The concept behind “Medicare for All” is to create a single-payer, government-run healthcare program that covers all Americans, and not just older Americans who are currently covered by Medicare, thereby replacing the current health insurance system comprised of a plethora of public and private plans. As with any social program, however, there has been fierce debate regarding the mechanics and feasibility of such a program, including among physicians. A key concern for many physicians has been that a single-payer plan will negatively impact earning potential, but a recently published article by Christopher Cai, MD, in the Journal of Internal Medicine makes the case that “physicians would prosper under single-payer reform.”
Dr. Cai notes solid evidence suggesting benefits to physicians’ bottom line with implementation of a single-payer system, including:
- Recent estimates by the nonpartisan Congressional Budget Office (CBO). The CBO has undertaken an economic analysis of single-payer health reform, providing projections of five single-payer models versus continuation of the current healthcare model of public and private insurers. Based on its estimates, in 2030, the weighted average of public and private payments to physicians will increase to 116% of the 2019 weighted average, compared with a range of 108% to 117% under the various single-payer models examined. Although some of the single-payer options showed lower returns than those projected if the current system is maintained, the CBO anticipates clinicians’ total revenue will still increase because of greater demand for healthcare services as health insurance coverage becomes nearly universal and fewer restrictions are placed on patients’ use of care. Overall, the CBO estimates that total outpatient revenue will be 5% to 9% higher with a single-payer system versus the current system.
- Data showing cost savings from streamlined billing and fewer administrative tasks. Currently, US hospitals and physicians must manage multiple payers, each with their own complex and varying coverage rules and payment procedures, adding significant administrative burdens. It is estimated that a single-payer plan could free up 5% of physician work hours that are spent on billing. This would enable physicians to spend more time on patient care, which has the potential to boost per-physician revenue by almost $40,000 to almost $160,000 annually.
- Experience/lessons from countries with single-payer systems. A study examining the average net income of Canadian physicians over 150 years found that physicians’ income increased after a single-payer system was implemented in the mid-20th century. The study showed there was an initial windfall in earnings that eventually stabilized but was still enhanced from the pre-single–payer days. Furthermore, medicine remained the top-earning profession in Canada relative to other professions until at least 2005.
Dr Cai suggests that Medicare for All may be particularly instrumental in decreasing inequities in physician pay as demand for federal funding for primary care increases, noting that non-White and non-male physicians are more likely to specialize in primary care. He also notes that revenue for safety-net hospitals and clinics, which disproportionately employ physicians of color, are also likely to see revenue increases under a single-payer system.
