National Healthcare Question

[Mr. Blonde]

My cousin is a doctor and has stated that the day national health care passes is the day he stops practicing medicine. He says that it will no longer be financially worth it.

My question is, how much of a pay cut would doctors experience under a single-payer system?

[Whoa_Nelly]

1. Found this answer at a link

http://www.pnhp.org/facts/singlepayer_faq.php#income

<snip>
What will happen to physician incomes?

On the basis of the Canadian experience under national health insurance, we expect that average physician incomes should change little. However, the income disparity between specialties is likely to shrink.

The increase in patient visits when financial barriers fall under a single-payer system will be offset by resources freed up by a drastic reduction in administrative overhead and physicians’ paperwork. Billing would involve imprinting the patient’s national health program card on a charge slip, checking a box to indicate the complexity of the procedure or service, and sending the slip (or a computer record) to the physician-payment board.

on edit:
Also found this answer at another link:
http://www.grahamazon.com/sp/other.php

<snip>
Physician Income

Wouldn't physicians make much less money in this system?
Most physicians would make less gross money, but the same net amount. Because the system would have much simpler billing (there's only one form to fill out), physicians would have much smaller costs, too. Canadian physicians make similar amounts to what US physicians make; specialists generally make less, but medical school is much less expensive and debt-ridden in Canada than it is in the US. Physician income is also much more stable in Canada, where the government is required to pay physicians within 30 days of the bill, or interest is charged to the government. (And surprisingly, when Saskatchewan, the first province to enact national health insurance act in Canada, started its program in 1963, physician incomes increased by 35% the next year.)

[Mr. Blonde]

5. Interesting

I'm guessing that would mean as a radiologist his income probably would fall some.

I can't imagine his patient visits would increase as technology has advanced to the point that he works from home for the most part.

[Clark2008]

2. If your cousin is only in it for the money, then I feel sorry for his patients.

That's not meant to be snide, but the medical profession should be about caring for and healing people - not pocketing huge amounts of cash.

I realize doctors need to earn a living - and a decent one to pay off student loans - but to only be concerned with money makes for a bad physician.

[Mr. Blonde]

8. He doesn't actually have patients

He is a radiologist and in a few weeks won't have to step foot in a hospital again. His work is now done from home.

The setup he has to do that is pretty amazing.

[newfie11]

12. So he doesn't do interventional radiology

and he doesn't do stereotactic Bx's, and no IVP's, BE's, etc,and any number of thing radiologists have to be in the room for. Does he now use a radiology assistant to do those things? I am a tech and if he is not seeing patients and works for/in a hospital I guess I am at loss as to how he does it. Yes the films can be read digitally at home but some things require a Rad on site.
this is one of the highest paid specialties and one of the top ones for law suits.

[Mr. Blonde]

13. I'm not sure what all he does

my uncle has stated he has a license to read some kind of scan that fewer than 100 doctors are licensed for in the country. Apparently the ones he does do not require his presence in the room.

I have seen his setup at home and it is quite impressive. Especially how the system pushes scans to him and then pulls them back if he is distracted and not reading them fast enough. Like when he was showing us around his new house.

[supernova]

3. Then good riddance to your cousin

Sorry, but your cousin is in it for the wrong reasons then, if he's just out to make a buck. I try to stay away from those types anyway.

To answer his question, MDs currently in UHC systems (UK, Canada, France) still make very decent livings, and have a very nice lifestyle. He should watch Sicko to see how MDs in France and the UK live and work. One Doc in Canada said it was nice to concentrate on caring for patients and not have to worry about wrangling with ins cos over care.

And Ironically, they have a lot lower malpractice in UHC systems too. Isn't that what they say they want?

[glowing]

4. When we decide to have National Healthcare, we are also going to have

to fund higher education for those who have the talent to become a Dr. Personally, I think that allowing more people with talent to enter the field will lead to better Drs and better healthcare. Some Doctors become doctors for the financial gain or for the mere fact that their parent was a doctor... I'm sorry that your cousin thinks he deserves much more money than someone else. As our system is set up now, it is expensive to attain the degree, takes a lot of time training in residency and establishing practices, and the insurance costs are through the roof. Doctors make a set amount of money because they need to pay off all these other things... but one should not enter a profession that they desire because they want money.. that's why money is evil.

