Physicians

Doctor fee stalemate exemplifies problems of universal health care

The thousands of physicians and millions of Medicare beneficiaries who think the government should provide “universal health care” insurance to all Americans are getting a good look at how ugly such a politically-driven scheme would be. Doctors would see their incomes fall, and patients would suffer big time.

Because Congress cannot agree on how to prevent a 10.6 percent cut in Medicare payments, doctors are threatening to drop their Medicare patients. And because the Democrats want to prevent the cut in Medicare payments to doctors by cutting payments to private insurers that cover millions of Medicare beneficiaries, insurers are threatening to drop out of that program and make those Medicare beneficiaries very unhappy.

The Washington Post’s report on the politically-driven stalemate is here. Clearly, the Democrats are intent on winning political points regardless of what happens to patients. And the Republicans are intent on preserving Medicare Advantage, which they created when they controlled Congress.

Under a “universal health insurance system,” which is advocated by the Democrats, political fights like this would happen every year. Doctors and insurers, if they were still in business, would face payment cuts. Patients would face uncertainty about who their doctors and insurers would be. And relationships between doctors, insurers and patients would become more strained than some of them already are.

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  1. I would like to Thanks for the informative post. Some patients avoided long waits for medical services by paying for private treatment. In 2003, British Columbia enacted Bill 82, an “Amendment to Strengthen Legislation and Protect Patients. Health care can have a zero price to the user, but that doesn’t mean it’s free or has a zero cost. The problem with a good or service having a zero price is that demand will exceed supply. I’m wondering just how many Americans would like Canada’s long waiting lists, medical czars deciding what treatments we get and an exodus of doctors. Thanks for sharing .

  2. With a Universal Health care system there is no dought there will be less personalization with doctors and patients, because patients will be seen by whoever is available at that time. This would lead to “cookie cutter diagnoses” and treatment.It will become more of a business and the bottom line is volume.
    If a doctor had a patient for many years the likelihood of catching something in early stages are higher than not. Due to the experience the Doctor had with this patient over the years. But that patient doctor relationship would be eliminated. Malpractice suits will double if not triple due to doctors misdiagnosing serious illnesses simply because they didn’t have the time they needed to treat or get to know the patients medical history. Patients will become hostel over the lack of concern for their medical care and will consult legal help. This potentially could lead to an encouragement to sue because they would be suing the government; a bigger pocket means bigger payouts.

  3. “no money = no initiative. these bright individuals will find their place in other fields of the private sector”.
    I wonder which other fields of private sector offers the financial reward close to medicine.
    Pls tell me how we get the capable,committed individuals in the armed forces. It is called professional interest. As a matter of fact, the least desirable doctor is the one that entered the profession purely for money !!

  4. i think we are all ignoring the human nature of incentive. all benefits of any of the systems aside, how do you get people who want to become doctors to pay for all the schooling required and invest years of their lives to training to accept drastic reduction in payment that all of these socialized systems of health care would cause. no money = no initiative. these bright individuals will find their place in other fields of the private sector.
    also coverage does not equal care. ask the canadians and the british about gate keepers and long waiting times. we have the highest survival rates in the world when dealing with cancer for a reason. the populations of the countries who do have universal care fall way short of the 300 million people that we have.

  5. “Am I mistaken to this that the “universal” system Peter describes treats doctors almost like slaves? That is, their choices are to either play by the rules, leave the country, or quit?”
    Brian, it’s called collective barganing, not beneath doctors and gives them many more options than other workers in the economy. If you consider the options for docs to be that narrow then what is your reaction to strikes in other industies and your view of worker options then – do you say, “If they don’t like the working conditions then find another job”? People entering the profession in Canada know the rules so if they don’t like the rules then, “find another job”.
    Ontario has had doctors strikes, as well as nursing strikes and both parties do not take the action lightly. Public opinion palys a very large role in the resolution. If bad policy means a shortgae of docs then policy will have to change. I’d rather have that than a closed guild (with the aid of legislation) dictating compensation.
    “The very principle of universal coverage is to enable EVERYONE to have a policy that actually PAYS for healthcare. This is in contrast to today’s system where providers must eat the cost of delivering care to those that can not afford to pay…not to mention the destructive economic and social ramifications for the individual that can not pay.”
    Doug, universal coverage under the present U.S. system will bankrupt us. Single-pay cannot be separated from universal coverage and offers cost controls and efficiencies. Yes under single-pay ALL providers will be compensated and there will be no free riders.
    “Better to remove the items that obfuscate pricing; to remove politics (and campaign contributions) from the equation; and let the market set the prices thru patient demand for services.”
    Marco, what a perfect system, except when patients demand for services falls due to price the disease doesn’t go away. We’re talking about healthcare, not cars that you can junk when they get too expensive to maintain.

