counter some of the noise coming from the other side.
To be clear, I’m talking about individual physicians. Various physician advocacy groups or professional organizations have been active in the debate to one degree or another, though their generally low profile tends to reinforce my initial point that doctors seem sidelined in this debate.
David Kurtz is Managing Editor and Washington Bureau Chief of Talking Points Memo where he oversees the news operations of TPM and its sister sites.