"Single payer" is another way for saying somebody else pays. Of course the single payer is using our money, but it is convenient to let somebody else worry about the cost. Nevertheless we've forgotten about the old adage, "He who pays the fiddler names the tune".
Medicare has been our single payer for everyone over age 65 for the past 50 years. We've given the job to the CMS bureaucrats to worry about the cost, but what can they do? They're not in the doctor's office with you to decide whether you really need this or that test or how often you should come back for a visit and so on. How are they supposed to figure out what the right fee should be for any of the millions of medical transactions that go on every day. So they do the only thing they can under the circumstances, they issue regulations. They put out fee schedules and tell medical providers what they have to do to qualify to get the fees. And this is how they name the tune and run the show.
What's going on in the present bureaucratic highly regulated system reminds me of when I was in the Army and I found out that the way to prosper in that environment was to learn the regulations and use them to get what you wanted. The master sergeants were the ones who played the regs like a Stradivarius. Not that they were bad guys - just the opposite. They just did what any smart person would do considering the incentives. Later when I worked in the VA for a couple of years it was pretty much the same thing.
Well bureaucratic regulations seem like a necessity in the military, but in medical practice? Unfortunately that's where our Medicare single payer has lead us. Complying with regulations is a large part of what your doctor does every day. And to a considerable extent it's taking away from his thinking about you, sometimes even more than he realizes. For the young guys it's the environment they're used to. (For you gals I'm sorry but it's just too cumbersome not to keep using the default English male gender).
In all the medical economic blogs we keep reading that independent medical practice is rapidly declining, now under 50% and even around 35% of doctors in one source I read. Doctors are fleeing to salaried jobs with hospitals and big medical organizations. It's the regulations folks! They're just too complicated and expensive for the little guy. Well you say, what else is new. Isn't consolidation what's happening all over the economy? Well I think it depends on the type of business and how personal you want it to be, and it's hard to think of anything you want more personal than your medical care. I clearly understand the lure for doctors to work for a medical conglomerate as opposed to having an independent practice. I've been in both situations. Especially in the present difficult environment the temptation is great to abandon your independence and leave the complex legalistic and economic headaches to others. But there is a subtle difference in your allegiance. As long as the dominant mode has been independent practice, looking out primarily for his patient's interest was the norm that all doctors adhered to but I fear for how things will go when all doctors become employees of big entities, the point toward which our system seems to be rapidly heading. Then will doctors become just the highly skilled technicians following disease protocols that the medical leaders and bureaucrats envision? Then not just doctors but more importantly patients will be part of the medical brave new world where it is more society's and less individual interest that determines the nature of your medical care.
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