Jul 3, 2019

Medicare for All's winners and losers

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Adapted from Zirui Song, 2019, "The Pricing of Care Under Medicare for AllImplications and Policy Choices"; Chart: Andrew Witherspoon/Axios

Many specialties would still take a pay cut even under versions of "Medicare for All" that aren't as full-throated as what Sen. Bernie Sanders has proposed, according to recent analysis in JAMA by Harvard's Zirui Song.

The big picture: This is a feature, not a bug, of Medicare for All. Part of the point is to spend less on health care — through steep cuts in how much many doctors and hospitals get paid.

Yes, but: The figures above represent the change in how much doctors would get paid for patients who currently have private insurance — not the pay total change across all of their patients.

  • Doctors are already receiving Medicare's lower rates for their patients who are on Medicare, and are in many cases getting paid less than that for Medicaid patients.

What they're saying: "The assumption that physicians and hospitals would not react as their commercial prices are reduced substantially to Medicare levels is likely unrealistic," Song writes.

  • Doctors and hospitals would likely to try to boost their reimbursements under a single-payer system using some of the same tools they lean on now: Performing more procedures, steering patients toward more profitable services, and consolidating independent doctors' practices within hospitals, which get paid more.
  • And without patient cost-sharing, people may demand more care.

The bottom line: Setting rates above Medicare levels would be less disruptive, as would phasing in the changes over time, Song argues.

Go deeper: Hospitals that treat poor patients aren't opposing Medicare for All

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