Three out of four dentists recommend this tooth brightening toothpaste — make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger — make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States — make your health care system heal like never before!

But how do we do that?

Do doctors think the Affordable Care Act is the soothing balm for the festering wound that is the economics of the American medical system—paying too much while delivering too little population health? What do our health care experts think about health care reform? Do we think it is a step in the right direction? A step towards doom and damnation?  A small step for insurance companies, a huge leap for mankind?

Personally, I think the idea that all Americans need to have health insurance is a huge leap forward in our social programs, suggesting that all Americans have a right—and a social obligation—to ensure health.  Other small steps allow us to shift incentives to slowly, with time, restructure the health care system to optimize health, instead of medical care delivery. I’d love to see fee-for-service abolished, and reward promoting health. The Affordable Care Act takes small steps in this direction.

As a doctor, I’m optimistic about health care reform. Other doctors aren’t.

“Doctors” are not a monolithic population, all created equal and working under the same set of social circumstances.  Doctors can be primary care doctors or specialists, private practitioners or salaried members of accountable care organizations, living in rural or urban or suburban lands, with different concentrations of specialists and hospitals and communication amongst physicians and different rules in different states governing interactions with other members of the healthcare team.  Doctors do not all share the same opinion, in the same way that not all Americans share the same views.

Polls of doctors show that many doctors have a concern about health care reform. Some think it goes too far.  Others think it doesn’t go far enough.  Others think it is just right.

What all doctors (or at least 9 out of 10) can agree on is the need to understand what is in the bill, and work within the constraints of our system to promote healthcare, however we think best.

Kohar Jones is a family physician who blogs at Progress Notes.

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