Laura S. Gordon, MD, LLC
I am a solo-practice surgical specialist in rural eastern Oregon. That means I am also a small business owner. I strongly support single payer healthcare financing, as a physician, as a business owner, and as a human being. I believe health care is a human right, and our nation is completely backwards in treating it as a commodity with a non-system to pay for it that has perverse incentives to profit from human misery, and very little incentive to promote wellness.
As a business owner, I think a single payer system makes economic sense. First, the economics unique to being a physician argue that single-payer would be better for my bottom line. Right now, I have more than 2 full time employees to be sure I get paid, and get paid the right amount, by the thousands of entities who I have to bill for my services. The easiest one to deal with, by far, is Medicare. With Medicare, I submit one bill, they bill any secondary insurer, and they are completely transparent about what they will pay. There is a certain percentage of my patients for whom I don't get paid because they are not insured. There may be fewer patients without insurance when the Affordable Care Act is fully implemented, but with the higher co-pays, co-insurance and deductibles, it will be physicians like me left holding the bag when our patients are unable to afford those expenses. If I could get paid for every patient I see, with perhaps one employee to do the billing, I would come out ahead, no question. I would get paid less per patient than I might get from the best payer I contract with now, but since I have to take all comers in our rural area, those patients are only a small percentage of my practice. Some specialists can cherry-pick patients with "good" insurance in urban areas, and they might not come out ahead with single payer, but as costs shift to the patients with higher co-pays, etc, it will get harder to cherry-pick.
As a business owner, I provide health care to my employees. Partly, this is economic self-interest because I get a group rate for my own family's health insurance (this may be less of an issue now with the ACA). The cost has gone up substantially every year (approximately 13% per year for the last two years, with the cost today being two and a half times the cost, in unadjusted dollars, compared to when I started this business in 2001). To be able to afford to provide comparable health insurance coverage each year, I have had to forego pay raises for my employees. Health insurance last year cost the equivalent of $3.00 per hour for coverage for employee and spouse (I know because an employee asked to be paid the equivalent instead of having health insurance, since she had insurance through her husband's employer. Now that he lost that job, I pay her $3.00 less). Despite having pretty good coverage without huge deductibles, my best paid employee had to declare bankruptcy several years ago when her son had to be Life-Flighted to Portland and had an ICU stay.
I hope these specifics about why I think a single payer system would be good for business, good for health care providers and good for everyone else (we are all potential or actual patients) is helpful.
Laura S. Gordon, MD