From the desk of the EMD: Is it time for “Medicare for all?”

March 4, 2019

As EMD of the College, I usually don’t take up controversial topics in this column. In fact, the College walks a fine line when we are approached to sign off on letters promoting a particular opinion on a health care issue.  So why do I want to sound off on one of the most controversial issues facing our country, which no doubt will occupy our newsfeeds throughout the 2020 elections? Because this is an editorial column, where I can give my opinion. Before I start, let me say that this is my opinion alone and is NOT the opinion of the American College of Allergy, Asthma, and Immunology, its officers or its staff.

Is it time for “Medicare for all?” Yes, or something close to it as a universal or single-payer system. Now I have upset part of the College membership and made others of you happy. Let me give you the reasons I believe we need to move to some type of true single-payer system in our country.

As residents of the U.S., every citizen should be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Everyone should be able to have access to our excellent allergy/asthma services. It should not take a PhD to understand and navigate your health care coverage. Health care costs should not be able to put you into bankruptcy. We should not have to stay in a job we don’t like or need just to make sure we have health care benefits. In fact, health insurance should not be a benefit from an employer – this started during World War II as a way to help employees when the U.S. was under a wage price freeze. I believe that health care is a right for all of us.

But how do we fund a single-payer system? If you are an owner or partner in your allergy practice, you know how expensive health care insurance is for your employees and how it reduces their salaries related to the benefit. These monies could be moved to the single-payer system. It is estimated by Physicians for a National Health Plan that over $500 billion in administrative savings would be realized by replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer.

The bottom line is that total costs may stay the same or even decrease as we save money by slashing the “middle man” and adopting some cost controls in fee schedules, global budgets for hospitals and negotiating drug prices with pharmaceutical companies, as is done in just about every other developed country. 

Just because we have some type of universal or single-payer system doesn’t mean that private health insurance will go away. In fact, I have relatives in London who, along with their National Health Services coverage, have private health insurance for special issues if needed. Australia has a mixed system with primary universal government coverage and, if the individual elects, a form of private insurance. Just like any other type of insurance, we could buy supplemental health care insurance for increased benefits and choice if we want it.

 You are probably thinking that any type of single-payer or universal health care system will reduce your income as an allergist. Granted, some very high-income allergists may see a decrease, but many of you have already been seeing decreases occurring over the last few years as overhead rises, reimbursements drop and collections shrink. When I was in private practice in Memphis, our single-specialty allergy clinic had four full time employees who dealt solely with insurance filing for seven allergists, two NPs and one PA. Think about the amount of your overhead costs related to our fractured health care system. How much is this system leading to the epidemic of burnout in the physician population?

Are our allergy colleagues in most developed countries making less than we are? According to Healthcare Salary Guide , the average annual salary in the U.S. is about $263,000, compared to more than AU$351,000 ($281,232 USD) in Australia, NZ$295,000 ($215,478 USD) in New Zealand, and C$255,000 ($208,863 USD) in Canada. As you can see, there are not big differences here compared to our country. Average annual salaries in the UK also top six figures at just under £135,000 ($161,026 USD), followed by more than R1,535,000 ($116,054 USD) in South Africa and Rs1,533,000 ($23,892 USD) in India. 

Will a single-payer system lead to rationing of health care? If you don’t believe rationing occurs now, why are you filling out all those prior authorization forms and dealing with step therapy?

Of course, there are negatives in changing our health care system. It is hard to trust the government. Yet, if we are truly the greatest country in the world, should we not have the greatest health care for all, and not just for some, of our population?

Let me know your thoughts. I am happy to give any of you my space in a future edition of Insider to express your point of view.

Michael Blaiss, MD, FACAAI, Executive Medical Director