Thank you for writing such an open and honest letter about the problems a physician in private practice faces in out current health insurance “system ("Please, someone destroy the insurance companies -- before they destroy me," July 29).
You are absolutely right, a single-payer universal system would be much better. Everyone is fully covered and doctors are paid for their services.
I’d just like to address one not-so-small misconception in your letter, however. In the first sentence you say that a single-payer system would “… have doctors earning a salary and not allow earning more for doing additional procedures and visits.” No, it won’t.
My father, also an OB-GYN, practiced for years under the Canadian system and he always was in private practice; all the doctors there are. No doctor, except those employed by a hospital or a medical school, is an employee on salary.
To be sure fee schedules (and whether a fee schedule system is best is a whole other discussion) are negotiated between the government and the College of Physicians and Surgeons, but that’s it. There are no limits on the number of services a doctor can perform nor a limit on how much they can earn (in theory, in practice time is always a constraint).
In fact, doctors are one of the main beneficiaries of a universal, single-payer system. In Saskatchewan, the province where Tommy Douglas pioneered the plan, doctor’s receivables disappeared overnight. And because doctors no longer needed an army of support staff to deal with insurance billings, their take-home earnings actually increased.
So, universal, single-payer health insurance does not eliminate the potential to be in your own small private practice, it enlarges it.
Chair, Health Care for All – Napa County
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