Bernie Sanders’ ‘Medicare-for-all’ gets mixed reviews by physicians

In a campaign season where healthcare has taken a back seat to other issues, one presidential candidate feels it’s time to move America toward a single-payer system to further capitalize on the progress of the Affordable Care Act.

Prior to the latest Democratic presidential debate held on January 17, Vermont Senator Bernie Sanders unveiled details of his “Medicare for All” health plan for all Americans.

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Sanders’ vision builds on the 50-year history of the Medicare program and eliminates private payers and employer-sponsored plans altogether in favor of a federally administered single-payer healthcare program. The plan, Sanders notes, would cover the entire continuum of healthcare from primary care to specialty care and allow Americans to choose the physician they want without worrying about in-network privileges or how to afford out-of-network costs.

Sanders’ campaign also estimates that the plan would save $6 trillion, but it would also cost $1.38 trillion annually, paid for primarily through a new 2.2% income tax on all Americans, a 6.2% tax on employers, and raising income tax rates for those in the highest income brackets.

“What a Medicare-for-all program does is finally provide in this country healthcare for every man, woman and child as a right,” Sanders said at the recent Democratic presidential debate in Charleston, South Carolina. “…My proposal [is to] provide healthcare to all people, get private insurance out of health insurance, lower the cost of health care for middle class families by 5,000 bucks. That's the vision we need to take.”

Next: Physicians react

Sanders added that his intent would not be to “tear up” the Affordable Care Act, but instead “move on top of that” to a Medicare-for-all system.

Physicians are divided on how effective such a plan would be, as evidenced by the reactions from the Medical Economics’ Reader Reactor Panel, a group of 200 professionals nationwide:

It sounds like a good program but will be complicated to implement. Today we are spending too much money on Medicaid, Tricare, Medicare, and private health insurance without improvements in access or quality or outcome data like life expectancy and infant mortality. Most of the healthcare money is spent on practicing unnecessary defensive medicine. Private insurance is getting very expensive with high deductibles. Everybody loses health insurance (except our senators and congressmen) when they lose their jobs. Now the average family is paying almost $6,000 to $8,000 per year, in addition to co-pays and deductibles.

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In this program, they should also add a nationwide physician licensing/hospital credentialing system, so that physicians can move across the state lines which will decrease the physician shortage. Medicare should start negotiating drug prices which decrease the cost the medications. There should one nationwide health care pricing system. Most important of all, we need a solid tort reform which is the root cause for our unnecessary hospital admissions and tests.
 
Raju Patnam, MD
Family medicine
Greenville, South Carolina
 

Next: 'You cannot manage what you don't measure'

To paraphrase Peter Drucker, business management guru, you cannot manage what you don't measure and you cannot measure what you don't manage. Single payer is, to me, a former physician-executive, an opportunity to collect more comprehensive process and outcome data, and then better manage the continuum of care by it.

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With a single-payer system, by definition, we can integrate all the patient care data in all the applicable settings-hospital, primary care physician (PCP) [practices]/medical home, specialty, and ancillary care. This non-silo view of things also allows incentives to be better aligned. For example, I, as a practitioner can make more if I help patients better, and I practice within a reasonable standard, efficiently, cost-effectively and effectively. The obverse is that if I churn, over utilize, over refer, fractionate the care, have a high preventable hospitalization rate, etc., I should make less.

In single payer, when the incentives are properly aligned, "for profit health care" becomes an oxymoron, medical loss ratios will once again be used to help us refocus on putting “patients before profits,” and the gross disparity of earnings-PCP to specialist-will diminish, allowing the primary care supply to better meet the demand for appropriate, timely care.

Jeffrey Gene Kaplan, MD, MS
Pediatrics
Monroe, New York

Next: 'It will be just another massive hole'

About time.

The issue remains in medicine unlimited demand with limited supply.

If there is a list of covered benefits like Oregon has for its Medicaid benefits-only essential issues with the return of many years of life-I will support this.

What can be done about soaring drug costs?

If it is just another boondoggle, paying millions and millions of dollars for [drugged], demented elderly to live for months in the ICU for “experimental” chemotherapy etc. …  It will be just another massive hole where billions of dollars are poured into with minimal return for the populace at large.

The health insurance companies are gouging out 15% or more of the GNP to “regulate” health care. They must go!

John Bakos, MD

Internal medicine/Pediatrics

Roseville, California

Next: 'I have been ready for single-payer for a very long time'

I am in favor of the "Medicare for All" plan. I was a member of Physicians for a National Health Plan 30 years ago, but can't afford the dues now. I am reimbursed extremely poorly for the time I take listening to patients, educating, preventing disease, and complications.
I visited Canada recently to explore their health system, and it is amazing. As a primary care doctor, I saw a society where primary care is respected, well paid, and [daily] hours are not wasted trying to figure out all of the health plans, preauthorizations, and formularies. It was like visiting Wonderland. I asked my friend, who is having knee issues and had an MRI scheduled, "How long did you have to wait?" "I didn't wait,” she said. “It's scheduled for next Tuesday." "Did they have to submit requests? Preauthorizations? Did you have to go to a center only covered by your health plan?" "No, they just called the hospital and scheduled it," my friend said.
I returned to the U.S., to my desk full of paperwork. Here's one, a nursing home patient, whose plan no longer covers the insulin he has been on for years. OK, there's no formulary here. Somehow, I must try to get into their website and hope that it is up to date, and it is not indexed, so I will have to scroll through hundreds of pages, just to find out that all of the insulins are now tier 4 or tier 5.
Yes, I have been ready for single-payer for a very long time.

Susan P. Osborne, DO
Family medicine
Floyd, Virginia

Next: 'Do you want the government to have complete control of our lives?'

Well, on the surface it sounds like such a wonderful idea: just one payer to deal with. We physicians would not have to please multiple payers with different requirements. It would streamline what we do. But let’s say that happened. And Medicare was the only payer. There would be no alternatives. They would have complete control over physicians. They could do what they want and would. If you don't like what they do then you could not choose a different plan to be in; because there aren't any. You could just choose a new profession. So this is a really bad idea. Really. Do you want the government to have complete control of our lives? That would be a disaster.

Leon Driss MD, MMM
Internal medicine
Lakeside, Arizona

Next: 'Let's not move into socialism any further'

I don't agree with Bernie Sanders’ universal health care plan. I've seen quickly how the debacle of Meaningful Use, government driven incentives for electronic health records, and ongoing confusion with CMS regulations/payment structures have led to physician burnout, early retirement, and the deterioration of physician morale. The public doesn't like it, physicians don't like it, and further attempts at a single payer system will continue to breakdown the doctor-patient relationship.

I can't possibly expect young men and women to assume over $200,000 in osteopathic or medical school debt and enter a system that relies on the whim of CMS and tax revenues.

Physicians and patients are best served with fee-for-service models or you will see the consolidation of services towards larger hospitals, leaving rural America with hospitals offering no surgical or ICU services. I practice in Dayton, Tennessee, and our hospital made the decision to not schedule any further joint replacements secondary to the "bundled" mandate of total hip and knees. We had an excellent orthopaedic surgeon basically shut down from doing joint replacement in our hospital. Maybe this is what America wants, to live in this unrealistic world where patients have no consequence for their actions, no need to control their diabetes or quit smoking, so Dr. Bernie can replace their joints. I doubt it. Let's not move into socialism any further.

Dan Logan, DO
Family medicine
Dayton, Tennessee