Insurance & Benefits

U.S. Physicians Survey: We Want Single-Payer/Private Pay Options

They were most divided on the health savings account model.

Physicians prefer a two-tiered system that features a single-payer option plus a private pay option for the future of the U.S. health system, according to a survey conducted by The Physicians Foundation and Dallas-based Merritt Hawkins.

That said, they are as divided as the rest of the country about how to solve the problem of paying for healthcare. The doctors ranked the two-tiered system highest, but not far behind was a market-based approach with health savings accounts, where patients can put untaxed money from their paycheck into an account to be used for medical expenses.  The health savings account option was the second-most preferred option, but it was also the most disliked option, with 42 percent of physicians ranking it last. Both of those options were favored more than continuation of the Affordable Care Act as it stands now. They ranked a single-payer model where everyone was enrolled in a Medicare for All system as the worst option.

Physicians showed support for streamlining prior-authorization with insurance companies to improve access to care and also showed support for improving telemedicine reimbursement and simplifying access to mental health services. The survey reflected physicians’ frustration with dealing with insurance companies, pharmacy benefit managers, and other hurdles to practicing medicine as they were trained. “Our current health care system is directed by policymakers and business executives, instead of physicians,” said Robert Seligson, CEO of The Physicians Foundation via release. “Physicians are the foundation of health care, and as such, they know what is best for our system and the patients they serve. These data provide a clear picture of what physicians want to see in our health care system. It’s critical these insights are included in any and all are reform discussions if we hope to improve access to quality care.”

With the nation’s healthcare costs soaring, each part of the system points to another to pin blame. Physicians point to insurance company profits, which have skyrocketed with the passing of the Affordable Care Act and because of  the pandemic, as many people are pausing medical treatment that would have accessed insurance funds. Insurance companies point the finger at providers who use the fee for service system to rack up profits with unnecessary treatment. Both groups blame pharmaceutical companies for pricing drugs too high, but those companies maintain that any price controls will slow innovation.

Surveyed physicians also embraced the need to improve social determinants of health, and many thought that it would drive demand for healthcare moving forward. They also noted that these factors should be included when insurance companies calculate patient complexity. Providers, insurance companies, and public health entities are working to measure, track, and improve social determinants of health to bring down overall healthcare costs. It may be more efficient for an insurance company or even a provider to subsidize transportation, healthy food, or proactive contact with at-risk patients who are liable to cost the system in the future if problems aren’t addressed in their beginning stages.

See the results from the health system question below. The full survey can be found here.

Considering all relevant issues such as patient access, value and quality, health system efficiency, physician autonomy and compensation, and the COVID-19 public health response, what direction should the health care system take?  Rank the options below 1-4, with 1 being the best approach. 

Ranking 1 2 3 4
Maintain/improve the current ACA influenced system 19% 30% 39% 12%
Implement a single payer/Medicare for All system 19% 21% 22% 38%
Implement a two-tiered system 36% 31% 22% 11%
Move to a market-driven system with Health Savings Accounts 30% 15% 13% 42%



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