Single-payer: Is the ivory tower this naive?

Many academic physicians support a single-payer system. This physician from Yale writes in the WSJ:

The only solution is to eliminate the HMOs and go to a single-payer system that does not have to be administered by the government. The savings would increase reimbursements to health-care providers (and, it is hoped, stem the annual loss of primary care physicians) so that there would be greater access to care for more patients with fewer hassles.

Dr. Gaines is laughably naive if he puts his faith that the government will use the savings to increase physician reimbursements.

Comments

Anonymous
I doubt if it’s changed from my days as med school faculty.
Yes, they are that laughably naive.
Anonymous
I am sure that his academic salary would not be affected, so why should he care. The myopic views of academicians are even worse than those of politicians. At least politicians have to ultimately answer to the voter. Academicians answer to nobody but their own internal flights of fancy.
Unfortunately, people tend ascribe credibility to these folks, who are often neither great physicians nor great teachers.
Anonymous
“Dr. Gaines is laughably naive if he puts his faith that the government will use the savings to increase physician reimbursements.”
They’re not increasing reimbursements under the current system, so that’s hardly a criticism of a single payer system.
Anonymous
A single payer system that is not administered by the government?
How do you get the authority to impose a single payer system if not through the government?
I don’t see that Congress would do that, then write themselves out of the loop – nor should they.
While they are hacking away at HMO executive salaries they can take on other executives as well –
shadowfax
Most academic physicians have no fricking clue how the business of medicine works, and most not only don’t care but actively disdain the topic as beneath their notice.
It drives me nuts since not only does it drive such naive pronuncments, but it actively harms the newer generations of physicians who continue to graduate with no education in the mechanics of their business.
Having said that, he’s only half wrong. Single payer probably would save a lot of money, but it sure would not go to physician reimbursement!
Anonymous
It’s silly to say what “single payer” would or wouldn’t do. A single payer system based on what we have now would cost far more – adding in 80 million people’s worth of questionable MRIs and elective hip replacements would far outweigh increased efficiency. A single payer system based on that of other countries, with rationing for non-emergent cases as a limit on spending probably would cost less.
Of course in neither case will any money go towards increased reimbursements.
Anonymous
So what are you critics doing that WILL increase reimbursement?
“adding in 80 million people’s worth of questionable MRIs and elective hip replacements would far outweigh increased efficiency.”
Of course, given that physicians already claim they do this anyway due to “defensive medicine”, won’t this be a wash?
Anonymous
Amazing. The author has done absolutely no research and is devoid of even the most minimal clue. I am astonished this would find its way into print.
Next door in Massachussetts (with the highest per capita U.S. physician population), “reforms” and “universal coverage’ are annihilating primary care medicine as we speak. And try to get a PCP in Ontario, despite the presence of single payer tyranny. And the Canadian system goes downhill from there.
Yeah, single payer is the road to responsive, high quality medical care, with a big increase in physician income.
Ed Sodaro MD
Amityville, NY
Anonymous
“Of course, given that physicians already claim they do this anyway due to “defensive medicine”, won’t this be a wash?”
Uhh.. no? Because they’re not doing it (much) on the 80 million people without insurance? That’s kind of the point.
Anonymous
The host of this site believes the Massachusetts example is the way to go. Why is he wrong?
masaccio
If the host likes the Massachusetts plan, he must love the Clinton plan, which extends it to the entire country.
Anonymous
Maybe he is right. It’s too early to tell.
However, the Massachusetts plan does nothing to address the spiraling cost of care due to simple increased consumption. As long as our legal system provides huge incentive to overtest we will see a massive excess in the usage of diagnostics. Even that may not be enough to defeat demographics, but it’s a more palatable start than heading straight to rationing of care that is actually useful.
Anonymous
“As long as our legal system provides huge incentive to overtest we will see a massive excess in the usage of diagnostics.”
It’s always someone else’s fault, isn’t it?
Roy M. Poses MD
It appears Dr Gaines is not a full-time faculty member.
See this link for his private office address:
http://www.med.yale.edu/intmed/education-new/pdf/general_medicine_preceptors.pdf
He is not on what appears to be the roster of full-time internal medicine faculty here:
http://info.med.yale.edu/intmed/faculty/index.html
So regardless of what one thinks about his position on a single payer system, it cannot be blamed on his holding an “ivory tower” full-time faculty position.
Anonymous
For better or worse, it would be nice to see the Massachusetts plan actually tried, and see how it works out.
It’s barely been implemented.
It’s easy for me to say ’cause I’m not in Massachusetts.

Single-payer: Is the ivory tower this naive?

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