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Single payer system

Discussion in 'Anesthesiology' started by acidbase1, May 6, 2018.

  1. acidbase1

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    So it’s pretty much a forgone conclusion that a single payer is coming. What will this do to reimbursements/our income? Doesn’t Medicare/Medicaid pay about 50% of private payers for Anesthesia services? I believe for surgical subspecialties it’s closer to 75%, so we are the ones who are going to get hit harder than anyone. Also, this is all pure speculation, but when do you believe this crossover is going to take place? I’m thinking 2021 once the New Democratic President takes office whomever that may be. No way in hell trump wins again.

    Berkshire Hathaway's Charlie Munger says single payer healthcare will come when Democrats take control
     
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  3. dchz

    dchz Avoiding the Dunning-Kruger
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    Get this guy some peanut brittle, may be he'll change his mind.

    he also thinks the single payer system won't be that much better than what it is now.
     
  4. Dr.whom

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    I dont think its a forgone conclusion. If Sanders is president with majority democrats in house and senate, then yeah, maybe he can get it through. But even Obama couldn’t get single payer with a democrat congress. There’s too much money and lobbyists involved.

    Also, I’m no fan of Trump, but I wouldn’t count him out in 2020. Everyone pretty much thought he was going to lose 2016 and look what happened. That dude is drenched in scandals and yet nothing is happening to him anytime soon. Roaches know how to survive.
     
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  5. ambiturner

    ambiturner ASA Member

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    Without major reimbursement changes single payer would destroy anesthesia. Medicaid pays what, $13 a unit? And Medicare 22? You'd have to do 10,000 units solo just to hit 200k before expenses.

    And sure CMS pays more to other fields, but their overhead is much higher (offices etc) and they keep less of what they generate overall. Everyone would take a huge hit under such a plan.
     
  6. Money Moniker

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    God I hope so. The only thing smaller than my concern about how many porn stars Trump has had sex with is how much the aforementioned number affects me: zero. On the other hand, seeing my income potential cut by anywhere from 20-50% while the tax rate on what's left goes up to over 50% would put me in a murderous rage that might well cut into my life expectancy. And all this after the interminable life-hold that is medical training. Trump 2020 all day long.
     
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  7. algosdoc

    algosdoc algosdoc

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    My prediction is Trump will not win in 2020 due to the American public tiring of his irrational theatrics, his inability to tell the truth, and his hyperbole that is likely to cause another war before that time. He will have gone through about another fifty Cabinet members by then, and will have an army of the formerly employed willing to disclose the true degree of mental instability that will worsen rather than improve over time. A single payor system is likely in the year 2021 as a lash-back against decades of Republican intransigence regarding healthcare and their inability to develop a coherent healthcare plan of their own.
     
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  8. acidbase1

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    This is what I see coming. I don’t see anyway we won’t have a single payer honestly. The liberal media machine is working hard towards this one. So if this is the case, what’s the plan?
     
  9. aneftp

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    Single payer is coming rather we like it or not. Obviously if the democrats control everything in 2021. They will push hard this time. Once u start giving an entitlement. It’s over. It can never be taken. They will do a Medicare for purchase for those over age 50 people can “buy in”. But of course will rig it for those who cannot afford it so government will buy their Medicare buy in.

    The most successful part of Obamacare isn’t the the exchanges. It’s the free Medicaid give a away. I’ve always said. The people on the exchanges most of them already had insurance. Just switching from non exchanges to exchanges and the Obama’s administration tries to brag 8-12 million on the exchanges when in fact. Very few of them were newly insured previously uninsured.

    But we have like 8-10 million free Medicaid give a way.

    Govt also likes to brag 6 million ages 26 and under on parents plans. When in fact half of them would be on parents plan anyways due to being full time college students. And the other half are healthy and insurance dirt cheap for health young adults.
     
  10. nolagas

    nolagas Member

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    Single payer is inevitable though I wouldn’t predict when it will go into place. Single payer isn’t so much the problem as Medicare-based single payer would be. Even if it is based on Medicare, anesthesia is an extreme outlier on the negative side for Medicare payments so hopefully we’d be able to get an adjustment to current rates.
     
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  11. aneftp

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    Field of Anesthesia is not sustainable at Medicare rates. I tell everyone. Even in crna only practices. They average around 300k.

    Rate adjust for work hours/call hours. It will cost 300k for crna only.

