Private insurance pays the most, Medicare pays less and Medicaid pays even less to physicians. Proposals for Medicare for All assume Medicare level payments and in Congress there are calls for cuts to Medicare now.
Shall the twain ever meet? Many of our objectives are inconsistent, they can’t be achieved. So, what do we want when it comes to health care? One thing for sure, we aren’t getting more of everything for less.
The American Medical Association and nearly 100 other physician groups recently called for “long-term, substantive payment reforms,” saying Medicare payments to clinicians have declined 22% from 2001 to 2021, when adjusted for inflation.
Axios.com
- The doctors want an inflation adjustment built into their rates, to help ensure they can make enough treating Medicare patients while costs rise.
- “Our payroll has gone up 20% in the last year,” said Bobby Mukkamala, a head and neck surgeon and immediate past president of the AMA Board of Trustees.
- Physician groups say the burden is especially hard for independent practices struggling with year-to-year cuts.
- “I have heard from a few people who have said this may push them into early retirement or changing to a nonclinical career or potentially selling their practice,” Tochi Iroku-Malize, president of the American Academy of Family Physicians, told Axios.
QUINNSCOMMENTARY 
As a patient, medical care is expensive. But when I go to my orthopedic doctor for an office visit, he bills the insurance $255 but accepts $78 for a 15 minute visit. I look around the office and wonder how he pays his bills. I interact with a receptionist, a nurse, and the doctor. In the background, there is the billing person and all the other support people from IT people, lawyers, accounts, janitors, etc… Then there is rent, utilities, the x-ray machine in the office and who knows what else besides drugs and band aids. There is economy of scale since on some days there is more than one doctor in the office at the same time. It seem hard to believe that the office can cover all those costs while the doctor is getting paid only $312 / hr (but bills at $1020 / hr).
I also think that is why so many practices have sold out to the corporate overlords. To get those cost savings with economy of scale. But the “profits” are not going to the doctors anymore but to corporations and stockholders. In the case of “non-profit” health systems, they use the money to buy more practices and build more buildings. It doesn’t seem like they are lowering costs to the patient but billing and charge per service that the bean counters know that they can get paid for from the insurance companies.
Doctors have just become employees working another job. Cutting reimbursements will only lower the doctors pay and the smart people will follow the money toward another field. New doctors are entering the workforce at least 8 years later due to schooling. An electrician or a plumber probably will make the same amount of disposable income by the time they retire from not having student loans and will probably retire at an earlier age too.
If they keep cutting reimbursements one of two things will happen; a shortage of doctors and nurses or not the very best people will become doctors.
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I realized the Medicare reimbursement was low since I first became eligible for Medicare. The additional costs of higher reimbursement will be an eye opener for all who propose universal Medicare. It will be a shock to current Medicare recipients when the pols get around to raising reimbursements. The cost won’t be cheap.
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The proposals for M4A assume it pays Medicare rates. Think of the consequences of that.
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