One big stakeholder in the debate over single-payer health coverage is physicians. Opponents of a single-payer system argue physicians would be paid less under a government-paid health plan and leave the profession.
But a recent poll by physician recruitment firm Merritt Hawkins shows 56 percent of doctors say they support a single-payer health system, with 42 percent indicating “strong support.”
A June survey by the Chicago Medical Society reported the same number. More than 1,000 doctors were surveyed by each organization.
“I don’t see medical care primarily as a business,” says Dr. Jim Powers, associate professor of medicine at Vanderbilt University School of Medicine and chief of geriatrics at Vanderbilt University Medical Center.
Powers, 65, leads the Middle Tennessee chapter of Physicians for a National Health Program, a group he’s been a member of since 1987.
Powers says he’s seen too many cases where patients delayed getting medical treatment because they didn’t have health insurance.
One patient who came in with chest pains had struggled with his health until he reached 65 and was able to enroll in Medicare.
“He knew he had heart problems, and he had diabetes and high blood pressure. He had to have emergency surgery, and we ended up having to have bypass surgery about a month later,” Powers recalls.
Another patient said he would rather die than bankrupt his family with medical bills.
“I think health care is a human right and any barrier to obtaining it leads to harm,” Powers adds. “I’ve seen so much of it and I’ve tried to work against it. That’s been my career and the reason for my [philosophical] leaning.”
One reason for physicians’ support of single-payer is frustration with the complexity and paperwork currently involved in filing claims, billing and reimbursement with multiple insurance companies, each with its own procedures and numerous plans offering different levels of reimbursement.
Physician practices now spend an estimated two hours on administrative work for each hour of actual patient care. It’s one reason why less than half of practicing physicians now own their own independent practices, according to the American Medical Association.
In recent years, physician practices have consolidated, sold to a hospital or liquidated so physicians can join a hospital staff as an employed physician instead of running a business.
That’s something medical students don’t learn about in class, says Anand Saha, a medical student at the University of Tennessee Health Science Center College of Medicine and a student activist for a single-payer system.
Saha co-founded the first southern chapter of Students for a National Health Program in 2013 after hearing an eye-opening talk on single-payer health care.
“I’d always known that there were gaps and cracks in our health care system but didn’t know to what extent,” he says.
“But I didn’t realize that pretty much every industrialized country in the world has figured out, in one or way or another, to incorporate universal health care at a lower cost than we have.”
The economic arguments for single-payer appealed to his technical, quantitative side, he adds. Since then he has taken his talk on the road and helped start SNaHP chapters at all five medical schools in Tennessee.
“When I began giving talks on single payer and Medicare for all, people had an epiphany, like I did,” he says.
“We knew the issue was bad but we didn’t know how to put it in context, how to quantify anything or even what we were trying to measure. The cost of medicine isn’t remotely on the radar of the med school curriculum … we don’t talk about where money comes from and where it goes.”
Saha points out he and his fellow students do worry about their future incomes because of their huge student debt loads.
New doctors owe a median $190,000 when they leave med school, according to the Association of American Medical Colleges.
But he explains the idea that physicians in places like Canada don’t make much money is unfounded.
“Perhaps the highest earning specialists don’t earn as much there, but the lowest earning doctors – the pediatricians and the primary care doctors – earn more. There’s more parity,” he says.
In the U.S., orthopedists are paid an average $489,000 a year, while plastic surgeons, cardiologists and urologists make more than $400,000, according to Medscape’s annual Physician Compensation report.
Primary care doctors in the U.S. – those in internal medicine, family medicine and pediatrics – average less than $225,000.
In Canada, average gross pay for surgical specialists is $446,000. Medical specialists make an average $338,000, while family physicians average $271,000, Canadian Institute for Health Information records show.
That doesn’t include the cost of operating a practice or pension, health and dental plans.
However, Canadian doctors graduate with substantially less debt – about $72,000 on average, according to the AAMC’s Canadian Medical School Graduation Survey.
Canadian doctors are also somewhat more insulated from the high cost of medical malpractice insurance by a national insurance collective. In the U.S., malpractice insurance varies widely depending on specialty and state of practice.
Over the past four years since Saha has gotten involved in the single-payer movement, he’s seen a shift in the conversation over health care.
“We’re going through kind of the life cycle of a hot button issue, where now it’s seeping into the common vernacular but we’re having to fight misinformation now,” he explains.
“Stuff like, ‘Do you want big government to do all this?’ or, ‘Do you really think something like Canada has can work on the scale of some place like the United States?’ Or, ‘What about my freedom of choice?’
“That’s kind of where we are now, unfortunately.”