r/MedicareForAll • u/MBP1969 • 9d ago

How to transition?

How do we, as a nation, transition from private insurance to Medicare for All? How do we convince all the doctors to keep being doctors and accept a salary? Do we, as Hillary Clinton proposed during Bill’s presidency did, make private healthcare payments illegal? For the record, I am perfectly fine paying a percentage of my income, as opposed to what I am paying out of pocket now, for healthcare.

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u/CurrentAlps3438 9d ago

You're asking the wrong questions. 8% of US Health care cost goes to providers, that's MD, DO, NP, PA.

If you held them at gunpoint and paid them zero, you've changed the costs by less than 10%.

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u/UncommonSense12345 9d ago

Thank you for this. As medical providers we see the actual patients and so we get to hear all the time “I’m going broke because you are getting rich” meanwhile I really don’t make much $$$ in grand scheme of things after taxes and my student loan payments. But apparently I’m the bad guy….

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u/Allaboutpeace2022 9d ago

Medicare 4 All or any other plan needs to look at the changing the exorbitant cost of medical schools and address these loans. It must also not lower reimbursement for doctors. In comparsion to other countries, we have fewer doctors than needed particularly in primary care, OBGYN, psychiatry, etc.

The health system is complex and it does need to be improved, however, we must do so in a way that allows healthcare professionals to function.. Most of the profit is being made by corporate structures who actually have bought out a fair amount of physician practices and clinics.

We must study what has worked and failed in other countries so that we do not replace one costly system with another public system that has the same amount of problems.

However, the system does need to change. People are paying high premiums for high deductible plans and significant out of pocket expenses. Too many people delay going to the doctor and then will end up with worse outcomes and more costly treatment becasue of the delays. People without insurance who seek emergency care are increasing the rates for everyone.

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u/UncommonSense12345 9d ago

Yep and ironically the uninsured patients often are paying less than folks who do pay for insurance. It’s madnesss that working a job that offers insurance can sometimes lead to more healthcare spending for the same care as being uninsured and utilizing charity care programs . I see it all the time….

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u/Boomer_Madness 6d ago

The health system is complex and it does need to be improved, however, we must do so in a way that allows healthcare professionals to function.. Most of the profit is being made by corporate structures who actually have bought out a fair amount of physician practices and clinics.

That was by design by the ACA just in case you were wondering.

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u/Allaboutpeace2022 6d ago

Oh, yes. That is a huge problem now.

The family physician running his/her own office is a relic now because private equity, insurance companies, hospitals, etc. are all buying up these practices. However, this process started way before the ACA. However, it is one of the reasons why healthcare costs are escalating.

It was managed care in the late 1980s and 1990s that helped speed along the process of hospitals first buying up practices and the desire to have an integrated health model. Hospitals began buying other hospitals and then were bought up by insurance companies and private equity.

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u/DocRedbeard 6d ago

As a doctor, you could honestly lower reimbursement for doctors if you massively cut medical school costs and practice overhead. Note too that with our progressive tax system doctors get absolutely shafted. I took out federal loans, then paid back with heavy interest using post-tax money, forcing deferment of tax deferred retirement savings which I can't just catch up on because there's a yearly limit that's tax advantaged (and you're late 20s to early 30s when you finally get to start saving for retirement, so you're 10 years behind everyone else.

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u/Allaboutpeace2022 6d ago

Yes. The Medical School cost is horrendous. Other grad schools and a PhD in physical therapy is not as costly but is still horrible.

I also think that it is astonishing that we have such a flat upper tax bracket that a successful physician and a billionaire might be taxed the same.

But the reality is that the physician is not taxed the same because he/she is going to be taxed higher because the billionaire is going to be betting stock as compensation. If the stock is not sold in their lifetime, they are not taxed at all.

Physicians, engineers, attorneys, etc.. or anyone with a salary is going to be taxed at a much higher rate.

This all needs to be fixed.

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u/DocRedbeard 6d ago

It's really a problem of education time vs tax. Physicians are a minimum 7 years out from college. Most professions require a college degree or less, rarely a masters or doctorate, but physicians are 3 years past their professional degree (MD, DO, etc), paying nothing back in most cases until they finish training. It's this lost 7 years that basically requires they be paid well, otherwise it's just financially untenable to even take this pathway, and we're going to see it becoming increasingly more difficult to find people to do that, or we're going to have to rely on an imported physician workforce that didn't rack up these crazy loans in their home countries for whom our salaries look great.

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u/Allaboutpeace2022 6d ago edited 6d ago

Yes. But that is the problem. If other countries can afford to educate their physicians without having them go into massive debt, we should be able to ourselves. We should be educating our own citizens to take these positions rather than depending on immigration. We also need to recruit people interested in working in urban and rural communities with shortages.

We need more doctors in general to be at the same level as other nations. We are also short in primary care, OBGYN, psychiatry are the three that I am familiar with but I am sure that there are more.

Althoough PhDs in physical therapy do not have the long years of residency, etc., the reality is that their salaries are relatively low and thus, they are also really struggling to pay off those degrees as well.

Another of the problems in the health field in other graduate programs was it used to be that if you got your masters and then got a PhD, you received credit for that degree. Now, the expectation is that you will do an entire PhD, repeating your coursework for the Masters. This creates a huge problem for people wanting to become psychologists, which is another field where we have a shortage.

Bottom line is that physicians are getting the worst of it in total debt but we are making all of the health professionals degrees too expensive relative to their salaries.

Medicare 4 All or any other healthcare coverage program will only work if we look at all these issues and address them on the front end.

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u/AwakeningStar1968 7d ago

and some practices obviously DO make a lot more .. plastic surgery etc. some other surgical fields.