Doctors Who Support Medicare for All Should Be Careful What They Wish For

Doctors are growing increasingly comfortable with the idea of a government takeover of the U.S. health insurance system.

The nation’s second-largest physicians group, the American College of Physicians, came out in January in support of Medicare for All. A study from BMJ, a medical journal, found that younger doctors are leaning further and further left, politically speaking.

Doctors should be careful what they wish for. Medicare for All would exacerbate the epidemic of burnout that’s plaguing physicians by forcing them to work longer hours for less pay. Many of those currently practicing would retire or leave the profession. Promising young people, meanwhile, would likely shun careers in medicine.

Under Medicare for All, health care would be free at the point of access—courtesy of the American taxpayer. In theory, patients could see doctors of their choice, including specialists, with no need for referrals. That would stoke demand for care.

But there are scarcely enough doctors and healthcare personnel to meet patient demand now. In 2018, the typical physician worked about 51 hours a week, according to a report by the Physicians Foundation. Over 15 percent worked 61 to 70 hours per week.

Hours like this cause physicians to burn out. In a 2019 survey of more than 15,000 physicians by Medscape, half of doctors who work 61 to 70 hours a week reported symptoms of burnout; 60 percent of those who work more than 70 hours a week did the same. Nearly one-third of doctors had already cut their hours to try to reduce burnout.

Many more will likely exit the field once they see how much Medicare for All would pay them. The plan would likely use Medicare’s current reimbursement rates as its guide. Those rates are about 25 percent less, on average, than private insurance rates, according to the Mercatus Center at George Mason University, which estimates that within 10 years, Medicare’s reimbursement rates will be about 40 percent less than those for private insurance.

Ironically, the American College of Physicians endorsed Medicare for All in part because they believe it could lead to higher pay for the internists who are its members. Given Medicare’s current payment schedule, that doesn’t seem like a smart bet.

Longer hours and lower pay are a recipe for an exodus from the medical profession. One study from FTI Consulting projects that Medicare for All would cause the United States to lose over 44,000 doctors by 2050.

The American health care system can ill afford that outcome. The country is already projected to be short 120,000 doctors by 2032.

As the physician workforce thins, patients will struggle to receive timely care. For evidence, look no further than Canada and the United Kingdom, whose government-run systems are close analogs to Medicare for All.

Canadian patients wait a median of 20.9 weeks to receive care from a specialist after getting referred by a general practitioner, according to the Fraser Institute. Hospitals across Canada are so crowded that patients are routinely treated in hallways, conference rooms, kitchenettes and other “unconventional spaces.” Thirty-two hospitals in the province of Ontario were filled beyond capacity for at least three of the first six months of 2019.

Twenty percent of those who visited an accident and emergency department in England this past December had to wait more than four hours to be seen. More than 2,000 people waited over 12 hours to get a hospital bed.

2019 survey found that one in every 10 doctors in the United Kingdom saw 60 patients a day, double what was deemed a safe number. Nine in 10 hospital bosses in the United Kingdom’s National Health Services say they fear the nation’s physician shortage could jeopardize patient safety.

Doctors who believe Medicare for All would improve the lives of patients and providers are making a faulty prognosis.

Sally C. Pipes is president, CEO and the Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, (Encounter 2020). Follow her on Twitter @sallypipes.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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