The Volokh Conspiracy
Mostly law professors | Sometimes contrarian | Often libertarian | Always independent
A recent survey of doctors by the Physicians Foundation finds that most give low grades to Obamacare. Some 46% of the doctors polled gave Obamacare a grade of "D" or "F" and 29% gave it a "C." Only 25 percent give it an "A" or a "B," including just 4% who gave it the highest grade. It's possible that some of the doctors who chose C really meant to say that it was at least reasonably good. But in modern America, thanks to grade inflation, a C is generally considered a very bad grade. Thus, it seems likely that a large majority of doctors have strongly negative views of the program.
I. The Case for Voter Deference to Doctors' Views on Obamacare.
The interesting question is how much the views of the doctors should influence others' evaluations of program. This turns out to be a more complicated issue than it might initially seem.
In this recent column for The Hill, Dr. Jeffrey Singer argues that the doctors' views should be given considerable weight. It's not hard to see his point. Doctors are experts on health care, and they are in a better position than most of the rest of us to judge the impact of Obamacare on patients. Among the general public, there is widespread ignorance about fairly basic aspects of Obamacare. It often makes sense for "rationally ignorant" voters to defer to the views of experts with greater knowledge. Deference to doctors on health care policy might be one case where this is true.
But there are also possible countervailing considerations. One is that earlier surveys suggest that many doctors are also ignorant about aspects of Obamacare. Being a doctor does not automatically make you an expert on health care policy, any more than my being a professor automatically makes me an expert on government policy on higher education.
On balance, however, it is still likely that the average doctor knows a lot more about Obamacare than the average person. Moreover, they may be particularly well-positioned to observe the effects of the program on the doctor-patient relationship, such as the diversion of time and resources to dealing with bureaucratic red tape that Singer emphasizes. Most doctors may not be full-fledged experts on health care policy. But their views are on the subject are likely to be better-informed than those of the average voter, so the latter might do well to defer to them.
II. What if Doctors' Views on Obamacare are not Really Based on their Superior Expertise?
But perhaps doctors' distaste for Obamacare isn't really a result of their superior expertise. Like the rest of us, doctors' opinions about Obamacare may be a product of their overall political orientation. Many liberal Democrats probably support Obamacare primarily out of ideological and partisan loyalty, and many conservative Republicans probably oppose it for the same reason. Historically, doctors have often tended to support the GOP, so their distaste for Obamacare may simply be a product of partisanship. Studies show that voters routinely overvalue evidence that confirms their preexisting views, while ignoring, misinterpreting or downplaying data that cuts the other way. This point applies to me as well as to the doctors. I have long been opposed to Obamacare, and that could lead me to overestimate the significance of evidence – like the survey of doctors – that supports my preexisting view.
But it is unlikely that partisan bias accounts for anything close to the full extent of doctor's distaste for Obamacare. Doctors dislike Obamacare at a much higher rate than they support the GOP and oppose the Democrats more generally. A recent study of doctors' donations to political campaigns finds that, over the last twenty years, what used to be a large preponderance of donations to the GOP has changed to the point where doctors contribute to both parties equally. The donation data probably overstates the actual degree of doctors' support for the Republicans, because people who donate to political campaigns are disproportionately older, male, and higher-income, while younger, female, and lower-income doctors are more likely to donate to the Democrats. Thus, a much higher percentage of doctors give low grades to Obamacare than would be predicted based purely on their partisan loyalties.
Finally, it is possible that doctors dislike Obamacare not because of an objective evaluation of its merits, but because it somehow harms their self-interest. Contrary to conventional wisdom among non-experts, public opinion scholars consistently find that there is only a modest correlation between voter self-interest and issue positions. Still, self-interest does influence public attitudes on some issues, and this may be particularly likely in occupational groups' views on programs that directly impact their profession.
Even if doctors' political opinions are somehow more influenced by self-interest than those of other voters, it is not clear which way that cuts. After all, Obamacare requires both individuals and businesses to purchase more health insurance than they would otherwise, which in turn increases the demand for medical services, thereby potentially increasing the income of health care providers – including doctors. That is likely one reason why the American Medical Association – which lobbies on behalf of the interests of the medical profession – supported the Affordable Care Act. The fact that most doctors differ with the AMA on this issue and choose not to defer to an organization with a long history of effectively representing the interests of the profession, is itself some indication that their views are not merely the product of narrow self-interest.
Overall, it is hard to avoid the conclusion that doctors' negative views of Obamacare are at least in substantial part driven by their expertise on health care. To the extent that this is so, it should indeed influence the rest of us to take a more negative view of the program. Still, it is also important to remember that most doctors have only limited expertise on broad issues of health care policy. Moreover, there are risks in deferring to the views of even genuine experts. Doctors' negative evaluation of Obamacare is noteworthy evidence. But it certainly should not be considered anything like a definitive resolution of the debate over the program.
UPDATE: It is worth noting that even subsets of physicians who are disproportionately likely to be liberal Democrats still give the ACA poor grades. For example, 69% of female physicians and 70% of those who are 45 or younger assign the ACA a grade of "C" or below (compared to 77% of male doctors, and 77% of those who are 46 or older).