Some doctors support single-payer health care — even if that means a lower salary. I’m wondering more and more, about who is Cookoo, Cookoo today?? I know that Bernie, Nancy and many of our politicians are crazy or Cookoo, but educated physicians?
Remember last week when I discussed the explanation that if we adopt Medicare for All that one of the outcomes of this system would be a reduction in physician salaries. Dylan Scott reviewed the feedback regarding the Medicare for All plan as he reported from the muscle of the health industry lobby — pharma, health plans, doctors, and hospitals — some of which is gathering to stop proposed single-payer systems.
The Hill’s Peter Sullivan had the report on Friday morning. The industry’s influence can’t be underestimated: It stopped Clintoncare. And, for better or worse, it was a boon for passing Obamacare that the industry mostly supported the legislation.
The industry’s disparate interests fight over a lot of issues, but Medicare-for-all unites them. That is going to be a factor if we get to 2021 with a Democratic Congress and president, and they decide to pursue single-payer health care.
That moment really might come. A sign times are changing: A Republican health care lobbyist called me recently to ask whether all-payer rate setting would be a better alternative to single payer, by causing less disruption. (I quibbled that you would need some kind of coverage component, given the moral urgency that is animating the left on health care.)
Still, a Republican almost endorsing price controls. That is a pretty strong indicator of where our health care debate seems to be heading.
Payment cuts for health care providers, if we eliminate private insurance and move everybody to Medicare rates, are going to come up a lot in this debate.
Those cuts are an easy thing for industry lobbyists to target and for Republicans to run ads on. Cuts could be overstated, depending on how much legitimate waste single payer can actually eliminate by consolidating the administration of health care, but the projections for Medicare for All plans are going to anticipate big cuts.
That explains the industry’s lobbying position. But the reality on the ground is more complicated than that. There are absolutely health care providers who support single payer. Quite a few of them sent me emails after I asked for their thoughts last week.
Here are some of the most interesting responses. From a registered Republican working at a next-gen gene sequencing company:
Medicare is, without question, the most reliable, most predictable payer that we deal with. And for somebody like me, it would be a dream to only have to deal with them. Yes, they are pretty heavily regulated. And yes, they have pretty strict guidelines for who to cover. But unlike other payers, who make life virtually impossible for smaller providers because they’re in the for-profit game (the not paying for care game), Medicare at least adheres to a clear set of rules. Other payers put up an endless set of traps against reimbursement, contracting, and other parts of the revenue lifecycle that add substantial cost to services and thus increase the cost to the consumer. I can say with near certainty that parties in my industry would provide services at a materially lower price and with more predictable out of pocket costs if every payer was as reliable and consistent as Medicare.
As such, I’m now, despite growing up a conservative afraid of such government largesse as “Medicare for all,” convinced that a single public payer, either as rate setter or as a true single-payer, is needed. In contrast, I remain a staunch defender of private medical care, where companies such as my own and our competitors do battle to increase quality and lower patient cost.
So I guess you could count me as pro-Medicare for all, a sentence I never thought I’d write 15 years ago.
From a retired neurosurgeon, who had also thought of himself as a Republican:
I practiced neurosurgery in Texas and retired 20 years ago. I started out as a pretty solid, but non-thinking, Republican, opposing perceived intrusions of Medicare into my practice. I read Himmelstein and Woolhandler’s NEJM articles and thought they were Harvard hippie Communists. Over time, I came to see that they were right, that we really need a universal health care system, as so many of my patients weren’t getting needed care. I was a bit embarrassed making as much money as I did and would have done it for half of that.
From a radiation oncologist of more than 20 years, in Chicago and for the military:
I left full-time medicine a few years ago after getting fed up with continuously fighting insurance companies for pre-authorization and for the right to practice medicine the way I was trained within the standard published guidelines. I now work part-time seeing primarily uninsured and Medicaid patients.
A 2011 Health Affairs study found that the average US physician spends nearly $83,000 a year interacting with insurance plans. And a 2010 American Medical Association Study found the average doctor spent 20 hours a week on pre-authorization activities. This has only gotten more expensive and much worse. Under a single-payer plan, this would be much easier and far less expensive.
In addition, we know that the major cost of malpractice coverage is for the continued medical care of the patient that was harmed. A single-payer system would ensure that any such patient would be covered for the rest of their lives and as a result, malpractice coverage would also be dramatically lower.
While reimbursement under a single payer plan most likely would be less, so would the headaches and administrative hassles and costs. And I would be able to see far more patients instead of being on the phone fighting with a case manager, while my office and malpractice coverage costs would be far less.
From a Texas oncologist still early in their career:
My general view of Medicare-for-all is that it would moderately contribute to remedying our health care spending problem, but by no means fix it.
My understanding is that the biggest savings would come from getting rid of the huge administrative dead weight in our private insurance system. However, that in and of itself would not fix the fact that billing rates are through the roof here in the US. Saving a few percents on overhead would be great, but MRIs and appendectomies are still going to cost 2x-4x here than in other OECD countries.
I am definitely heterodox among physicians in believing that our salaries (mainly among specialists such as myself) ought to be significantly lower. The greater bargaining power than a single, government payer might have could potentially rein in some of that.