[Mr. Blonde]

11. I think that was his point

he spent 13 years after high school in training before he was actually employeed fully as a doctor. That is a lot of time to spend racking up bills when you could be out working and not racking up bills (at least of the same magnitude).

As attractive as national healthcare is, it becomes much less so if we are not getting the best and brightest to become doctors. I have been blessed with very good health so far, but when I have to have some form of surgery I certainly don't want someone second rate doing it.

[Nickster]

6. Hard question to answer in the hypothetical. What shape will our plan take? Not every national

healthcare plan is the same. In some plans, doctors have a choice of taking a salary, or an amount per patient. I'm sure that our doctors will do just fine in which ever system we come up with.

[Mountainman]

7. A lot has to do with how a doctor works. If he/she is an employee and gets a percentage of what

cash he generates he/she could negotiate for better terms. If the doctor is self employed they may make less since there will not be payers that pay higher rates than Medicare. But Medicare payments are already changing. Doctors will be paid based on the severity of the illness and the outcome of treatment. Before some doctors took only the most economically treatable patients because the payment was the same no matter how much treatment was necessary.

Most insurance companies base their reimbursements on Medicare rates. They are increasingly coming closer and closer to Medicare.

So if there is a single payer system doctors will be paid like all patients were medicare.

It will force doctors to be like the rest of us. If they want more money they will have to work harder.

If a doctor threatens to stop practicing, what else will they do? It has been my experience (and I have worked with many doctors as an accountant) that doctors may be brilliant physicians but they are not very good at anything else.

[lovuian]

9. Doctors are working for Insurance companies

and have been cutting their salaries over and over again

Most Doctors are in favor of Universal Health

in england the Doctors are still paid very well

[Jackpine Radical]

10. First, not all MDs feel that way.

Second, if your cousin is only praciticing because of the large income, then medicine is better off without him.

Third--and to finally address your question--various proposals would reimburse providers at different rates. I think the Canadian experience is that an MD makes maybe $150k instead of $200k. Some specialties might actually see their reimbursement rates increase. In outpatient mental health, for example, average reimbursement rates have actually dropped by maybe 50% in my area. Some insurers are demanding that providers sign contracts with them that cut fees by 2/3--while the insurer increases the premiums on its clients.

The fact is, the insurance system is a huge barrier between the provider and the patient. They limit who the patient can see, they siphon off immense profits, they find ways to deny people needed care, etc. And we have to hire a person who spends most of her time hassling and haggling with them over payment issues. Insurers are always arbitrarily and retroactively denying payments. They will sometimes authorize a service and then refuse to pay for it.

Some of my work as a psychologist is in what is at least an analogue of a single-payer system. I do psych evaluations for the criminal justice system and get paid either by the courts, by prosecutors, or by the public defenders, depending on who hires me. I run this operation doing my own billing--I just fax my itemized bills to the responsible party and get paid. I would never consider trying to operate this way in the health care world. I retain an affiliation with a clinic just to have them handle my scheduling and insurance billings for the healthcare part of my practice. I make considerably more money out of the forensic part of my work, being paid by governmental entities, than out of the health care end, paid privately.

Your cousin is probably assuming that he will be paid at medical assistance or medicare rates. Those rates are truly abysmal, and I doubt that a full-blown single-payer system would pay at those rates. That is certainly not the case in the rest of the world.

[catnhatnh]

14. Not to pick on your cousin, but horsecock...

what other thing will he do for a career as well paying? Will he move to storm ravaged areas and become a roofer or carpenter? Can he dance well enough for a "reality show"? Does he have a slot as a business guy not better filled by an MBA? Your cousin is a spoiled brat who opposes having to serve as a doctor to proles or figures other high end earners are not as clever as he is. I'd love to see him try...

[hokies4ever]

15. That's stupid. It's not like salaries would change overnight.