Senator Bernie Sanders, who looks ripe for a good showing in New Hampshire tonight, may make Medicare for All sound idealistic.
But it could put health care out of reach for millions of Americans.
In a must-read opinion piece in this morning’s Wall Street Journal, Sally Pipes, CEO and Thomas W. Smith fellow in health care at the Pacific Research Institute, explains why Medicare for All Might mean doctors for none. It has to do with basic economics.
A single-payer program would pay doctors at rates similar to Medicare reimbursement levels, already at least 25% less than private insurance pays, according to estimates by Charles Blahous of the Mercatus Center. Under the current legislative drafts of Medicare for All, government rates over the first decade would be 40% lower than those paid by private insurers.
That amounts to an enormous pay cut for doctors. U.S. physicians earned on average $313,000 in 2019, according to Medscape’s international physician compensation report. The average physician in the U.K. earned only $138,000. The Commonwealth Fund reports that American general practitioners earned a little more than $218,000 on average in 2016, compared with $146,000 in Canada and $134,000 in the U.K.
Drastic pay cuts would inevitably drive physicians to give up the practice. Patients can’t afford an exodus of doctors. Nearly 80 million people live in <a data-cke-saved-href="https://www.kff.org/other/state-indicator/primary-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7b" href="https://www.kff.org/other/state-indicator/primary-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7b" target="_blank" "}&mod="article_inline"" style="outline: none;">areas with too few primary-care professionals, the Kaiser Family Foundation reports. Even under current policies, the country may face a shortage of as many as 120,000 doctors in a decade, according to the Association of American Medical Colleges.
The prospect of lower pay and stressful work would also discourage young people from entering the profession. Medical school is expensive; the median graduate takes on $200,000 in debt. It’s time-consuming, too. The typical doctor spends four years in medical school, followed by three to seven years in residency and fellowship. Lucrative jobs in finance, technology and law require far less preparation time.
One report from FTI Consulting found that Medicare for All would reduce the projected number of U.S. physicians in 2050 by about 44,000, including more than 10,000 primary-care doctors. Patients would have to compete for appointments with a dwindling number of overloaded and underpaid doctors. Everyone would have coverage, but that’s not the same thing as care.
Some who most loudly cite health care as a human right, ironically, espouse policies that would deny that very right.
Pipes is most recently author of “False Premise, False Promise: The Disastrous Reality of Medicare for All.” (Encounter 2020).
Read the whole piece.