How specialists view universal health care

I have to agree about the Medicaid rates. The temptation to reduce payment to that level with all of the pressures to come on the Medicare system–the over-committed federal budget, more retirees with fewer taxpayers per retirees–will be necessary and irresistible.

The natural floor to cuts will be the business failure of private practices; and more than just a few will fail. That will be a new and frightening experience for the profession. Some specialties will feel more pain than others, particularly those that cannot replace lost per-encounter payment by volume. For some practices, if single-payer is instituted, there will be loss by substitution of better paying insurances received now with lower government payment. For EDs, fewer encounters will go unpaid, but there won’t be any such thing as better payment from better insurance either. Some specialists will disappear as their practices become unsustainable under the new terms.

Those who have made second income sources of surgery center ownership had best hope they soon clear their debts from their purchases. There will be big cuts in facility fees, regardless of the recent history of sustaining levels of compensation. Look for cuts on the order of 50% or more for some codes. That will make some services and even some surgery centers financially unfeasible. Again, with a single payer, the floor and the ceiling are much more likely to be closer together for a given procedure, and both will be much lower than they are today. Some centers will be shuttered, and some will go bankrupt. If you are a doctor with a large loan out for the purchase of a surgery center, settling that note or finding a buyer might be a good idea about now.

Business failure in private practice will create shockwaves through the medical education system as well. The ability to charge and get premium tuition rates from medical students will likely see its first real challenge, as many otherwise-interested students will shy away from medicine once real risk of failure and insolvency face graduates at the other end of the pipeline. Nostrums such as “trading” theretofore higher pay for a supposed better lifestyle under the new paradigm will be given the lie when it becomes obvious that the “new” lifestyle won’t be all that much better but the pay will be much lower. Sullen comparisons between medical pay and pay for professions demanding far less investment of time and money and requiring far less responsibility and accountability will cause many more doctors to become bitter and disillusioned of practice and their profession. Unlike the doctors of a generation before, these doctors will be trapped, unable to generate personal income surplus sufficient to retire, indebted heavily for their educations and with little prospect for relief, some will quit outright for other careers, an unheard-of choice in years past.

As health care becomes something fully within the political realm as a single government-payer responsibility, its attractiveness to politicians all too ready to promise services without regard as to how the resources will be found,
the demands placed upon the profession, in fact upon the whole medical system will bring the whole system closer to collapse than anyone might ever have imagined. Greatness will have long given way to mere survival and ultimately to exhaustion.