Healthcare Professionals weigh in on Barack Obama's Plan, Hillary Clinton's Plan, and John McCain's Plan

“Politicians and physicians need to work in tandem if the United States is to develop the most effective and efficient healthcare delivery system in the world.” 

This paraphrase has been repeated by the thousands of physicians that Jackson & Coker speaks to on a daily basis. 

As a result, Jackson & Coker commissioned a survey to determine the opinions of health professionals, especially practicing physicians, on the topic of healthcare reform. The survey results convey their views and advance the ongoing debate at this point in the presidential election cycle. 

Hillary Clinton 28% John McCain 30% Barack Obama 24% Other, please specify  18%

Extremely important 55% Somewhat important 39% Not that important 6%

Very familiar with the issues 42% Somewhat familiar 47% Admittedly, not too familiar 11%

Less than 5 years 12% 6-10 years 15% 11-15 years 12% Over 15 years 61%

The current healthcare model 2% The current system—with significant improvements 46% A universal healthcare delivery system 38% Other, please specify  14%

Make health care available to the uninsured 29% Reduce costs associated with medical care 32% Streamline all facets of healthcare delivery 31% Make prescription drugs much more affordable 35% All of the above 55% None of the above 7%

Doctors treating more patients over a specific period of time 6% Increased standardization of regulations concerning patient care 31% More efficient processing of electronic medical records 46% Greater access to affordable prescription drugs 51% Doctors able to spend more quality time with each patient 43% All of the above 14% None of the above 21%

Probably better 32% Possibly worse 47% No difference 7% Not sure 14%

Probably increase 37% Likely stay the same 21% Possibly decrease 28% Really can’t say 14%

Definitely 48% Perhaps 31% Not a good idea 21%

The system would encourage more innovation and cost-effectiveness. 16% There would probably be little significant change overall. 11% There would be less financial incentive to develop new drugs and procedures. 41% It’s difficult to predict the outcome with so many factors involved. 32%

Definitely—with no restrictions 6% Yes—with some restrictions 34% Not at all 37% This question calls for further debate. 23%

Probably increase dramatically 60% Possibly decrease 5% It might stay the same. 16% It’s hard to say at this point. 19%

Personal income potential 51% Amount of government regulation 66% Quality of resultant patient care 61% Costs associated with overhauling / streamlining my medical practice 42% Other, please specify  13%

Across-the-board healthcare costs for consumers 32% Insurance company reimbursement to healthcare providers 21% More efficient billing procedures 25% Better total health care 31% Increase the number of persons with access to quality healthcare. 46% All of the above 21% None of the above 13% Other, please specify  5%

Totally voluntary 37% Absolutely mandatory 26% Perhaps there is some middle ground 31% No opinion on the matter 6%

Yes 63% No 10% Maybe 20% Can’t say 7%

$2500 per individual or $5000 per family 34% Less than these amounts 8% More than these amounts 18% Not certain on this issue 40%

The federal government 25% State governments 5% Private companies 16% Private companies with government oversight 39% Not sure 15%

Yes 57% No 20% Maybe 23%

More tax credits 9% Reduced healthcare costs 25% Both 45% Neither 21%

Definitely 31% Perhaps 31% Probably not 28% Not sure if it will make a big difference. 10%

Government controlled 15% Privatized 20% Private with government oversight 37% This calls for further debate. 28%

Very likely 10% Somewhat likely 24% Realistically, unlikely 54% My crystal ball is broken—I can’t say. 12%

OVERVIEW

The discussion of what changes may need to be made to improve the current healthcare system in the United States may sometimes overlook the opinions of physicians who are the actual providers of health care.  This survey helps give  voice to their questions, concerns and suggestions for implementation. 

This election cycle brings to the forefront a serious discussion of how health care in America can be improved.  On the political side, Senators Clinton, McCain and Obama have positioned this discussion as a centerpiece of their campaign platforms.  On the consumer side, most voters would agree that some aspects of healthcare delivery in the United States require attention.  The real question is twofold:  What essential changes may need to be made?  What new or modified system would most efficiently and cost-effectively incorporate any changes? 

