The Association of American Physicians and Surgeons surveyed 1,208 adults -- the majority of whom were physicians or other types of medical professionals -- and found that 90 percent are opposed to a single-payer health care system.

Respondents also provided commentary either supporting or opposing single payer – but some of the most interesting open-ended comments included alternative suggestions for how to improve the current system in the U.S.

Those opposed to single payer checked the following objections (most giving multiple reasons):

increased rationing (87 percent)
unaffordable (75 percent)
harm to patient privacy (66 percent)
unconstitutional (58 percent)
other (28 percent)

“Single payer has never worked well,” says a respondent who was not a medical professional. “Socialized medicine countries are struggling to pay for these systems because the lack of competition undermines incentive for the one payer to be efficient. Meanwhile the quality is poor for patients, because it is a one -size-fits-all system that determines coverage and benefits based on collectively bargained agreements -- where diseases and treatments that qualify for reimbursement are driven by political power and agenda, rather than needs of the patient. Other socialized medicine countries with single-payer systems are trying to diversify to get other payers into their markets because the burdensome costs and lack of coverage.”

For those respondents who favor single payer, their reasons include these:

“Physicians are overwhelmed by administrative burdens from multiple private insurers" (79 percent)
“Government-funded programs provide more value for less cost" (34 percent)
“It isn't fair that some people can get better care if they can afford to pay” (27 percent)
Other (22 percent)

“The present healthcare system is not working and has placed the work burden on physicians,” says one physician respondent. “Medical decision-making has been put into the hands of hospital and insurance administrators, and the American public is suffering health-wise and financially. Instead of the monies going into care, it is going into profit for these executives.”

Another physician favors a baseline single-payer system that covers “most basic needs for all.”

“I just do not think America wants to not treat people in need,” the physician says. “I favor higher more robust plan for certain groups - disabled from spinal cord injury, MS - chronic severely disabling conditions that prevent someone from working. All citizens receive the baseline ‘coverage’ - if they elect to add on to that coverage with other insurance or payment system they are free to do so without penalty or oversight.”

Many respondents offer alternative ways to improve the current system:

“I want the health insurance companies to have rules in place -- even if it has to be regulated by law -- that they can't overcharge patients for medically necessary tests, surgeries, treatments, medications so they can feel better,” says one non-medical respondent. “The reason why hospitals and doctors have to charge more to self-pays is because they get crap reimbursements from the insurance companies. If they played fairly, instead of being greedy and all about profit and screwing sick patients over, we wouldn't be in this mess.”

“I myself have left the insurance-based medical market and moved to a direct-pay practice, and things have never been better for me or my patients,” says one physician respondent.

“I prefer a hybrid system where the federal government pays for nationally recommended preventive care for all, and provides reinsurance for catastrophic expenses by commercial insurance plans that provide ‘sick’ care for patients,” says another physician. “The federal government also needs to help people with subsidies when those people cannot afford health insurance.”

“Have one set of rules but allow multiple insurance companies to provide the service,” says another physician respondent. “Have on policy for single, one for single + spouse, and one for family. Same fees, same formularies, same set of rules. No negotiating fees---take it or leave it.”

“We need to get both the government and the insurance companies out of health care,” says another physician. “The best way to do this is a single-payer nonprofit owned and run by physicians. All physicians would belong and be in charge of administrating all the care. This would be the only insurance accepted. This does away with Medicare, Medicade and all private insurance as exist today. There would be a standard national fee schedule that payments and insurance premiums would be based. Premiums could be paid by the government of behalf of groups of individuals based on whatever criteria they want or by employers or by individuals. I predict current costs would immediately be cut in half.”

“Healthcare is broken, but the only thing that will fix it is to open it back up to pure capitalism and let people buy insurance from anywhere in the country,” says a non-medical respondent. “Have the insurance companies compete openly for our business.”

“With insurance covering things I don't need, putting them on my policy is ridiculous,” says a medical professional. “We should buy our own coverage for only what we want in a competitive market, allowing companies cross state lines and decide how they can compete for business. Insurances should not be able to decide what a medical procedure should cost. Allow patients to work directly with patients to get the best price and go to doctors of their choice. Costs could reflect the skill and attention you get from physicians. If some want a basic plan without bells and whistles, choose that, if some want a Cadillac plan, choose that, or just choose catastrophic coverage.”

“Open Medicare to compete with private insurance so if BCBS is charging about $2000 per month for a family, then Medicare could charge something like $1800, based on income,” says another physician. “Families can choose between Medicare option and private insurance as it is now. Veterans get 5 percent off of monthly premium for every year they serve so in 20 years it is free. States can move Medicaid patients to Medicare and free up state money for other purposes. Once enough families on Medicare, the program is solvent and payroll deductions can cease or be reduced. Insurance companies can still sell supplemental insurance to Medicare as well.”

“We need health savings accounts, insurance that goes with the individual, rewards for those who live healthy and penalties for those who chose unhealthy life style,” says a medical professional.

“We need to establish a ‘Health Security Account’ for ever woman, child, and man who citizens of this country,” says a physician. “This would be partially funded with a 500 dollar tax credit to each individual and allow an above the line tax deduction of 2500 dollars.”

“I have found that concierge medical service might be a great alternative to traditional plans,” says another medical professional. “I would prefer a local concierge service with a flat monthly fee and affordable service rates for pharmacy and lab work and carry an affordable catastrophic policy for complicated medical problems.”

“Cash system, with catastrophic insurance, the best and most efficient,” says another physician.

“Let's spend the money on healthy food and active lifestyles and paying doctors to keep us healthy instead of covering up symptoms with pharmaceuticals,” says a non-medical professional. “At 80 I take no drugs, I’m healthier than I've ever been, and I work 40 to 50 hours every week farming and marketing produce grown for high-density nutrition.”

Instant Insights /

More than 90% of physicians oppose single-payer medical care: AAPS

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