The two biggest sources of frustration for the majority of physicians are the EMR systems and bureaucracy within the work environment that physicians are forced to deal with daily. EMRs are a ship that has sailed, unfortunately, and our only option currently is to try and improve this situation.
However, the bureaucracy and administrative burdens that physicians encounter are issues that we should challenge, and I feel single payer is a solution (not the only solution, but the best) to this morass. Frankly, physicians’ hard work directly supports the immense bureaucracy that is present in the hospital and private insurance companies. Why are physicians forced to see ever more patients in a shorter period of time? So visits can be billed, and the lifestyles of the C-suite and middle management can be supported. These individuals have salaries in the hundreds of thousands of dollars and never lay eyes on a patient. Ironically, physicians are increasingly pushed to provide “high-value care.” It is impossible for the managers to provide any value if they are not involved in patient care! If one is in private practice, the same issues manifest — but the physician’s clinical volume supports her office staff, most of whom deal with the insurance companies and not take care of patients.
There is no perfect solution to our health care conundrum, but I would argue the pros for the patient and the physician in a single-payer system — arguably the two most important participants in the healthcare equation — outweigh the cons. Three of the most common arguments heard against single payer from physicians are that: 1) Medicare reimburses less than private insurers; 2) the regulations imposed by the federal government are onerous; and, 3) access would be restricted. All of these observations are true but, for practitioners and their staff, there is a daily challenge to collect from insurers.
The insurers’ strategy is to delay and deny claims so their profitability is not impacted. So the overall cost of collecting from the insurer could negatively impact the practice’s bottom line. Keeping track of multiple sets of onerous rules instituted by the insurance company are less challenging than one set instituted by CMS. Dealing with MACRA, MIPS etc. is more difficult when one has to track formulary requirements and inane clinical rules restricting clinical decisions. Access currently is functionally restricted by narrow networks and economic burdens posed to the patient by our health care system. Additionally, in a single-payer system, the PCP can make the referral based on the quality of the physician and not whether the specialist is in the network. A single-payer system would possibly make it easier for graduating physicians to practice in rural settings since initial and ongoing overhead and cost to set up a practice would be less thereby improving access.
The devil is in the details, as they say, of what a single-payer system would look like (Medicare for all, regulated competition, state initiatives like those in Minnesota), but I am writing this from the physician’s and patient’s viewpoint. Most of us went into health care and became physicians to help the sick and would like to get back to doing what we love. Would it not be nice to see patients, help them and not worry about whether insurance would put obstacles in your way or whether the patient is in your network?
Giri Venkatraman is an otolaryngologist.
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