It is only in the last 10 years that “Medicare for All” has become the “health care equality” catch phrase and proffered solution to rising health care costs. But Medicare isn’t health care; Medicare is insurance. There is an argument that Medicare forces the cost of health care to decline if it is the single insurer available to Americans. But there are consequences to such an approach; once we move to single payer, the insureds – you and I – won’t dictate what procedures we need or want, Medicare will. The insureds won’t determine who our doctor is, Medicare will. And since Medicare pays about 60 percent of the amount other insurers pay for the same procedure or physician visit, the current shortage of physicians in America will escalate, leaving rural states in the cold.
The shortage of physicians available to provide care to Americans is real, and many states, including Montana, make significant efforts to recruit physicians to serve our population. But the barriers to obtaining a medical education are significant. The cost for a physician’s education is enormous; many physicians leave medical school and residency hundreds of thousands of dollars in debt. They take the risk of the debt, assuming a high salary sufficient to cover the debt will be available to them when they enter practice. The salaries of most physicians are paid by the revenues collected from patients, usually via insurance payments. The amount an insurer will pay for a visit to a physician varies, with Medicaid paying the least, followed by Medicare.
So, in order to meet overhead, physicians rely upon patients with private insurers to subsidize the losses they may realize in treating Medicaid and Medicare patients. Thanks to the Baby Boomers, 10,000 people per day become eligible for Medicare, which further skews the payer mix. Thus, if we eliminate the private insurers from the payer mix, this will affect the ability of physicians to generate revenue. This is not a plea for sympathy for the physician; it’s simply a fact that must be recognized if single payer is pursued. No doubt, the desire to become a physician becomes less palatable when a 40 percent pay cut greets the physician as they exit residency, combined with sleepless nights from being “on-call” every three days, and a malpractice system that generates white-knuckle fear for many.
Recruiting good physicians to remote areas is incredibly difficult even without single payer health care. And if the health care in and of itself is unavailable, the value of single payer is pretty minimal. This would be akin to having car insurance but no mechanic available within 250 miles. Unquestionably, our health care system is broken and in need of a fix, but the fix must work for all Americans, not just those who live in high population areas.
Tammi Fisher is an attorney and former mayor of Kalispell.