The catch phrase bandied about by politicians, health industry analysts, and medical practitioners is “Universal Health Care.”  Theoretically speaking—and as part of stump politicking--it sounds interesting.  After all, there are millions of uninsured citizens—and those aspiring to acquire citizenship—who may not have access to affordable medical care.  In a nation that leads industrialized society in medical, technological and pharmaceutical advances, the candidates feel that it is highly appropriate to discuss the best approach for “fixing” our healthcare system and making quality medical care generally accessible--at more affordable rates--to the vast majority of families living in the United States.

Jackson & Coker has framed the central debate issues in a 26-question survey that captures responses in three key areas. 

1. Doctors’ personal opinions concerning universal health care in general
2. Their views on the health plans of the presidential candidates
3. Their suggestions for implementing universal health care.

The survey results are quite informative, as illustrated by the physicians’ well-thought-out comments.  Jackson & Coker has contacted the three presidential campaigns, and all of them expressed an interest in receiving the survey results. 

SURVEY DESIGN

To investigate health professionals’ views on the topic of Universal Health Care (UHC), Jackson & Coker commissioned a survey during March 2008 that queried thousands of physicians and other health professionals across the healthcare spectrum.  The survey results showcase wide-ranging personal and professional opinions concerning both defining and implementing any improved health care system in the United States.   

The survey design included commonly asked questions concerning UHC in a multiple-selection answer format, as well as ample opportunity for respondents to elaborate on their personal views. The comment sections of the survey captured strong opinions of respondents who obviously have given extensive thought to this serious topic. 

SURVEY RESULTS

The political implications

Without doubt, the concept of “Universal Health Care” has been a linchpin debate topic among the three presidential contenders.  A key survey question focused on respondents’ opinions as to which candidate would most likely improve the US healthcare system if elected. The survey results were close:

• Senator McCain – 30%
• Senator Clinton – 28%
• Senator Obama – 24%.

The other responses favored politicians who have dropped out of the presidential race.  In particular, the views of Ron Paul were the most mentioned of all the former presidential candidates. 

A related question queried survey participants as to how important healthcare issues are when selecting a presidential candidate.  Fifty-five percent indicated that it is extremely important, and 39% felt it is somewhat important.

Personal perspectives

In general terms, the majority of respondents (89%) are somewhat familiar or very familiar with the concept of Universal Health Care as it is discussed in the medical field and debated in the political arena.  Only 2% of doctors are comfortable with the current healthcare model in the U.S., whereas 84% favor either significant improvements to the present system or adoption of a universal healthcare plan--however it is defined and implemented. 
 
The length of practice experience is noteworthy.  Almost two-thirds of physicians have practiced medicine for fifteen years or longer. This indicates a seasoned perspective on healthcare delivery in terms of what promotes or detracts from it—as well as carefully expressed opinions on what should be involved in “fixing” a system that most respondents concluded is “broken” in one way or another.

Fixing the system

Although the preponderance of survey responses indicated that health care in the United States requires dramatic overhaul, how to implement such dramatic improvements is open to conjecture and further debate.

When queried concerning the major changes that would characterize an improved healthcare model, over half of respondents favored all the suggestions offered:

• Make health care available to the uninsured
• Reduce costs associated with medical care
• Streamline all facets of healthcare delivery
• Make prescription drugs more affordable.

The goals of any modified system would be:  more efficient processing of medical records, greater access to affordable prescription drugs, and physicians being able to spend more quality time with each patient.  One possible downside to achieving these goals, according to 60% of respondents, is the possibility of a significant increase in wait times for medical procedures. 

An interesting observation concerns the amount of office support staff anticipated under UHC and the quality of patient care anticipated.  More than half of the respondents believe that the number of office support staff will stay the same or actually increase.  However, 47% forecast worse patient care as a result of adopting a universal medical system.  This less-than-optimistic response certainly raises additional questions that healthcare executives, insurance companies and politicians need to address. 

Another interesting correlation can be drawn from the survey findings.  While nearly half of the physicians believe that pharmaceutical costs should be regulated under UHC, 41% of respondents maintain that there would be “less financial incentive to develop new drugs and procedures.”  This raises questions that need to be examined by the pharmaceutical community. 

How universal? 

A key survey question concerns whether universal health care should be available to non-citizens, such as “undocumented workers” living inside the U.S.  A slim number of physicians (6%) agreed—with no restrictions.  Just over one-third favor non-citizens having access with some restrictions, whereas almost 40% answered “not at all.” 

