Doctor Biases Lead to Irrational Healthcare. Is Single-Payer the Rational Choice?

Doctors do not check their biases at the door when they walk into the exam room. According to Yale University researchers, on certain issues such as marijuana use, abortion, and firearms, a doctor’s political affiliation may influence his or her reaction to patients and the quality of care provided.

Doctors who identify as Republicans, for instance, are more likely to be concerned about a patient’s use of marijuana, more likely to attempt to dissuade patients from having abortions, and are less likely to discuss firearm safety with patients who admit to owning guns. Democratic doctors, on the other hand, were more likely to simply dismiss patients who owned firearms by telling them that they shouldn’t have them, rather than explaining how they could mitigate risks to themselves and to young children in the household. Though the study did not examine issues such as end-of-life care or transgender healthcare, how physicians discuss these matters with patients could also be impacted by political affiliation.

Yale researchers also discovered correlations between doctors’ specialties and their political affiliations. Surgeons, for instance, are much more likely to be registered as Republicans, while psychiatrists are more likely to be registered as Democrats. What the research does not show, however, is whether a doctor’s experiences in a particular specialty might lead her or him to identify with one party over the other or if a person’s personality traits and life experiences that might lead her or him to identify with one party might also lead to being predisposed to practicing certain fields of medicine.

Regardless of why certain doctors in particular fields might identify with a political party, the results of this research demonstrate that far from being completely objective and rational actors, doctors can be just as influenced by their biases as anyone else. Being aware of potential doctor biases and their impact on care is an important aspect for patient self-advocacy. Often discussed in the context of patients with cancer, HIV, and other chronic conditions, patient self-advocacy involves an individual’s own self education and understanding of their medical condition and the ability to navigate the complexities of the United States’ health insurance system. Ideally, a patient who is fully informed about the care and treatment of a health problem will be able to better advocate for the best care and defend the need for that care to insurance providers. Knowing potential doctor biases is one more aspect of healthcare that patients should be aware of in order to be fully informed and communicate their needs to their doctors.

Unfortunately, political biases are not the only biases that influence doctors or that impact the quality of their care, and many patients, especially low-income individuals, don’t have the time, energy, or experience to fully advocate for themselves or their children. Research has shown that uninsured parents in particular are at a disadvantage in attempting to navigate the healthcare system for their insured children. In the fee-for-service healthcare model in place in the United States, physicians may be incentivized to refer patients to facilities from which they get a kick-back, whether the patient genuinely needs those services or not. From the patient’s perspective, excessive referrals can also often lead to conflicting medical advice and confusion. One study published in Health Services Research described the frustrations of parents whose children were referred to many doctors, some of whom unnecessarily repeated tests or gave contradictory prescriptions.

Rather than an irrational healthcare system based on individual physician biases and profit incentives that impede real care, our healthcare should be based on rational diagnoses and treatments that deliver the best quality care to all patients. Unfortunately, the US for-profit healthcare system all too often impedes these ideals. A more rational, caring healthcare system might be a single-payer model, which cuts out the insurance companies and guarantees that doctors and patients can focus on quality care, rather than worrying about payment incentives or a patient’s inability to pay.

Single-payer may also play a role in mitigating the political biases of physicians and their effects on patient care. Because of its emphasis on preventative medicine, a single-payer healthcare system emphasizes a strong, consistent relationship between patients and primary care physicians, a relationship that can be difficult to foster in a for-profit healthcare system where patients may frequently change insurance providers or where insurance companies may drop coverage of one primary care practice for another.

In a single-payer system, with patients consistently seeing one primary care physician who provides a central point for all aspects of healthcare, patients are encouraged to form a trusting relationship with their doctor. This relationship would ideally foster communication between doctor and patient and allow patients to better understand their healthcare, ultimately empowering them to better advocate for themselves as patients. This communication between doctors and patients might also allow patients to provide better checks on doctors’ biases. Physicians for a National Health Program states that under a nationalized, single-payer system, “Accountability, achievable only if patients are maximally empowered and involved, is structurally nurtured by an open and publicly controlled funding process and impeded under managed competition by multiple intermediaries between providers and patients.” By cutting out the complexities of navigating the insurance system and streamlining the healthcare system itself, single-payer would make self-advocacy easier for patients.

Many physicians increasingly see the benefits of such a system. A survey by Physicians for a National Health Program found that an increasing number of doctors across specialties support single-payer (even in specialties the Yale researchers found are more likely to attract Republicans, such as surgery and anesthesiology). If physicians, even those who are more likely to be politically conservative, are starting to see the rationale in switching to a single-payer healthcare system, then humanists should as well. I’ve written before about why single-payer is a more compassionate healthcare system than our current for-profit model. But it’s also the more rational one. If humanists are unconvinced to support single-payer through appeals to compassion, then perhaps they should consider single-payer as the more rational alternative to for-profit healthcare.