Single-payer supporters, be careful what you wish for

Sure, Charlie Baker has a vested interest not to have a Medicare for all or single-payer system adopted. But what he says makes sense, and I wonder myself why some physicians (*cough*PNHP*cough*) have such blind faith that the government won’t take a hatchet to the medical profession in the name of saving money.

Governments have consistently shown their stripes in these times of budget shortfalls, repeatedly cutting physician and hospital payments despite the fact that this will obviously lead to higher costs down the road:

In Massachusetts, the state is not only cutting Medicaid payments prospectively – it’s cutting Medicaid payments for some providers retrospectively – simply choosing not to make payments to them they had planned on and expected.

I must say, each time this happens, I can’t help but wonder if the hospital operators and physician leaders who think a single payer like Medicare For All is a good idea ever stop to think about how these agencies deal with their financial problems. When they have a problem, they unilaterally whack their provider community hard – in ways private sector payers would never consider.

If there was only one payer, we will be slaves to their arbitrary payment cuts. There will be no recourse. We can’t “drop” our only payer, like we can now with Medicare and Medicaid.

And tell me how is that better than what we have now.

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  • DX

    No, private insurers would never think to hold back on their bills – except when they do.

    The problem with Medicaid is that we – and our leaders – find it all too easy to scrimp on poor people. Folding Medicaid into a broader program might remove that temptation.

  • Peter

    Even though there would be a “single-payer” system, that does not mean that physicians are forced to take only those payments. They can simply move to take cash only. Unless Pete Stark et al decide that it is illegal to practice medicine outside of the single-payer system.

  • Anonymous

    Yes, plan on your surgical specialists opting out in droves. It won’t be pretty but how cheaply do you want (or expect) a surgeon to work?

  • charlie

    DX – Read the article. Thanks for sharing. While I get your point – that private payors aren’t always great business partners either – I need to point out that the article you link to references the fact that the markets in which disputes between payors and providers run hottest tend to be ones in which health plans have consolidated. As a result – and I’m paraphrasing the authors here – providers (and probably employers and members) don’t feel like they have a lot of options to choose from when disputes over what’s covered and what’s not arise. That’s a bad thing – and in the end, neither side steps up and does what needs to be done to clean up the administrative dispute.

    I wonder if this isn’t exactly the scenario that would play out under a single payor. The markets we operate in all have more than three private carriers – and we compete – on a number of fronts – including on our ability to get our administrative act together and make our claims processing systems work the way are supposed to. We know our provider network, and our customers, have options – good ones – to choose from, and it forces us to be accountable business partners.

    That said, I’d offer up two other key points in response to the article. First, almost all private health plans support independent third party reviews for claims in dispute – which in most states, is done by the state department of public health or the state department of insurance. This makes most of us pretty careful about not paying claims that might be overturned on review. It looks bad, and it is bad, when it happens. Second, sometimes, it really isn’t our fault – hard as that may seem for many to believe.

    But like I said – this is a call I believe the provider community will have to wrestle with in the not too distant future – and while I understand the attractiveness and simplicity of one payor, people should appreciate that that comes with its own set of risks and downsides as well.

  • Anonymous

    The best we could hope for is a Canadian-style system which we are not well equipped to accept or implement, at present. We have a population very used to specialty care on convenient terms and relatively few generalists compared to Canada, per capita. We would not accept delays for non-emergent problems, as they do, either. And the concessions the Canadians have made to afford their coverage, high personal income taxes and the absence of income tax deductions on home mortgages would be an unwelcome price for many Americans, no matter how much they admire the Canadian model of egalatarian care.

  • Anonymous

    The PNHP people are True Believers–and True Believers are impervious to facts, experience, and reason–there is no point is discussing things with them.

    Medicaid will continue to go down. We once thought that churches and families and private individuals were the proper source for the weak in need, we decided about 150 years ago that the absolute weakest–mentally ill and orphans mostly, were proper recipients of state aid. We have expanded that to the point that we now open the public trough to no only the poor but the middle class and the wealthy as well–college students and their parents, bankers, sugar barons, industrial scale farmers, etc. There is a terrible press of strong pigs at the public trough, and the weak get pushed out of the way. So medical service for the poor and especially the mentally ill just wither away.

    Don’t think that making Government care universal will solve it, or that you will have freedom. On the first point, one must remember that most people are healthy most of the time in need of nothing but incidental limited services from the health care system. The expensive patients–the seriously desperately sick are few in number and here are the “weak” who will get pushed back from the trough–as in Canada and UK where an unneeded visit when you have a cold is available (lots of votes there) but timely brain surgery when you have cancer is doubtful.

    Freedom to opt out is a threat to any “universal” system. Look at how Bernake bullied the healthy banks into taking the King’s shilling to keep them under his control and not risk embarrassing the whole bailout premise by demonstating by their independent unaided prosperity that this crisis is in fact a particular mismanagment problem by numerous but particular banks that ought to fail rather than a systemic problem that justifies more money and power in his hands. The planners have seen how the efficiency of private care in Britain has been an embarrassment to the NHS (contributing greatly to its erroding public support) and even how the US has likewise provided unfavorable comparison to the Canadian system for availability of services. The True Believers will always explain the failure of their statist solutions by blaming those who try to stay outside of it, like Stalin blamed the Kulaks for the famine, and so eventually even without initial conscious intent end up effectively pursuing Mussolini’s “Everything under the state, nothing outside the state, everything for the state”.