Physician Support for Covering the Uninsured: Is the Cup Half Empty or Half Full?

More than 43 million Americans—17.2% of the population younger than age 65 years—lack health insurance (1). Over the past 25 years, in good times as well as bad, the general trend has been one of growth in the numbers of uninsured (2, 3). This trend has continued despite substantial expansions in Medicaid eligibility in the late 1980s, enactment of the State Children's Health Insurance Program in 1997, and incremental reforms in the regulation of private health insurance (2-4).

Why is expansion of coverage so difficult to achieve? Stuart Altman, a former Nixon Administration and Congressional appointee and an expert on health policy, once observed that although people disagree over the best path to reform, the status quo is everyone's second choice (5). Despite our proclivity for inertia, health insurance reform is likely to be a potent issue in the upcoming presidential election as the public feels the effects of mounting job losses, the rising cost of health care, and a sharp increase in the number of uninsured. What do doctors think at this critical time?

In this issue, Ackermann and Carroll (6) report the findings of a nationwide survey of physician attitudes about national health insurance. Participants were drawn from the American Medical Association (AMA)'s Physician Masterfile, a database that includes both AMA members and nonmembers. Sixty percent of those contacted participated. A plurality of respondents (49%) expressed support for the concept of national health insurance; 40% opposed it. The “single payer” approach, in which all health …