    So if government continues to pay 30 cents on the dollar for commercial insurance pays anesthesia. Hospitals (or AMCs) will have hard time even paying crna let alone MDs.
     
  12. anbuitachi

    anbuitachi ASA Member

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    I'm guessing there'll be a lot of lobbying. Why is it 30c on dollar anyway and not the actual dollar?
     
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  13. Man o War

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    When/if single payer materializes, I’m sure the whole system will be overhauled. It won’t really matter what Medicare/aid rates are now. Plus, the insurance lobby has enough money in lobbying that there will still be an option to purchase private insurance which will allow people with the means to have better coverage and care. Employers in most cases will still purchase private insurance for their employees. Very similar to the 2 tier systems we see in countries that currently have single payer. CRNAs will likely be paid closer to other advanced practice nurses. We will likely see hospital consolidation where many less profitable(read:rural) hospitals will close.
    Who knows. So many variables to consider.
     
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  14. Twiggidy

    Twiggidy ASA Member

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    Agree. There's now way the private insurance industry will just end. As said above, the people with money will purchase boutique insurance and likely get prioritized in hospitals. As is the big complaint in the NHS system, the wait times will increase for those on the national system.
     
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  15. caligas

    caligas ASA Member

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    Agree about two tier but why would most employers buy private insurance when there is a free option? Maybe for high income jobs but I think it will be a very small percentage of the payer mix. And I would predict the law likely WOULD be based on Medicare rates as this will make the bill look cheaper and more predictable, improving the chances of getting it passed.

    Anesthesia would have to lobby for an exception to that payment schedule.
     
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  17. Man o War

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    I am assuming we are all on salary at this point. Individual specialties wouldn’t need to lobby for rates in that scenario.
    Like @Twiggidy said, there will be hospitals that cater to people with money, and they will be able to afford higher salaries for their doctors.
    If we remain on fee for service, that opens up many possibilities that I couldn’t even begin to make a prediction on.
    I think employers will use supplemental group policies as part of their benefits package, since the base care will suck. People who only have base care will wait for care. If you’re an employer, you want your employees to be healthy and productive and back to work quickly.
     
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  18. Twiggidy

    Twiggidy ASA Member

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    This is how a health care gap (larger that what already is) would be created. Basically upper middle classe/wealthy and people with very good jobs (ie professionals) would get the good insurance while middle class folks would get the single payer system. It would probably lead to the creation of "boutique hospitals/clinics" and "everyone else".
     
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  19. Twiggidy

    Twiggidy ASA Member

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    And it's in this scenario that just about every specialty with mid-levels will have to worry because these hospitals will do everything they can to pull a profit, even it means cutting back on higher paid MDs in favor lower paid mid-levels. This is where the single payer would really start to worry me.
     
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  20. Man o War

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    One wild card I really am not sure about it surgeon owned surgery centers. Not sure if those become part of the “boutique” hospitals or the hospital lobby slashes their reimbursements to the point they’re not viable anymore.
     
  21. Man o War

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    Then it’s a game of musical chairs where you’re the doc trying to be sitting at the boutique hospital when the music stops. People who can afford the private insurance aren’t going to settle for substandard care from nurses.
    Surgery is not even safe in this scenario, since number of surgeries will be rationed, therefore demand/compensation goes down.
     
    #19 Man o War, May 7, 2018
    Last edited: May 7, 2018
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  22. SolidWater

    SolidWater Anesthesiology Resident

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    The above doomsday scenarios making Australia look pretty nice.
     
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  23. Man o War

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    I don’t think doomsday is a foregone conclusion by any means.
    Don’t vote for politicians who want single payer, no exceptions. I’ve held my nose and voted more times in my life than I can count.
     
  24. anbuitachi

    anbuitachi ASA Member

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    The problem is the current system is unsustainable. At some point they'll be forced to make a change for the sake of change.
     
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  25. SolidWater

    SolidWater Anesthesiology Resident

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    Agreed. It's definitely not a forgone situation.

    Insurance companies will put up a fight.

    Additionally, two logical fallacies are buried within the comments above:
    1) Trump losing means no other "Republican". (And don't write him off so easily just because he continually shoots himself in the foot with the things he says.)
    2) A Democrat (or Bernie) would automatically push single payer or be able to (have house and Congress, etc.)

