Meanwhile, lots of countries achieve universal health care – everyone is covered somehow – but the method can vary. For example, France requires all citizens purchase coverage, which is sold through nonprofits. In Germany, most people get insurance from a government-run “public option,” while others purchase private plans. In England, health care is provided through the tax-funded National Health System.
American skeptics often use the phrase “socialized medicine” pejoratively to describe all of these models.
“Few really understand what you mean when you say single-payer,” said Frank Opelka, MD, medical director of quality and health policy for the American College of Surgeons, which opposes such a policy. “What they mean is, ‘I don’t think the current system is working.’ ”
But the willingness to explore previously unthinkable ideas is evident in young doctors’ ranks.
Recent surveys through LinkedIn, Merritt Hawkins, and NEJM Catalyst indicate growing support. In the March NEJM Catalyst survey, 61% of 607 respondents said single-payer would make it easier to deliver cost-effective, quality health care.
Delving further, that survey shows support is stronger among younger physicians, said Namita Mohta, MD, a hospitalist at Brigham and Women’s Hospital, Boston, and clinical editor at NEJM Catalyst.
But it’s unclear whether these findings reflect young doctors’ feelings about the policy or whether they are tapping in to broader frustrations with the American health system.
Much like the general public, doctors often use terms like single-payer, Medicare for all, and universal health care interchangeably.
“Our younger generation is less afraid to come out and say we want universal health care,” said Anna Yap, MD, an emergency medicine resident at UCLA, who served as a medical student delegate to the AMA until this past June. “But how? It’s different in what forms we see.”
Younger doctors also pointed to growing concern about how best to keep patients healthy. They cited research that broadly suggests having health insurance tracks with better health outcomes.
“Medical students, I would say, are very interested in public health and improving social determinants of health – one of them being access to health insurance,” said Jerome Jeevarajan, MD, a neurology resident at the University of Texas–Houston, referring to nonmedical factors that improve health, such as food or housing.
Some of the shift in opinion has to do with the changing realities of medical practice. Doctors now are more likely to end up working for large health systems or hospitals, rather than starting a practice. Combined with the increasing complexity of billing private insurance, many said, that means contracting with the government may feel like less of an intrusion.
The debate is, at this point, still theoretical. Republicans – who control the White House and both houses of Congress – sharply oppose single-payer. Meanwhile, single-state efforts in California, Colorado, and New York have fallen flat.
Also, doctors represent only one part of the sprawling health care industrial complex. Other health care interests – including private insurance, the drug industry, and hospital trade groups – have been slower to warm to catchphrases like single-payer or universal health care, all of which would likely mean a drop in income.
But increasingly physicians seem to be switching sides in the debate, and young physicians want to be part of the discussion.
“There’s tremendous potential ... to be at the table if single-payer becomes a significant part of the political discourse, and create a system that is more equitable,” Dr. Pean said.
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.