Doctor opposition to health care overhaul proposals is broad and deep, revealing concerns not just about soaring costs, declining care, possible rationing and a lack of limits on malpractice suits, but also about government competence and motives, detailed responses to a new IBD/TIPP Poll show.
As reported Wednesday, 65% of the 1,376 practicing physicians who responded to a mailed questionnaire over the last two weeks said they opposed health care plans that have emerged from the administration and Congress. Just 33% supported them.
Perhaps the most shocking result: 45% of these professionals said they would consider closing their practices or retiring early if the reforms now under consideration were enacted.
The questionnaires were sent out Aug. 28 to 25,600 doctors nationwide. The sample was purchased from a list broker, Lake Group Media of Rye, N.Y. One hundred of those responding were retired, and their answers were not included in the final results.
Our poll also invited those taking part to tell us the reasons why they didn't like the health care reforms - or, in the minority of cases, why they did. The outpouring of written responses IBD received - about 1,300 in all - was stunning.
Doctors Speak Up
Those in Washington would do well to pay attention to the 65% who don't like reforms, whom we will quote today. (Tomorrow we will give space to the minority of doctors who support reform.)
These opposing physicians' opinions will be significant for the upcoming debate over health care, since any program that's passed will depend greatly on the support of doctors.
That includes the new plan unveiled Wednesday by Sen. Max Baucus. This plan, which Baucus estimates will cost an estimated $856 billion over 10 years, includes health care "co-ops" to compete with private insurers, and will likely require large tax hikes on many Americans - including the middle class.
Given the proliferation of plans, we wondered: What is it that bothers doctors so?
In combing through the responses, we identified no fewer than 21 separate issues doctors felt either weren't addressed or weren't solved by proposed reforms. The issues are many, but boil down to three big categories: costs, controls and courts.
One complaint was common: Doctors feared any government reform would turn into a kind of "socialized" medicine. Some were quite blunt: "I oppose socialism in all its forms or incarnations . . . government should be shrunk drastically, not expanded."
"No government 'option' or government-run program should be allowed," said another doctor. "It would ultimately lead to total government takeover of health care, with high costs and low quality."
The strong convictions of some came from a direct experience with socialism. "We came from a socialist country and we know socialized systems do not work!!!" wrote one emphatic physician.
Still others were adamant that any nationalized health care scheme - and a significant number see the plans emerging from Congress and the White House as just that - is against basic American constitutional law.
"This unconstitutional plan gives sovereignty over our bodies to unelected, unaccountable, ignorant bureaucrats," went one response along these lines. "Every governmental micromanagement of our lives has failed in its objective, and caused moral and economic bankruptcy."
But constitutional concerns were eclipsed by anger over the lack of tort reform - mentioned by hundreds of respondents. Physicians say they practice too much defensive medicine, which drives up costs, just to protect themselves from lawsuits.
The costs of this are enormous, though hard to precisely quantify. Estimates range from $100 billion to $200 billion in total added costs to both doctors and patients. Doctors in some specialties, such as neurology, pay as much as $250,000 a year for malpractice insurance.
Fear Of Lawyers
A number of our respondents used identical wording for why they didn't support health care reform: "No tort reform."
"The more lawsuits against doctors, the more testing is done," said one respondent, uttering a frequent complaint. "The government never interferes with lawyers - why? They are afraid, or they're all lawyers."
A big issue for others was efficiency. They fear government control would mean massive waste and interference with their practices. "All the efficiency of the post office, all the compassion of the motor vehicle bureau," quipped one doctor.
Another looming worry: exploding costs. With expectations that the government will spend upward of $1 trillion on reform, doctors fear the inevitable controls, including rationing, that will come to rein in costs down the road.
"A government-run plan will be too expensive and will not be effective," according to one physician. "The plan will expect doctors to take a lower fee for a given service. The private plans will follow, and outpatient medical services will be forced out of business."
This is "typical government, throwing trillions of dollars in one swoop to 'fix' the system," said another. "They need to slow down, dissect the system and fix it properly."
"There will be mandated protocols, long waits, rationing of care, infringement upon a doctor's right of conscience, abortion paid for by (tax) dollars, with eventual euthanasia and infanticide," said still another, voicing the ethical concerns of many.