    It's still very "un-American" (read: would be a hard sell) to ration care like Europeans or Canadians. As an example, consider the differences in physician decision-making capacity around CCM and withdrawing futile care in USA vs. UK.

    All that said, though, I'll still peace out to Australia if the bottom falls out. I'm too far in debt.
     
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  26. SolidWater

    SolidWater Anesthesiology Resident

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    Or just keep doubling down (bandaid) like the government likes to do.
     
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  27. Man o War

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    Item 1 on my agenda: cap administrative costs at each hospital to a set percentage of gross revenue....not profit. Let the C suite fight over a finite piece of the pie. Hopefully all these worthless nurse middle managers and administrators who provide zero patient care and make our lives hell go the way of the dodo bird. Save money, make doctors’ lives easier.
    Streamline operations and make things more efficient.
     
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  28. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    Don’t forget NZ.
     
  29. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    If I was CEO all “managers” would be given 6mo sabbaticals. If things run smoothly in their abscence, they would return to work to find a pink slip on their desk.
     
  30. SolidWater

    SolidWater Anesthesiology Resident

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    ANZCA

    Problem is they make you do your "registrar" (residency) or some similar skill verification years in BFE regions.

    Yes, I've actually mapped out how to do it.
     
  31. Man o War

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    I cannot believe some of the people on the payroll at hospitals I’ve been at. I know we need managers and executives, but there is so much waste and redundancy it’s unreal.
     
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  32. LebronManning

    LebronManning Probationary Status

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    Oh my god lol. No offense but I can't believe someone would make statements like "Single payer is a foregone conclusion" in this country. I expect that kind of talk out of UC Berkeley feel the Bern sophomores.

    Why didn't it happen when Obama had the house, senate, and supreme court? He didn't even make an attempt. The ACA was NOTHING like anything a single payer country would implement.

    Single payer is fundamentally un-American. If you all haven't noticed this country is still very "american" and will be so for at least the next 100 years.

    Also...Trump is more likely than not going to win in 2020. How can you guys say scandals even matter when this guy won the presidency 2 weeks after "grab em by the *****" was released. No one cares about his controversy..people will continue to vote for him cause he's a no BS guy that gets stuff done. He's already done more than enough in the public eye (tax plan, north korea) to win again and I'm sure he'll do more by 2020. He sure didn't lose a single voter who voted for him in 2016 but he gained plenty.

    Finally, do you have any idea how strong our private insurance companies are in this country? What, they're just going to bow down and out?
     
    #30 LebronManning, May 7, 2018
    Last edited: May 7, 2018
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  33. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    But a lot of the BFE regions actually the best parts. Hell, outside of Auckland pretty much all of NZ is BFE. Great surf, beautiful scenery, and all the sheep you can . . .

    Anyways, just marry an Aussie/Kiwi. The process is easier if you’re a citizen.
     
  34. SolidWater

    SolidWater Anesthesiology Resident

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    Definitely can't underestimate the power of insurance group lobbying.

    Also, I'll leave this here:
     

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  35. LebronManning

    LebronManning Probationary Status

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    Also don't forget lobbying power. AMA is consistently top 5 lobbyers in the country and big pharma is obviously up there. Both vehemently oppose single payer for obvious reasons.

    At the end of the day, lobbying power and funding is one of the most important things that affects legislation. Just look at how the ASA has been doing work and pretty much fighting off the CRNA threat single handedly.
     
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  36. dhb

    dhb Member
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    We have a single payer and our system is also unsustainable. We have experienced the same rise in administrative (non productive) positions as elsewere.
     
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  37. caligas

    caligas ASA Member

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    Forget moving to another country. Make hay while the sun shines, save and invest well, and retire just in time to benefit from free nationalized healthcare long before reaching Medicare age.
     
  38. algosdoc

    algosdoc algosdoc

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    Obama lacked the support from his own party for single payer insurance and had to limit his redefinition of the American health landscape accordingly. Whether Trump can realistically take credit for changes that he had no direct input into (e.g. Korea) is merely conjecture. And I give the American more credit than to believe they would continue to follow Trump with all his antics for another 4 years.
     
  39. Twiggidy

    Twiggidy ASA Member

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    Most certainly. There are way too many “white coat” nurse admins getting paid way too much to do nothing
     
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  40. jonnythan

    jonnythan Some men play tennis, I erode the human soul

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    I think it's a great idea to base your political ideas and votes on what will affect you personally, without regard to how it will affect society at large and especially those far less well-off than yourself.
     