On the other side, from an anesthesiologist intern in Chicago, fiscally liberal but socially conservative, who has some concerns about how single payer would handle Catholic hospitals:
The one part of a more single-payer system that worries me relates to the socially conservative opinions I have. I’m sure you have seen the series FiveThirtyEight has had the past week on the effects of Catholic hospitals coming to predominate in more rural areas and even some cities. (As someone who grew up in a small town, I can say the main healthcare provider in the area is a Catholic hospital.) I don’t fear a single-payer system would result in individual providers being required to provide services they individually oppose for religious beliefs.
However, I do worry about whether or not there would be requirements for Catholic hospitals to provide services contrary to Catholic teaching, generally surrounding abortion or end of life care, in order to be eligible for billing Medicare. I do presume a Medicare-for-All system would pass on a party-line vote with only Democrat support and could see them trying to expand abortion coverage–either directly in a law or through regulation like many abortion coverage issues have been changed–at the same time since that issue has also grown much more partisan in the past decade.
Again I believe that even these physicians fail to see reality. My question is are you willing to accept Medicare for All as the new health care system including the lower reimbursements and lower salaries, and when will it stop? Will the salaries see continual reductions to make the huge debt to continue the program? And how will the newly trained physicians pay off their loans and pay for their required malpractice insurance?
The real problem here is that these experts touting the Medicare for All programs is that they don’t realize that in order to make a universal health care/ single payer health care program to work tort reform and the cost of education of health care workers has to be part of the solution. If not the new program, whatever it is, will fail or become so expensive and expand out of control.
The solution to the health care crisis is not one factor but an equation that needs to have a solution to each factor!
And Trump continues to change the present system. Consider this article in USA TODAY:
Trump administration takes aim at the Obama-era Medicare program for 10.5 million seniors
Ken Alltucker of USA TODAY published a recent article of President’s Trump’s continued attack on Obama’s modification of the Medicare program.
The Trump administration on Thursday moved to tighten controls over an Obama-era health program by making doctors and hospitals take on greater financial risk for 10.5 million Medicare patients.
Seema Verma, the Centers for Medicare and Medicaid Services administrator who has been critical of the Affordable Care Act, said the changes are necessary because the Medicare program had “weak incentives” for health-care providers to slow spiraling costs.
Under proposed changes, hospitals and doctors would adhere to a more aggressive timetable to save money while maintaining the quality of care. Medicare, the federal health program mainly for adults who are 65 and over, projects the changes would save the federal government $2.2 billion over 10 years.
“Pathways to Success” shortens the maximum amount of time ACOs are not subject to performance-based risk to 2 years or 1 year for existing shared savings only ACOs.
“After six years of experience, we feel we know what works and what doesn’t,” Verma said. “We want to focus on delivering value for patients and taxpayers.”
Verma said, without changes, that the nation is on pace to spend $1 out of every $5 on health care by 2026, an unsustainable path that will harm families, businesses and the economy.
The Obama program, part of the Affordable Care Act, encouraged hospitals and doctors to band together as “accountable care organizations” to coordinate medical care and cut down on unnecessary tests and procedures. The idea is that if these organizations could deliver care at a lower-than-projected cost, they could collect bonus payments from the federal government.
However, CMS said that 82 percent of 561 accountable-care organizations chose a risk-free version of the program that provided little incentive to reduce spending. These organizations recouped savings if they cost Medicare less than projected, but they faced no financial penalty if they billed more than expected.
The upshot: Congressional Budget Office projections that the Obama-era program would save Medicare $5 billion through 2019 never materialized.
Under Verma’s changes, participants would be limited to two years in the risk-free version of the program. The current regulations allow these organizations to stay for 6 years.
The likely result will be hospitals and doctors dropping from the program.
CMS projects that nearly 20 percent of participants will drop out of the voluntary program due to the more aggressive timetable. However, an industry organization called the National Association of ACO’s predicts 71 percent will drop from the program.
The American Hospital Association said the proposed changes “ignores the reality” that hospitals are at a different point in transiting to this type of “value-based care.”
“The proposed rule fails to account for the fact that building a successful ACO, let alone one that is able to take on financial risk, is no small task,” the hospital group said in a statement. “It requires significant investments of time, effort, and finances.”
Verma also will require doctors and hospitals to notify Medicare patients if they are enrolled in such a program. Medicare recipients also could earn bonuses, such as gift cards, if they meet preventive care milestones, Verma said.
Well, this Fox & Friends Twitter poll on “Medicare for All” didn’t go as planned
Christopher Zara reported that in today’s edition of “Ask and Ye Shall Receive,” here’s more evidence that support for universal health care isn’t going away.
The Twitter account for Fox & Friends this week ran a poll in which it asked people if the benefits of Bernie Sanders’s “Medicare for All” plan would outweigh the costs. The poll cites an estimated cost of $32.6 trillion. Hilariously, 73% of respondents said yes, it’s still worth it—which is not exactly the answer you’d expect from fans of the Trump-friendly talk show.
Granted, this is just a Twitter poll, which means it’s not scientific and was almost certainly skewed by retweets from Twitter users looking to achieve this result.
At the same time, it’s not that far off from actual polling around the issue. In March, a Kaiser Health tracking poll revealed that 6 in 10 Americans are in favor of a national health care system in which all Americans would get health insurance from a single government plan. Other polls have put the number at less than 50% support but trending upward.
More on Medicare for All!
thanks for providing this balanced discussion!
Thanks for the comment.
I have been tryiing to present a balanced discussion for 5 years.
Difficult to do at times, especially with all the misconceptions out there.
I believe that it is up to we physicians to clear the air and lead the discussions help design a workable solution.