The federal government's notorious lack of success in running enterprises of any size, let alone one as big and complicated as a health care system - was also cited frequently.
"Health care in the VA (Veterans' Administration) shows how well government can render care," said one. "It is disgraceful."
Gov't Can't Run Diddly
Others pointed to the troubles with government-run Medicare, Medicaid and Social Security, which are all verging on insolvency and now account for an estimated $51 trillion in unfunded liabilities over the next half-century.
Government-funded rail was a favorite foil - so was the Cash for Clunkers program. The House health bill "is 1,200-plus pages of miniature and legalese," joked one eye-sore physician. "Please recall 130 pages of forms for each 'cash for clunkers' transaction!"
"Government control? Give me a break," said another. "Look what they've done to Social Security, the Post Office, the bailouts, etc. Medicare and Medicaid are not paying doctors enough, and the paperwork to participate is huge."
Other irate docs agreed: "Government has proven unable to manage many other programs, including Social Security, Medicare, and the postal service. Why do they think they can (run) a health care program?"
"Government health care will wipe out the private insurance companies," said another. "Most of the doctors in private practice will give up . . . because of a low reimbursement from the government. The Medicare, Medicaid program is a good example of government-run health care."
Still others railed against what they saw as the real villains: insurance companies. Anger at insurance companies, which are now the main brake on health care costs, was plentiful.
"Between the government and insurance companies, I now only collect 28% to 30% of billed charges. No other business can function at that rate," this doctor added.
As many noted, all of the plans now being discussed would require massive tax hikes - and debt.
Many of those who opposed the plan had a unique perspective: They had practiced or lived under national health care systems in other countries.
Their comments about the experience were often scathing. To paraphrase progressive journalist Lincoln Steffens, they have seen the future - and it doesn't work.
"I trained and worked in Canada prior to coming to the U.S.," went one typical letter. "The same arguments were used in Canada to launch 'universal health care.' It is anything but universal and free."
Others had similar complaints.
"I did two years of training in Canada - disaster. When the government needed money, it decided patients with a stroke would not get a hospital bed. I had to have interns carry hemiplegic (a condition in which half a patient's body is paralyzed) patients to their families' cars."
"I am a former Canadian and I am a physician," added another. "I know a lot about government-run health care. If it's so good, then all members of Congress, the president and all federal employees should be the first to try it."
'Real Horror Stories'
Yet another: "I don't believe Congress has the requisite knowledge to know what to do with health care. After experiencing Britain's health care system firsthand, I cannot feel anything positive about government-run health care."
"I grew up and was trained in Romania," still another physician said. "At the time, it was a communist country with a socialist medical system. The system continued after the communist regime fell. I find this socialist health care system a complete disaster with real horror stories being heard every day with huge limitations in health care and huge bureaucracy."
Others argued passionately on behalf of the quality of the U.S. health care system - while admitting it has faults.
"I have firsthand experience with European and Canadian national health plans - they stink," said one physician. "My medical training was at the Mayo Clinic where people came from all over the world. Why did they come? Because we have the best (care) in the world."
That was echoed by many others who wondered why 18% of the U.S. economy needed to be put under direct government control to cover the 40-million-plus uninsured - and how we could care for millions more people, while supposedly cutting costs, without increasing the number of physicians.
More Taxes, Debt
As many noted, all of the plans now being discussed would require massive tax hikes - and debt - for little real benefit.
"It will take away consumer choice, drive up health care costs, and drive down health care quality," said one. "It will sharply increase the demand for health care providers and sharply decrease the supply as doctors like me will retire early and students will avoid the field."
"No need to overhaul the whole system," summed up one doctor. "Just find a solution to the 47 million that have no insurance."
"Unless the government uses magic tricks," argued another, "it is impossible to care for 47 million uninsured people and lower the cost."
The disgust with the notion of a government-run system was almost palpable in some comments:
"The U.S. government is already bankrupt. Its health care plan is too expensive," said one typical comment. "The government will end up rationing health care. Taxes will surely go up for the middle and upper class. We are in a recession."
He added: "This is not a good time to increase government expenditures and increase taxes."
Friday: A second opinion - from the doctors who support reform.