How not to convince doctors to embrace single payer

What would happen to physician salaries if the United States adopted a single payer system?

The concept of a single payer system is a progressive ideal, and has been vociferously pursued by some left-leaning physician groups. For a variety of reasons, not least of which is the political climate in our country, I think the chances of single payer happening soon is relatively remote.

But if it does happen, it will likely be a vast expansion of Medicare, or Medicaid, to everyone — the proverbial “Medicare for all.”

Some physicians are wary of such a prospect, not least of which is the impact on salaries.

From Progress Notes, the blog from progressive-leaning Doctors for America, comes a physician written piece that describes exactly how Medicare for all will affect physician salaries. Unsurprisingly, every field will go down. Some more than others. Radiology, neurosurgery and orthopedics will experience a 20 to 30% decrease, while primary care, like internal medicine and pediatrics will experience drops of 8 to 10%.

Many progressives will argue that a drop in physician salary is a sacrifice worth making in order to ensure universal coverage while saving money. Of course, the doctors affected aren’t likely to agree. After all, no one likes their salary cut.

My issue is with the messaging. Asking anyone to sacrifice, without offering an olive branch in return, isn’t likely to go far. Relying on altruism sounds good in theory, but is rarely successful in practice.

I’ve written before that progressives need to offer doctors something in return for a drop in salary. Specifically, significant malpractice reform and relief in medical education. Yes, physicians get paid a relatively high salary, which generally garners no sympathy from the public when the topic arises. But they also pay exorbitant education fees, graduating with hundreds of thousands of dollars in debt, and American medical malpractice premiums are among the highest in the world.

Personally, I would be wary of a Medicare for all system because of the government monopsony that will result.  I realize progressives would tout that as a feature. But if the Indian Health Service is how the government will run a single payer system, I would be gravely concerned about relying on them to properly fund a national health system.

Like it or not, those on the political left need to convince more doctors to bring their of health reform vision to fruition. They need to offer something more than a pay cut to do so.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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