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Doctors and healthcare reform: a duty to understand?
  1. Theodore Long1,
  2. Joseph S Ross1,2
  1. 1Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Theodore Long, Robert Wood Johnson Foundation Clinical Scholars Program, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520, USA; theodore.long{at}yale.edu

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In the USA, the politics around healthcare reform have created polarised views of the Affordable Care Act (ACA), but underlying these views is a disquieting lack of knowledge that could have harmful consequences for patients. Recently, television host Jimmy Kimmel interviewed a series of citizens on the street, all of whom vehemently stated their objections to Obamacare but were supportive of the ACA, suggesting misperceptions and lack of knowledge about the legislation among the public. But this is not just a case of late-night comedy. A recent Commonwealth Fund Health Insurance Marketplace Survey found that only two out of five adults in the USA were aware of health insurance exchanges or that there might be financial assistance to purchase plans.1 Even among childhood cancer survivors with substantial long-term healthcare needs, almost all participants surveyed did not have knowledge about health-insurance related laws.2

Physicians, who are experts in practicing medicine, are often assumed by patients to be experts in the legal changes affecting healthcare delivery. However, the reality is that most physicians are not experts in health policy,3 and it is not only the public that lacks knowledge about the ACA. In a recent survey of 2958 physicians in the USA, 45% did not know what an accountable care organisation was, but 65% felt that healthcare will deteriorate over the next 5 years after passage of the ACA, while only 27% believed the ACA will have a positive effect on patients.4 Furthermore, despite the ACA increasing Medicare and Medicaid reimbursement to …

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