Universal Health Care: Is Medicare really a single-payer success? One doctor’s opinion.

by James Hubbard, M.D., M.P.H.

“If you want an example of a successful single-payer system, just look at Medicare,” many say.

I say, not really.

A single-payer system is the form of universal health-care Canada and Great Britain use.  Several groups are advocating for it.  People on the right tend to view it as socialized medicine at its worst. Many on the left think it’s ideal. President Obama has tried to distance himself–and his plan–from it, frustrating some Democrats.

With Medicare, the government is the single payer.  And it’s worked so well, some say, why not just extend it to all?

The problem is, Medicare is not working well. The reason it’s been somewhat successful is it has been subsidized, in an indirect way, by private insurers.

Medicare pays such low fees that many primary-care physicians would have trouble making ends meet and staying in practice with those payments alone.  Instead, health-care providers, including doctors and hospitals, have been able to make up the difference by charging the private insurance companies more.

Some doctors don’t even take Medicare.  It’s not worth it to them, especially after taking into consideration the extra personnel they have to hire just to go through the red tape to get paid.  If you don’t cross all the t’s and dot all the i’s (and keep up with when they change the rules right out from under you), the claim may be denied and the office has to start all over again.

I don’t tell this to whine and gripe.  Most doctors get along just fine.  We don’t need pity.  I just don’t want the system to fail.

What I worry about is when I retire.  I’m getting older and will be on Medicare soon and I want quality care.   Medicare for all is not the answer.  It won’t hold up.  Not without a major overhaul of Medicare itself.

What do you think?

Here’s our doctor debate on how to reform Medicare.

James Hubbard, M.D., M.P.H., is the publisher of My Family Doctor, a magazine written by health-care providers for the general public.

As with all information on this site, this article cannot replace professional, personal medical advice. Read more here.

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5 Responses to “Universal Health Care: Is Medicare really a single-payer success? One doctor’s opinion.”

  1. Steve Parker, M.D. Says:

    I agree that Medicare is not working.

    I had to close my primary care medical office in Pensacola, FL, in 2001 because I had too many Medicare patients. Medicare wasn’t paying me enough to keep the office open. I was generating $250-300,000 yearly in revenue, but office overhead expenses were so high that I was taking home less than $50,000 a year. My wife was my office manager and has a very good head for business – I’m too embarrassed to say how little I paid her. I couldn’t afford health insurance for me and my family. I did max out my IRA contributions for retirement – $2000/year back then – that was my only retirement plan.

    When I closed the office, I’m sure many of my patients replaced it with emergency room visits. Much more expensive for Medicare and inconvenient for the patients. But the nameless, faceless bureaucrats and our legislators don’t care.


  2. Brandon Says:

    Dr. Hubbard,

    I’m glad you brought up this issue of what a single payer system would look like. I often tell people, if a public plan is anything like Medicare and Medicaid is today in terms of poor reimbursements, delay in payment and bureaucracy, the government will have little support from physicians; despite what the AMA may say.

    I do have to respectfully disagree with two issues. First, I don’t think Medicare has been subsidized by private insurance companies, directly or indirectly.

    Medicare (and Medicaid) is subsidized by physicians.

    We know Medicare reimburses significantly less than private insurances. If a doc is getting $100 from a private payer and $40 from Medicare for the exact same services, who is eating the $60 if the doc treats a Medicare patient? It is NOT cheaper to treat a Medicare patient.

    In reality, it is the doc that foots the bill. See Dr. Harper’s comment above for a real life example of what Medicare can do to a practice. It was Dr. Harper (and his wife) that was subsidizing Medicare, not the private insurance companies.

    Secondly, your comment about providers charging private insurance more as a result of poor Medicare reimbursement can be misleading. The fact of the matter is that providers get paid what insurance company says they will get paid. Providers can’t charge more for anything. Fee schedules are set by insurance companies, not providers.

    So how do doc’s make up for subsidizing the government’s health plan? By seeing more patients an hour or by not seeing them at all.

    Keep up the good work. I enjoy your post.


  3. James Hubbard, M.D., M.P.H. Says:

    Good points, Brandon.

  4. James Hubbard, M.D., M.P.H. Says:

    Dr. Steve, thanks for a first-hand point of view.

  5. Dentist Palmdale Says:

    That was a very nice insight. Thanks for sharing it to us.

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