Photograph by Steven Higgs
Dr. Aaron Carroll from the IU School of Medicine has published studies that show American physicians overwhelmingly favor a national health insurance plan. A new study from the New England Journal of Medicine says 73 percent want health care reform to include a public option.
Don't count Dr. Aaron Carroll among those who were stunned by a Sept. 13 New England Journal of Medicine survey that said American physicians overwhelmingly support national health insurance. A researcher at the Indiana University School of Medicine, Carroll wasn't surprised because the data confirm studies he published in 2003 and 2008 on the subject of physician attitudes toward reform, work that drew national media attention, including an appearance on The Colbert Report.
In the New England Journal study, 63 percent of the doctors want a mix of public and private insurance plans, and 10 percent want a Medicare-for-all, single-payer health care system. In the April 1, 2008, edition of the Annals of Internal Medicine, Carroll and Dr. Ronald T. Ackerman, also from IU Med, published a survey that showed "a total of 59 percent supported legislation to establish national health insurance." Five years earlier, it was 49 percent.
"Those who tell you that doctors are against this or that doctors are really opposed to significant health care reform are not paying attention," Carroll said from his Indianapolis office during a telephone interview. "The good, carefully gathered evidence on this topic show that doctors really recognize that reform is necessary and are willing to take pretty big steps toward getting a better system."
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Carroll is a Philadelphia native, an associate professor of pediatrics and director of IU Med's Center for Health Policy and Professionalism Research, where he has been the past six years. His interest in the subject of physician attitudes toward universal health care was piqued at a 2002 symposium during his residency at the University of Washington in Seattle.
"I remember at the time listening to people talk about it and thinking, 'There's no way that doctors would ever support this,'" he said. "I believed the general things that had been said, that doctors would be very much against any kind of significant reform."
Carroll and Ackerman, who also attended the symposium, were intrigued enough to test their hypothesis and were stunned when their survey showed 49 percent favored national health insurance. "Even back then, in 2002 or 2003, a plurality of physicians actually supported government legislation for national health insurance," he said.
Dubious about their own results, the pair dove into the subject more deeply. And their follow-up study in 2008 showing the percentage had increased another 10 percent in five years was met with more media attention than the two researchers had anticipated. Carroll, for example, found himself in a New York City television studio not knowing what to expect after Stephen Colbert announced, "Ladies and gentlemen, please welcome Dr. Aaron Carroll."
"It's exactly what it looks like on TV, in that it's impossible to go in with any preconceived notion of what you're going to say or how you're going to do it," he said. "I think if you watch it closely it might have been a minute or a minute-and-a-half before I was able to get a full sentence out."
Carroll has made other media appearances, and there's usually a pre-interview meeting, where guests are prepared for what's to come, he said. "You get a general sense of what they may be asking, and they get a general sense of what you might be saying."
Not so with Stephen Colbert. The actual experience bore almost no resemblance to what had gone on before.
"It really was just a roller coaster," he said. "It's not for the faint of heart."
A proud member of the Colbert Nation, Carroll said he loved doing the show and felt it was an effective venue for his message.
The New England Journal of Medicine survey, sponsored by the Robert Wood Johnson Foundation, sampled 2,130 U.S. doctors, according to a Sept. 14 article from the Reuters news service. In addition to the support for national health insurance, it also found that, regardless of their medical specialty, 55 percent "would favor expanding Medicare so it covered people aged 55 and older." Medicare is the single-payer, federal health insurance plan for Americans over 65 and some disabled citizens.
Consistent with Carroll's read of the evidence, Dr. John Lumpkin, Johnson Foundation senior vice president, told Reuters, "The result shows that physicians see this system is broken and needs to be fixed."
Acknowledging that physicians in general and the American Medical Association in particular have opposed health care reform efforts dating to the early 20th century, Carroll, who was a Robert Wood Johnson scholar, attributes the attitudinal sea change since the early 2000s to a combination of factors.
Physicians recognize the significant amount of overhead that is included in health care costs, he said. They see patients every day who are uninsured or underinsured. And they understand a band-aid approach to system reformation will not work.
"It's not as if this is the first time we've thought about this," he said. "It's been proposed again and again and again, and everything is getting worse. At some point you have to realize that the road we're on is not the right road, and it might be time to take a different one."
After watching Carroll on Comedy Central's Colbert Report or on MSNBC's Ed Show, or talking with him on the phone, one could easily be left with the impression he's a proponent of a single-payer health care system similar to Canada's. But he said his role in this debate is that of a scientist.
"I like to say that I'm not an advocate, in the sense that I believe that this is the best position and I'm promoting it," he said. "I think there is a general consensus of evidence that shows that it's one of the best and most cost-effective ways of going about providing health insurance to a group of people."
A careful review of the literature at this time, he said, shows single-payer systems, as evidenced by their adoption around the world, are the most cost-effective means of providing insurance.
"That's what the evidence shows," he said. "If good research were to come out in the future and show that I was wrong and other ways would be better, I would absolutely change my mind."
In response to a comment U.S. Rep. Baron Hill recently made in Bloomington that America eventually will embrace a single-payer system, Carroll said there are other systems around the world that aren't single-payer but work reasonably well.
"I think if we were truthfully and actively talking about adopting one of those alternatives, then we might not get to a single-payer system," he said. "But if we continue to wring our hands and do nothing, I do agree that it's inevitable that the public part of our insurance will get larger and larger and larger, and we'll reach a tipping point where we might as well bring everybody in."
One aspect of the ongoing health-care debate that frustrates Carroll is the lack of attention being paid to cost-containment. "That's incredibly important, and at some point we're also going to have to talk about it," he said.
But as long as America's health-care system is based on private insurance, containing costs is going to be difficult no matter how they do it, he said, mostly because it involves sacrifice.
"Anyone who tells you they can make it 100 percent universal and increase the quality and have it cost less at the same time is lying," he said. "That's just not possible, as long as we're building on this sort of patchwork system."
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