  41. anbuitachi

    anbuitachi ASA Member

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    But you also have to prove that they are doing nothing. We have plenty of things that are not backed by evidence but we are still doing. Like not being allowed to wear undershirt underneath scrubs
     
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  42. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    I know you’re being sarcastic, but I actually think you should vote for what benefits you personally. Everyone should. Then, what gets passed/elected are the laws/people that benefit the majority. That’s kinda the point of a democracy. While I’m not some right wing zealot like a few people on here, my main problem with the Democratic Party is that they insist they know what’s best for me.
     
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  43. Man o War

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    In that case, I'm assuming you will go to your hospital admin tomorrow and volunteer your services for free. Because it will be better for society at large and those far less well off than yourself. You could save a patient hundreds, maybe even thousands just by volunteering your services.
     
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  44. Twiggidy

    Twiggidy ASA Member

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    SDN has been quite “troll-y” as of late.....I might take a sabbatical myself
     
  45. jonnythan

    jonnythan Some men play tennis, I erode the human soul

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    "What's best for the majority, damn the other people" is not the point and not ethically justifiable in my opinion.
     
  46. jonnythan

    jonnythan Some men play tennis, I erode the human soul

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    Silly argument. I won't volunteer my services for free, but I can accept less pay if it means drastically better outcomes for marginalized people. I think it's absolutely disgraceful and embarrassing that such a rich and powerful country as ours has people without health coverage. I'm willing to pay more in taxes and get less salary to achieve universal health coverage.
     
  47. Man o War

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    I pay 35-40% of my income in taxes and my group gives away more free care than all of us make a year combined take home. I’m doing my part.
    The problem with the left is it’s never enough. And plenty of marginalized people can do something about their situation, they just choose not to. I see it every single day.
     
    #45 Man o War, May 7, 2018
    Last edited: May 7, 2018
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  48. LebronManning

    LebronManning Probationary Status

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    Who doesn't have health coverage?

    Are you talking about the homeless or poverty stricken who have medicaid yet still bill thousands of dollars to the taxpayer each regularly because they'd rather not wait for their appointment and go to an ER? Or are you talking about our "tragic" middle class who can't afford to pay a couple hundred bucks a month for health insurance but will buy beer/new jordans/new cars/vacations with that money?

    People in this country that do not have health coverage DO NOT VALUE IT. People are short sighted and care about their luxuries rather than to insure their health and then they complain and go on Facebook tirades when they get a 50k bill for the STEMI they got after spending a couple hundred bucks each month on cigarettes/mcdonalds.
     
    #46 LebronManning, May 7, 2018
    Last edited: May 7, 2018
  49. Money Moniker

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    Don't feed the troll! He's been spouting his communist crap on every subforum on SDN, needlessly derailing discussions such as this one with holier-than-thou moral grandstanding.

    Great post. It's no different from entering into a job negotiation. You are assuming the party on the other side of the table is going to advocate for its own bests interests, and it's up to you to stick up for your own end of the deal in order to arrive at a fair compromise. If you operate under the assumption that other people/entities make decisions based on an abstract notion of "the common good" rather than their own best interest, you're a schmendrick who will inevitably end up being taken advantage of because the vast, vast majority of people DON'T act with the common good in mind.

    When I enter the voting booth, I already know that the lazy bum the next booth over wants to vote himself 100% of my hard earned money. My job is to vote in such a way as to ensure he cannot do that. If I had my way, the bum would get 0% of my money, if he had his way, he'd get all of it. If we both vote according to our self interest, he'll get some number greater than zero but less than 100, which isn't ideal but is much better than the alternative.
     
    #47 Money Moniker, May 7, 2018
    Last edited: May 7, 2018
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  50. jonnythan

    jonnythan Some men play tennis, I erode the human soul

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    You tell me. There are tens of millions of Americans without health coverage. Who are they?

    It's a national disgrace, and we need to move to universal coverage. Would also help with the quantity and overhead of administrators.
     
  51. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    So now when you file your taxes, how much extra do you go ahead and send in on top of what the IRS says you owe?
     
  52. acidbase1

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    Why would I vote to support the social program freeloaders isn’t this country? I worked hard to get where I am and pay 40% of my income in taxes.
     

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