Background: While improving the American healthcare system has been a top focus of the domestic policy agenda for decades, health reform debates since early 2020 have taken place against the backdrop of a global pandemic that has highlighted key challenges in public health infrastructure and healthcare access. U.S. physicians are at the forefront of this battle and directly observe the obstacles that cost, access, and quality have on their patients and the care they can provide. The goal of this study was to examine the relationship between physicians’ political ideological preferences and their chosen healthcare policy reform strategies.
Methods: We conducted a cross-sectional survey of 3,001 currently practicing physicians using contact information from the AMA Physician Masterfile. The survey was administered between August and November 2020 to understand how self-identified ideological preference as liberal, moderate, or conservative impacted physicians’ policy reform preferences with regard to the three domains of healthcare—cost, access, and quality. Policy preferences included a managed competition model with private insurances being the primary form of coverage (our current model), a public insurance option (i.e. the public option), free market optimization through general price transparency and consumer-informed competition, a nationalized health insurance program (i.e. Medicare-for-All), or none of the above.
Results: A total of 536 physicians responded to the survey—a response rate of 18.8%. The median age of respondents was 55 with 70% of respondents identifying as male and 28% of respondents identifying as female. Overall, 32% of physicians in our sample identified as liberal, 43% as moderate, and 22% as conservative. Chi-square tests indicated a statistically significant relationship between political ideological preference and preferred reform strategy under all three domains—access (p < 0.0001), cost (p < 0.0001), and quality (p < 0.0001). Most liberal-identifying physicians selected a national health plan as their top choice under the domains of cost (61%) and quality (43%), while splitting between a national health plan (48%) and a public option (42%) under access. Moderates favored a public option for both access (44%) and quality (31%) but tied between a national health plan (35%) and public option (35%) under cost. Conservative physicians preferred free market optimization under access (50%), cost (52%), and quality (59%).
Conclusions: Within our sample, we found that liberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, we observed variation in preferences among the domains of healthcare (Figure 1), suggesting that physicians diverge from strict ideologies of reform when considering specific, complex questions regarding access, quality, and cost. In general, physicians overwhelmingly support healthcare policy reform to continuation of the existing system, and their nuanced perspectives are crucial in informing future health policy conversations.
