Single-payer Judged Best for Health Care

Spin control isn't just for politicians.

"Doctors teach students HMO dislike" read the headline on an MSNBC article in their "Health" section on March 24, 1999. (On the web at: http://msnbc.com/news/ ) The thrust of the article was that medical school students and interns learn to dislike HMOs mainly because "faculty culture" at medical schools has a "hidden curriculum" which passes this attitude from teacher to student. The implication of course was that this attitude is arbitrary and wrong-headed, and that there has been a sinister conspiracy in the way that "doctors in training" acquire these attitudes in advance of their own experiences with HMOs.

In the MSNBC article there was no suggestion that the doctors' opinion of HMOs is perhaps legitimate, based as it is upon long and intimate experience with HMOs. There was no hint that conveying this knowledge to the next generation of doctors is something which a medical school staff ought to do.

The article was MSNBC's presentation of a study recently published in the New England Journal of Medicine, and it did mention that the study was sponsored by Harvard Pilgrim Health Care (a large HMO) and the Harvard Medical School. However, when MSNBC prominently featured a boxed quote from the author of the study, Dr. Steven R. Simon, they referred only to his medical school affiliation, not to the fact that he was being paid by a large HMO.

The study is based on recorded interviews with 2,162 students, residents, and staff at all 121 U.S. medical schools. In this sample of informed opinion, traditional fee-for service insurance coverage was generally rated superior to managed care coverage. It was particularly understood to be better at "...allowing access to care, minimizing ethical conflicts and preserving the doctor-patient relationship." 57% of the respondents believed that a single-payer system would provide the best medical care for a fixed cost. 22% thought managed care would provide the best balance between care and cost. Only 19% preferred fee-for-service in this context of cost effectiveness.

Given the substantive results of the survey, the startling fact is that a majority of U.S. medical experts prefer single payer to all other insurance schemes combined, and that they prefer single payer to HMOs by more than a two-to-one margin. This result is startling because it runs opposite to the policy of the Democratic and Republican Parties, and it is also contrary to the policy of the American Medical Association. The headline should have been something like "Medical school staff and students favor single payer." It is not a question of "disliking" HMOs - that is just an emotional reaction that anyone could have. No, it is a question of competent professionals making an informed judgment that there is a better way to insure health care.