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    Do you ‘feel the Bern’? What a single-payer system portends

    Henry Rosevear, MDHenry Rosevear, MD

    Dr. Rosevear is a urologist in community practice in Colorado Springs, CO. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, UBM Medica. Please let your voice be heard by joining the conversation in the comments section of each post.


    Maybe it's my military background or maybe my personality, but I tend to think about how certain hypothetical situations would affect my practice. The hypothetical that seems most relevant right now is how Sen. Bernie Sanders’ proposal of “Medicare for All” would actually work.

    But first, what is "Medicare for All"? According to Sen. Sanders’ website, "Health care must be recognized as a right, not a privilege... The only long-term solution to America's health care crisis is a single-payer national health care program." So when he says “Medicare for All,” he really means a single-payer national health care program.

    Let's think about that. A single-payer system is one in which one group organizes and finances health care but the actual delivery of care remains in private hands. The easiest way to implement this is to eliminate all private health insurers and have the government, via the Medicare program, take over.

    But the devil is in the details. For example, Medicare currently pays 80% of most health care, and most seniors either use Medicaid or a supplement to cover the rest. Under Sen. Sanders’ proposal, Medicare would pay 100% with no premiums or deductibles.

    Also by Dr. Rosevear - Cost variation among urologists: Can we trim the fat?

    Incidentally, the government doesn’t necessarily have to be the “single payer.” You could also imagine a system where all insurers across the country band together and set rates as a single payer. Seems like collusion, but as it turns out, a 1945 law known as the McCarran-Ferguson Act, gives this specific industry an antitrust exemption. (Turns out Major League Baseball also has such an exemption.)

    It’s also important to state what a single-payer system is not; namely, socialized medicine. This is not a VA-style system where the doctors and hospitals are owned by the government. Remember, the means of health care delivery are still privately owned, rather it’s just that all bills are submitted to one payer. Most of the articles I read that are against this system argue that single payer is simply an intermediate step between our current system and a governmental takeover of all health care, but in a true reading of the proposal it is not.

    Before I tackle the important question of how a single-payer system would affect my practice (and possibly your own), I wanted to address what the theoretical advantages of such a system are. The advantages and disadvantages of our current system are well known. A good summary of a single-payer system versus the Affordable Health Care Act (ObamaCare) versus the American Health Care Act (the Republicans’ proposed plan that didn’t pass the Senate) is found on a website of a group called Physicians for a National Health Program, whose opinion on the subject is easy to ascertain.

    The advantages of a single-payer system are fairly straightforward. Everyone is covered. Patient choice of physician would likely stay the same or increase; the only doctors who would not be “in-network” would be those who chose to not participate in Medicare, ie concierge doctors. Negotiation power on the side of Medicare would increase against everyone (hospitals, doctors, drug makers, and gadget makers), as there is no more playing one insurance company against another.

    Next: What would it cost?

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.


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