President Obama appeared in the White House Wednesday talking to a group of white-coated people -- nurses and other healthcare professionals, some of whom were doctors. It is reasonable to assume that these individuals wore their white coats not by accident. The White House apparently wanted to use white coats to emphasize that medical professionals were on the White House side of the healthcare debate. (Concerns about the potential health hazards of all those white coats not withstanding.) Check out the White House Web site for vivid pictures.
Nurses have the highest perceived honesty and ethics ratings of any individual profession Gallup tests. Our recent analysis of the healthcare reform credibility of various political and medical groups puts doctors at the top of the list -- significantly ahead of President Obama himself. Indeed, doctors’ credibility on healthcare reform has increased over the last nine months, while Obama’s has decreased.
The White House no doubt assumed that the presence of these white-coated individuals connoted tacit approval for the Obama healthcare reform legislation.
We know, of course, that these doctors and nurses were not a randomly selected sample of all such individuals nationwide. How representative they were is an unknown. I find it difficult to pinpoint exactly where medical professionals stand on healthcare reform. But certainly doctors have a lot of trepidation about the impact of reform on many aspects of their daily practice lives.
One of the major messages emanating from the president's East Room event was the castigation of health insurers as the Darth Vadars of the healthcare system. This was not a hidden or subtle message. The title of the president’s remarks on the White House Web site is “Moving Forward to Put the American People Ahead of Insurance Companies," which makes it pretty clear where the White House stands on health insurers.
In fact, Obama’s remarks had a good guy/bad guy tone to them, juxtaposing “doctors and nurses and physician assistants like the ones in this room” against insurance company “bureaucrats”:
So I don't believe we should give government bureaucrats or insurance company bureaucrats more control over healthcare in America. I believe it's time to give the American people more control over their healthcare and their health insurance. I don't believe we can afford to leave life-and-death decisions about healthcare to the discretion of insurance company executives alone. I believe that doctors and nurses and physician assistants like the ones in this room should be free to decide what's best for their patients.
Once again, it appears that the White House staff has done its research. Positioning health insurers as the bad guys in this scenario has an empirical foundation in public opinion data.
Health insurance companies have the lowest credibility on healthcare reform recommendations of any group tested in our research. And health insurers’ credibility has dropped significantly since last June.
Why are doctors’ views on healthcare reform so revered by the public and health insurers so denigrated? Doctors (and hospitals) and health insurance companies are all direct recipients of money spent on healthcare. They make their living off of healthcare expenditures. They are dramatically affected by any change in healthcare payment systems. All of these groups would appear to have vested interests in the outcome of reform efforts.
Big pharmaceutical companies and healthcare insurance companies make a lot of money out of the healthcare system. But clearly so do doctors and hospitals. Indeed, if there is any group that sits directly at the controls of the spigot of money that flows through the healthcare system, it is doctors. As witnessed by the ubiquitous phrase in most pharmaceutical ads: “Talk about [name of drug here] with your doctor." (The potential impact of healthcare reform on doctors' incomes is underscored by this interesting article that argues that if the reimbursement for certain cardiology tests is lowered, cardiologists will order more of the tests to keep their incomes up.)
So a cynical individual could be cynical about the advice, views, or recommendations of any group or entity that depends on profits from the healthcare system. Yet doctors are in essence heaped with praise by the American public, while health insurance companies are heaped with scorn.
Obama and his advisors didn’t create this situation, but they are certainly and shrewdly taking advantage of it. At his event Wednesday, Obama could in theory have had health insurers in the audience looking on as he assailed doctors’ efforts to earn more and more money by focusing on tests and procedures that generate the most income. He didn’t, and a review of current public opinion data shows why.