A similar query relates to who should participate in a UHC system.  In almost equal amounts, respondents felt that a universal healthcare system should be: 

• totally voluntary
• absolutely mandatory
• or perhaps there is some middle ground for deciding.

Obviously, determining who is included voluntarily or involuntarily in a universal health plan is of decisive importance and at the heart of the debate.

Paying for Universal Health Care

No matter what plan is adopted (if any), the question remains as to who pays for implementing a renovated healthcare system. 

A decisive number of physicians (63%) favor tax credits offered to purchasers of health care.  Furthermore, a third of respondents like the idea of a tax credit amounting to $2500 for individuals and $5000 per family.  Eighteen percent of respondents would insist on larger tax credits for health care purchasers.  Additionally, a general consensus is that purchasers with “healthy lifestyles” should be rewarded with reduced healthcare costs and / or more tax credits.

Who should control health insurance costs?  Twenty-five percent of doctors maintain that the federal government should be in control.  Thirty-nine percent opt for private companies being in control—with some degree of government oversight.  Similarly, almost the same percentage of doctors believes maintenance of medical records in a UHC system should be done by private organizations with general government oversight. 

How payer reimbursement is impacted by any proposed modification to the current system is of great concern to the majority of respondents.  As much as physicians are interested in implementing changes that benefit healthcare consumers, they are also concerned with how their work load and personal compensation will be affected by any proposed change in access to medical care. 

Personal implications

On a personal level, the respondents expressed strong views concerning how universal health care might affect them professionally.  Their greatest concerns center on the amount of government regulation, the quality of resultant patient care, and personal income potential. 

In terms of how adoption of some form of universal health care might have a bearing on their career plans, physicians provided answers to this open-ended question demonstrating a wide range of opinions, as the following sampling indicates.

• “My career would become more flexible because my own personal health insurance would travel with me rather than be provided by my employer.” 

• “I would seriously consider retiring from medicine.”

• ‘I’ll have even more patients and more visits to do.  When something is perceived to be ‘free,’ it gets consumed whether necessary or not.”

• “Since I am close to retirement, given the economy of the country and the paucity of physicians in my specialty, I would probably have to work 80 hours / week instead of the 70 I work now, and would never be able to retire.”

• “UHC should be accompanied by Universal Doctor Care with the government providing malpractice coverage for all doctors.  Another alternative would be to make it mandatory for insurance companies to provide coverage for all patients.  Doctors are really tired of working more and more for less and less.  We are all looking for an EARLY exit plan.” 

• “I am in transition already to a non-clinical position.”

• “I would NOT consider further training in medicine.”

• “I have recently retired.  One of the major reasons for my retirement was the dissatisfaction of the ‘tactics’ employed by private, third-party payors.”

• “It would be fun to practice medicine again if all had access and I didn’t ever again have to deal with a myriad of private insurers.”

Final thoughts

The final survey question also gets to the heart of the matter.  Despite the heated political discourse concerning universal health care, how likely is it that an overhauled system will be implemented during the next presidential term, regardless of who sits in the Oval Office?  One-fourth of physicians believe that adoption of a favorable UHC plan will occur.  Yet over half (54%) believe that, realistically, a major overhaul is not at all likely.

It remains to be seen how the presidential nominees will sharpen their message to make a convincing case that changes that are absolutely necessary to improve our nation’s healthcare system will be implemented if they are elected president.   

One thing is clear:  Physicians need to be included in the ongoing debate and considered part of the solution--not just as commodities in the healthcare system--or the doctor shortage will likely worsen as practitioners consider retirement or other career options. 

CONCLUSION

This survey represents a snapshot in time regarding the views of physicians and other health professionals concerning Universal Health Care.  Obviously, the respondents’ views can shift appreciably with significant changes in our fluid economy, legislative initiatives concerning immigration reform, and the manner in which the two final presidential nominees modify their proposals as we enter into the general election season. 

At this point, though, it is obvious that a sizeable number of practicing physicians have given considerable thought to what aspects of the current health system require improvement.  Furthermore, they have deep-seated feelings on what it will take to make quality health care more accessible and equitable to individuals covered by some form of universal health care, however it is designed and implemented.

Without doubt, the survey advances the discussion of universal healthcare as it is debated within the health community and in the political sphere.