  6. My understanding is that it was (maybe still is) illegal to run a private practice in Canada; if you wanted to practice medicine you worked for the government. That is Universal Care.
    Your understanding is off by quite a long way. The systems vary substantially from country to country. In Canada many, if not most, docs are in private practice. In some provinces, however, it is illegal to buy private insurance. In the UK most docs are government employees, however it is quite legal to see private patients too. In Germany and Switzerland private insurance is paid for by a consortium made up of the employers, the labor unions, and the government and prices are tightly controlled. In the Netherlands, private insurance is mandatory with the government providing subsidies for the poor, but in France government paid insurance is universal with supplementary insurance commonly purchased often by employers. In all of those countries the MDs are in private/group/clinic practices like the U.S. In short, it is very hard to generalize about universal health care by pointing to Yurup.

  7. My understanding is that it was (maybe still is) illegal to run a private practice in Canada; if you wanted to practice medicine you worked for the government. That is Universal Care.
    However, many countries (including Canada) with universal care systems are moving toward a parallel system, where they allow doctors to set up private shops (Germany and I believe Sweden have done this). It makes you wonder why Universal Care is something people aspire to?
    A ‘single payer system’ would presumably mean that the government pays for everything, but private contractors (doctors) would provide the services … think Defense Department (gov’t) and Defense Contractors (private doctors).
    For all the trouble with this arrangement, I don’t think anyone has seriously ever suggested that the government hire engineers & start building their own planes and missiles; today’s DoD arrangement may be imperfect, but its still better than the other options.
    The main problem with single payer as I see it is that you add another layer of obfuscation and politicization (I can see the first scandal now; cardiologists getting higher remuneration rates than oncologists because of certain campaign contributions). With the government as a single payer they set prices, not the market (a.k.a. the patients).
    With the government setting the prices, they also indirectly increase or decrease the supply of doctors to a certain specialties. As desirable as this might sound to some, they tried this type of planning in the USSR and it failed miserably.
    Better to remove the items that obfuscate pricing; to remove politics (and campaign contributions) from the equation; and let the market set the prices thru patient demand for services.
    With today’s co-existence of private and government payers, the government pays rates that doctors can choose to accept or not; if enough choose not to, then the government will have to pay more for those services … they’ll have to pay the market rate. If those rates stay high, more doctors move into that field, and rates come down.

  8. Peter writes: “A true ‘universal’ system does not involve private insurance or a two tier level of service that doctors can run to when they are unhappy with the “government” tier.”
    Am I mistaken to this that the “universal” system Peter describes treats doctors almost like slaves? That is, their choices are to either play by the rules, leave the country, or quit? Is this a respectful way to treat those who can save your life?

  9. The debate over whether to allow a reduction in Medicare physician fees or not is not connected to the concept of universal health insurance. There are many models currently in circulation that provide a roadmap to universal coverage while still enabling a private insurance market.
    Unfortunately, you are confusing universal coverage and a single payor system.
    I find it hard to fathom that people would advocate against universal coverage. It is hard to understand an argument that justifies anyone in the United States being denied health care services because of their economic status.
    The very principle of universal coverage is to enable EVERYONE to have a policy that actually PAYS for healthcare. This is in contrast to today’s system where providers must eat the cost of delivering care to those that can not afford to pay…not to mention the destructive economic and social ramifications for the individual that can not pay.

  10. Instead under a “single payer” system, when there’s a dispute between what a government is willing to pay physicians and what physicians need to make in order to stay afloat, we get the problem of doctors’ strikes, as has happened in countries like Germany multiple times in recent years.

  11. A true “universal” system does not involve private insurance or a two tier level of service that doctors can run to when they are unhappy with the “government” tier. If universal is going to work then we all have to be in the same system and have the same committment to its success. Trying to keep the old system while tinkering with a new one will mean failure and continuing escalating costs. Universal unfortunately for too many people means pay for all my healthcare wants, and pay the price I want – not going to happen.

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