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OPINION

Monopolistic Healthcare continued from page 19

lower. If you earn
money from healthcare,
you would have to be
very naïve to think your
income would not plum-
met under a federal gov-
ernment, monopoly run,
single-payer system. Fur-
thermore, when it is only
the federal government
mandating how and
what needs to be on a
claim form, I am not
sure it will be easier than
filing with many insur-
ance companies.
Consider the impact
of a single-payer system.
A monopoly or monop-
sony is the ultimate defi-
nition of control. The
love government-controlled healthcare! Furthermore, single payer difference between a monopoly or monopsony is the former is a sin-
can achieve lower cost; however, at the expense of the physicians gle seller, and the latter is a single purchaser. If you are a doctor, you
and hospitals by cutting their reimbursements substantially, which would "sell" your medical services to one entity; the government. If
would create a smaller supply of physicians and hospitals, and then there was no competition and the government felt the costs for
waiting lines. And I was a tad surprised when a high-profile physi- healthcare was too much, they would simply pay less for the services.
cian representative indicated that doctors like the idea of the Currently, even Medicare needs to be somewhat competitive, other-
"ease" of having only one payer to send their claims. What a trade- wise doctors would not take any Medicare patient. They can do this
off; ease of filing a claim form for a substantial reduction of their because there are many payers. When there is only one payer; i.e., the
income. I don't think the provider community that supports the government, it becomes a take it or leave it environment. All or noth-
simplicity of a single payer system has thought this through. My ing! And I have a hard time believing that doctors would have the
reply to the physician representative was for him to ask the doctors upper hand in negotiating with the federal government that is hostile
if the ease of filing a claim is worth having their income cut up to toward high-income earners already. Finally, the government can
90 percent! begin lowering the gap of high-income earners to become closer to
Just look at Medicaid; a federal/state run government program the low-income earners.
for the poor. Since the poor (133 percent of FPL) have little choice There is a move by politicians in the federal government to re-
in their healthcare plans, the government, acting like a monopoly for duce the income gap. We have all heard how terrible it is that there
this group, can pay physicians a lot less than they do for other gov- is a widening gap between the highest income earners compared
ernment programs. Medicare pays better, however the government to the lowest income earners. What does that suggest? Reduce the
knows that If they cut the reimbursement of Medicare, there will be number of high-income earners to be closer to the low-income
fewer and fewer providers accepting Medicare. This is because earners. I can assure you that people earning $15.00/hour will not
providers can earn a healthy living by taking commercial insurance be making $150,000 next year in an effort to reduce the gap with
100 percent. However, if there are no other means by which a physi- high-income earners. Medicare for all can fix two social issues at
cian can seek payment, other than the government monopoly, one the same time; pay less for healthcare by reducing the income of
can expect the reimbursement rates to fall to that of Medicaid or doctors and the impact will be a reduction of income between
continued on page 22
20 San Antonio Medicine • March 2019