Pipes gets it all wrong when it comes to doctor shortages


(re: “Medicare for All will cripple hospitals,” July 25)

Sally Pipes, a marketer paid by a Koch-funded California think tank, misrepresents facts in her recent Point of View. She maintains that there will be an exodus from the profession, and a severe shortage of doctors as a result of single-payer health care.

This is nonsense.

Pipes cites burnout as a factor in driving doctors from the profession, and then makes the unfounded assumption that the paperwork would be worse under Medicare for All.

Doctors disagree. In New York state, there are 55 insurance companies, each with its own set of plans and formularies. Surveys by the New York State Nurses Association indicate that 50 percent of doctors identify insurance company plans as the cause of burnout, since they spend hours fighting with insurance companies to provide their patients with appropriate medication and service.

Recent polling by the American Medical Association indicates that 47 percent of their doctors nationally support a single-payer system. As a result, the AMA resigned from an organization dedicated to defeating a single-payer health care system.

Doctors and hospitals in growing numbers understand that they will benefit from a single-payer system.

There are simply too many plans for a doctor to know what each covers. Hospital costs skyrocket because they need an army of clerks to handle pre-certifications and departures from what is covered by each plan. Under Medicare for All, there would be one expanded comprehensive plan, one formulary, and no out-of-network charges.

The New York Health Act, a single-payer for New Yorkers, gives patients more — dental, vision, mental health, reproductive and long-term care — plus real choice of doctors and hospitals, as every provider will be “in-network” within New York.

Americans care about choosing doctors and hospitals, not insurers, and would have a real choice about where to be treated. It may be true that government regulations contribute to burnout, but based on the experience of other countries with single-payer systems, the evidence shows the burden would decrease with Medicare for All.

Pipes points out that there already is a shortage of doctors, and that rural areas suffer the most. Since the current system depends on profit for insurance companies, areas with fewer people offer less profit for insurance companies. There is no incentive for the insurance company to pour more resources into rural areas, and so they don’t.

If our government, which today subsidizes insurance companies’ profits, instead used those resources to provide rural doctors and hospitals with the resources they need, fewer rural hospitals would close. Government, in contrast to private insurance, has a political incentive to meet rural needs.

Another unsubstantiated factor in burnout, according to Ms. Pipes, is that doctors would have to work longer hours because there would be more people needing care. The same argument was made when Medicare was passed, and studies show that the difference in utilization was minimal when levels measured before the passage of the bill and after the passage of the bill varied by less than a percentage point.

Mrs. Pipes also claims that physicians would earn 30 percent less for more work. This is pure fiction!

The payment schedule is not yet established, and no one knows today whether or not it will even be based on a fee for service. Her figures are pure speculation.

Her statement mischaracterizes the Sanders bill, which refers to Medicare payment “processes,” not Medicare rates, and it doesn’t apply at all either to the Jayapal bill or the New York Health Act.

And it’s the bill that affects Riverdale Press’ readers in particular and most immediately.

Unlike the current system, which has created “health care deserts” across the country — including in Upstate — the New York Health Act explicitly calls for payments that fully cover the costs of providing services, and mandates an increase over Medicare rates.

Providers welcome the bill’s provision of “global payments” for hospitals so they can focus on giving care rather than accounting for Band-Aids and aspirin.

The increase will be affordable because single-payer saves billions of dollars over what we now pay.

If our government were not subsidizing the insurance companies and could negotiate volume discounts with pharmaceutical companies, there would be more than enough resources to support failing hospitals — rural and urban — and to sponsor the education of doctors so that they would not face mountains of debt.

That is the way to approach the problem of a shortage of doctors.


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Helen Meltzer-Krim,