What would Single Payer Health Care Look Like?
The government, via Center for Medicare
& Medicaid Services would be the single payer, payroll deductions would be collected via individual and employer payroll taxes and set by congress, vice actuarially based. Thus the working population, and the General Funds of the Treasury (covers actuarial cost not covered by Congressional set premium) would pay for the health care of the complete population. In any case with the following changes the payroll and General Fund cost would go up from it current level. Possibly $21K – $26K per year for family coverage, based on FEHB plan cost plus long-term care insurance premiums.
Currently Medicare is funded by various means, payroll tax, enrollee premiums, employer contributions, and General Fund contributions.
Currently some of the items and services that Medicare doesn’t cover include:
- Long-term care (also called custodial care)
- Most dental care
- Eye examinations related to prescribing glasses
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
Presumably these would be added to the coverage of Medicare-for-All, with the possible exception of cosmetic surgery and acupuncture (To Be Reviewed).
Parts A, B & D have co-pays, Part C reduces or eliminates A & B co-pays.
Presumably all enrollee premiums (parts B, C, and D) would be rolled into the payroll tax and part D would be reformed to a single plan and formulary.
Currently each of the 746 Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. Sometimes, if your prescriber thinks you need a drug that’s on a higher tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
- Provide written notice to you at least 60 days prior to the date the change becomes effective.
- At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.
Currently health care providers and facilities may either agree to accept medicare payments as payment-in-full (with prescribed co-pay) or opt out. If this is retained it will create a two tiered health care system like the UK has, one for those who use the National Health Service (Medicare-for-All) and one for those who have “private medicine” via health insurance policies or out-of-pocket payment.
A medicare patient at Mayo Clinic/Hospital agrees to pay all cost not paid by Medicare, for hospital care this can amount to thousands of dollars.
Wikipedia reports “… in an attempt to comply with the Scottish Treatment Time Guarantee, a 12-week target for inpatient or day-case patients waiting for treatment, NHS Lothian spent £11.3 ($14.7) million on private hospital treatment for NHS patients in 2013-14.
The VA Model
All health care providers and facilities would be nationalized and be run by an expanded VA like governmental department. Presumably manufactures, medical suppliers, medical equipment and appliances, and drugs would remain in the private sector. Assuming the nationalized entities are compensated at fair market value this would be major cost to the government, presumably adding to National Debt.
There would be a consolidation with associated closure of redundant practices/facilities.
Operating expenses would be paid from the General Fund.
There would likely be an loss of physicians, who are not willing to accept the VA’s compensation level. A VA interventional Cardiologist has a salary range $98K – $355K, while in private practice it is roughly double at $263K – $631K.
Pay Table 1—Clinical Specialty
Tier level Minimum Maximum TIER 1 $98,967 $215,000 TIER 2 110,000 230,000 TIER 3 120,000 255,000
Pay Table 1—Covered Clinical Specialties
Allergy and Immunology. Compensation and Pension. Endocrinology. Geriatrics. Infectious Diseases. Internal Medicine/Primary Care/Family Practice. Neurology. Preventive Medicine. Rheumatology. General Practice—Dentistry. Endodontics. Periodontics. Prosthodontics. All other specialties or assignments that do not require a specific specialty.
Pay Table 2—Clinical Specialty
Tier level Minimum Maximum TIER 1 $98,967 $240,000 TIER 2 115,000 250,000 TIER 3 130,000 260,000
Pay Table 2—Covered Clinical Specialties
Critical Care. Emergency Medicine. Gynecology. Hematology—Oncology. Hospitalist. Nephrology. Pathology. PM&R/SCI. Psychiatry. Pulmonary.
Pay Table 3—Clinical Specialty
Tier level Minimum Maximum TIER 1 $98,967 $300,000 TIER 2 120,000 310,000 TIER 3 135,000 320,000
Pay Table 3—Covered Clinical Specialties
Cardiology (Non-invasive). Dermatology. Gastroenterology. Nuclear Medicine. Ophthalmology. Oral Surgery. Otolaryngology.
Pay Table 4—Clinical Specialty
Tier level Minimum Maximum TIER 1 $98,967 $325,000 TIER 2 125,000 340,000 TIER 3 140,000 355,000
Pay Table 4—Covered Clinical Specialties
Anesthesiology. Cardiology (Invasive/Non-Interventional). General Surgery. Plastic Surgery. Radiology (Non-Invasive). Urology. Vascular Surgery.
Pay Table 5—Chief of Staff
Tier level Minimum Maximum TIER 1 $150,000 $300,000 TIER 2 145,000 280,000 TIER 3 140,000 260,000
Pay Table 5—Covered Assignments
VHA Chiefs of Staff. Deputy Chiefs of Staff (Complexity Level 1a and 1b facilities only).
Pay Table 6—Executive Assignments
Tier level Minimum Maximum TIER 1 $145,000 $265,000 TIER 2 145,000 245,000 TIER 3 130,000 235,000
Pay Table 6—Covered Executive Assignments
Principal Deputy Under Secretary for Health, Deputy Under Secretary for Health, Chief Officer, Network Director, Medical Center Director, Network Chief Officer, Executive Director, Assistant Deputy Under Secretary for Health, VA Central Office Chief Consultant, National Director, National Program Manager, and other VA Central Office Physician/Dentist.
Pay Table 7—Clinical Specialty
Tier level Minimum Maximum TIER 1 $98,967 $375,000 TIER 2 140,000 385,000
Pay Table 7—Covered Clinical Specialties
Cardio-Thoracic Surgery. Interventional Cardiology. Interventional Radiology. Neurosurgery. Orthopedic Surgery.