Sally Pipes: Doctors need a second opinion on 'Medicare-for-all'

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The American College of Physicians, the nation's second-largest doctors group, has endorsed "Medicare-for-all." The group, whose membership consists of 159,000 internists, claims the plan would bring a host of necessary changes to the American healthcare system.

The American College of Physicians joins the American Nurses Association, the American Medical Association's Medical Student Section, and at least a dozen other medical professional groups who have called for the United States to implement a single-payer health care system.

These doctors may soon regret their decision. "Medicare-for-all" would saddle physicians with pay cuts, long hours, and rolls of regulatory red tape. That would cause even more doctors to burn out — and leave millions of Americans without access to quality care.

Doctors have seen better days. More than 40 percent of physicians say they're burnt out, according to a recent survey by Medscape. Over half of the doctors surveyed pointed to bureaucratic tasks as the leading contributor to burnout. One-third said long hours were a major stressor; a similar share pointed to insufficient pay. Sixteen percent said government regulations were to blame.

"Medicare-for-all" would exacerbate these problems. For starters, it would drown doctors in regulations and bureaucratic tasks. The "Medicare-for-all" proposal offered by Sen. Bernie Sanders, I-Vt., would establish "uniform reporting standards" that would order providers to report information on procedures, prices, and outcomes to the federal government.

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Doctors also better prepare to work longer hours for less money. "Medicare-for-all" would make health care free at the point of access. That would encourage Americans to consume more care than they currently do. Providers would have to spend more time on the clock to keep up with demand.

And they'd receive less money for each hour they log. If "Medicare-for-all" adheres to Medicare's existing payment schedule, then doctors would receive 9 percent less for every office visit and 60 percent less for every emergency department visit, relative to average private in-network rates, according to one analysis published by JAMA, a medical journal.

Canadian doctors are stretched so thin that some prohibit patients from discussing more than one issue per appointment.

Medicare's payment rates are projected to be 40 percent lower than those for private insurance over the first ten years of Medicare-for-all's implementation, according to the Mercatus Center's Charles Blahous. That would represent some kind of pay cut for doctors.

By making physicians' lives more miserable, "Medicare-for-all" would drive many from the profession. Already, about half of physicians say they want to change career paths; 17 percent are planning to retire.

A "Medicare-for-all"-induced exodus would exacerbate America's doctor shortage. According to the Association of American Medical Colleges, the United States will face a shortage of more than 120,000 physicians by 2032. Patients everywhere would struggle to get timely care, particularly in rural and urban areas.

None of this is hypothetical. It's the reality for doctors in countries with single payer. In the United Kingdom, nearly 60 percent of the National Health Service's staff work unpaid overtime each week, according to the organization's latest staff survey. The average physician in the United Kingdom takes home around $138,000 a year — considerably less than the $313,000 earned by the average American doctor.

Between the long hours and lackluster compensation, the NHS struggles to retain doctors. The NHS had over 9,000 doctor vacancies as of March 2019. Things are poised to get worse. A group of British think tanks predict the NHS will be short 7,000 full-time general practitioners by 2024, if current trends continue.

By forcing doctors to endure poor working conditions, single-payer hurts patients as well. In part because the NHS doesn't have enough doctors to treat every patient on schedule, 9 million Britons had hospital appointments and operations canceled between 2017 and 2018. Many of the patients fortunate enough to get an appointment are treated in dangerously understaffed facilities. Some general practitioners see more than 70 patients per day. Nine in 10 NHS hospital bosses say that staffing shortages could harm patients' health.

Things aren't much better in Canada. Canadian doctors are stretched so thin that some prohibit patients from discussing more than one issue per appointment.

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Of course, that only applies to the lucky few who can get appointments. Last year, an estimated 175,000 people in Canada's four easternmost provinces were waiting to be matched with a family doctor. All told, Canadians were waiting for over a million procedures in 2019.

The American College of Physicians claims "Medicare-for-all" would give Americans access to free, quality health care. In reality, it would make things worse for every single American, starting with physicians themselves.

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