Thread by @PNHP

It seems that #SinglePayer opponents are gaining traction with the argument that improved #MedicareForAll would require painful sacrifices from doctors. This is false. In fact, the opposite is true. Let's nip this in the bud, shall we?

For starters, PNHP represents over 20,000 American doctors. Our members are passionate about practicing medicine, but they are not interested in taking a substantial pay cut. Under a well-designed #SinglePayer program, they won't have to.

Think about how doctors are paid in our current system. Today, Medicare, Medicaid, and private insurance pay mostly on a fee-for-service basis. Private insurance usually pays the most, Medicaid usually pays the least, and Medicare usually pays in the middle.

BUT...private insurers make doctors jump through indefensible hoops in order to secure payment. Claims are denied on a regular basis. And coinsurance means we have to bill millions of patients individually. The amount of money our practices spend on overhead is staggering.

Under the plan we support (pnhp.org/nhi) private practices would continue under the fee-for-service model, but our byzantine billing apparatus would be consolidated into a (ahem) single payer. Provider rates would be negotiated with the national health program.

#SinglePayer fee-for-service rates may end up being higher or lower than current Medicare rates, depending on the procedure. Fees could not be so low that they would cause doctors to close up shop, but they don't need to be as high as current private insurance rates.

Of course, private practices are only part of the equation. Hospitals would be funded through "global budgets" based on the populations they serve (with capital expenses funded separately). Physicians here would be salaried employees, as an increasing number are already.

But this debate has been about fee-for-service rates, so let's focus there. Imagine #MedicareForAll rates that are roughly 10% lower than what private insurance pays. Under a well-designed #SinglePayer system, these rates could mean a pay *increase* for some doctors. How?

Improved #MedicareForAll would generate considerable administrative savings. And when we say considerable, we mean $504 billion per year (bit.ly/2Lda0Wp via @AnnalsofIM). That would go a long ways towards offsetting potentially lower reimbursement rates.

Also note that administrative staff aren't the only ones doing administrative work. Doctors spend hours each week (sometimes hours each day) filling out paperwork and haggling with insurance companies. #SinglePayer eliminates that, meaning we can see a higher volume of patients.

Of course, reducing administrative costs also means reducing administrative staff and any responsible #SinglePayer plan needs to provide income support and job training for displaced workers, as ours does.

Then there's the issue of malpractice insurance. We expect premiums would go down, because future medical costs are a big part of current malpractice settlements. #MedicareForAll removes these costs from the equation. Lower potential settlements, lower premiums for docs.

And there's the issue of student loan debt. Today, it's not uncommon for doctors to graduate with six-figure debts. We support tuition-free medical education for not just doctors, but nurses and public health professionals as well. @snahp_national will back us up on this one.

Overall, we estimate that average physician incomes would remain unchanged. Some doctors, such as family physicians and pediatricians, might see a pay increase while others, such as highly-paid specialists, might see a slight pay cut. But painful sacrifices would not be required.

We can also look to Canada for evidence that doctors are not harmed by, and ultimately benefit from, the transition to #SinglePayer. As @AMJPublicHealth notes, "the medical-income argument against moving toward a Canadian-style system is feeble." bit.ly/2wj2hfM

Now that we've established physicians won't be losing income under #SinglePayer, let's talk about what physicians (and patients) would *gain* under such a system. In short, we would finally be able to practice medicine.

#MedicareForAll means we would never have to worry about an insurance company overriding our judgement, or whether a patient could afford a particular course of treatment, or whether job loss or other life circumstance might cause them to lose coverage.

Our members understand that #SinglePayer is the *only* way to finance high-quality, cost-effective care for every American. We appreciate our colleagues and patients joining us in this fight. Now it's time for Congress to step up and finally pass improved #MedicareForAll.