Doctors believe that health care reforms proposed so far will hamper drug innovation and new medical technology, eroding America's lead in providing high-quality, life-extending medicine.
This is another picture that emerges from a recent IBD/TIPP Poll of 1,376 physicians from around the country.
We asked the following question: "Under a government plan, do you think drug companies will have incentives to develop as many lifesaving new drugs?"
Sixty percent of those who responded to our mailed questionnaire said "no," while 34% said "yes." Six percent didn't answer the question.
The survey was sent to 25,600 physicians on Aug. 28, and the results reflect questionnaires returned through Sept. 15. There are more than 800,000 physicians nationwide.
Of those responding, 100 were retired. We excluded their answers from the final tally. The names in our poll were purchased from a list broker.
In addition to soliciting "yes" or "no" answers, the questionnaire let physicians elaborate on their concerns.
One that came through was that drug and technology innovation in medicine - considered by many to be the most vital part of the U.S. health system - will wither under government-run health care.
One physician summed it up as follows: "It will crush medical research because new and innovative treatments/technology cost money initially and the government won't pay."
Another worried that "medical advancements will slow."
Still another added that there will be a "disincentive for drug companies to develop new drugs."
As we noted last week, what emerges from our poll is strong opposition by doctors to Congress' proposed health care reforms.
Respondents opposed Congress' reform plan by 65% to 33%. And in perhaps the most stunning result, 45% said they would "consider leaving ... practice or taking an early retirement."
That would be a devastating blow to plans to cover an additional 47 million people.
Indeed, we asked physicians that very question - whether "government can cover 47 million more people" for less money while improving quality. Fully 71% answered "no," while 25% answered "yes."
In recent months, many in the pro-reform camp have fought for sweeping changes based on the idea that drug companies and their profits are the villains in our health care debate.
Even some doctors believe that rising drug costs are part of a much bigger picture of runaway spending that must be tamed for the good of our nation's health.
As one physician, a supporter of health reform, told us: "We need to get some constraints on runaway use, technology, referrals, waste ... (We) need priorities in spending. We can't afford everything."
Given such sentiment, it's no surprise that a major part of the impetus for health reform has been that "we spend too much" on health care due to soaring drug and technology costs. Only government, reformers argue, can exert enough pressure on the system to cut costs.
Yet, when it comes to drugs and other lifesaving innovations, the picture is complicated by the fact that new technology is largely responsible for extending the lives of Americans in recent decades.
As such, any reforms that change our current system from its current emphasis on innovation to one based on top-down cost control run the very real risk of shortening American lives - or at least slowing down improvements in life spans and quality.
This year, Americans will spend $2.3 trillion on health care, about 17% of our GDP, or $7,500 per person. Of that, just 10% goes for drugs.
But economists who have looked at the issue mostly find that spending per se isn't the problem; what counts is how you spend it. It turns out that spending more on health care innovations, including pricey new drugs, actually improves health and lengthens lives.
A landmark report by economist Frank Lichtenberg in 2002 looked at the huge increase in life expectancy - from 69.7 years to 76.5 years - during the period from 1960 to 1997.
He found that much of the gain in life spans was due to improved drugs and technology. He further found that investment in new drugs shows an enormous return: For every $1,345 spent on drug R&D, about one life-year is added to the U.S. total.
Given that the average productive value of one life-year for a healthy person is about $150,000, economic gains from new drug innovation would appear to be enormous.
Take just one class of new treatments: anti-hypertensive drugs used to treat high blood pressure. In 2001, according to a study by economist Genia Long and six others, these drugs saved about 89,000 lives - and prevented 420,000 hospital visits.
And that's just one type of new drug. This is a big reason why doctors fear price controls and other constraints under reform. As one physician respondent to our survey said in explaining his opposition to reform: "We will have fewer medicines available."
Unfortunately, drug innovation itself is very expensive. Industry estimates put the cost of developing and bringing a new drug to market at more than $1 billion. And it takes 10 to 15 years to do it.
This dynamic of large investment in drugs and health technology has made the U.S. health care system the best in the world when it comes to actual quality of care.
Doctors and others who oppose health reforms worry that any new system, eager to control costs, will slash spending on money for drugs - and reverse or halt our gains.
"Expenditures on health care are driven by demand, which is spurred by income and by advances in biotechnology that make health interventions increasingly effective," Nobel Prize-winning economist Robert Fogel wrote recently in the American magazine.
Any reform that tinkers with this dynamic, Fogel suggests, is foolish. We will inevitably spend more on useful medical technology, especially drugs, as we get richer, he says. Every dollar we add in income, Fogel estimates, leads to an additional $1.60 in demand for health care.
Thus, when the Council of Economic Advisers promises that health care reform will lower spending by 1.5 percentage points of GDP, that may not be a good thing - unless all of it comes from waste.
Wednesday: How doctors think reforms will affect decisions to enter the profession.