What Could a Single-Payer Plan Mean for Pathologists?

November 27, 2017

Let’s face it, the United States is broke. As a country 12 percent of our tax dollars are paid just to keep up on the interest of our total debt. This would be like paying 12 percent of your paycheck every month just to pay the interest on your credit card bill. Not pretty, huh? Well, imagine you have this debt, plus you just got a big health care bill. That’s our country today.


So how do pathologists fit into this changing landscape? I believe we are heading to a single-payer system sooner rather than later. This means we will both ration and lower the quality of health care. We cannot keep going forward on the current path, which means the next election will be driven by this idea. In fact, it wouldn’t surprise me if our Tweeter-in-Chief actually proposes a single-payer system himself.

I’ve been lucky enough to see inside our current Medicare bureaucracy to learn how it works. We have to remember that Medicare is the largest insurance plan in the nation, given that they cover around 100 million people. It’s easy to see how Bernie Sanders’ Medicare for all plan could eventually gain legs.

However, the biggest obstacles to a single-payer plan are the private insurance plans. These giant companies have to make 5 percent a year to keep their shareholders happy. Do we really think the big insurance lobbies would stand by and let this happen? Nope. The only way it would work is if we can get them to also buy into the idea.

How do we do this? Perhaps we give them each a market share of the new national Medicare-for-all plan. This way, each company would get a fifth of the marketplace to manage. If we have 380 million Americans, then each company would get about 76 million covered lives. There would still be a market for Medicare Advantage plans, in addition to a smaller boutique market for those who wish to buy a supplemental plan.

In this instance, the commercial insurance industry wouldn’t disappear, it simply would change. If this plan was made enticing enough to insurance conglomerates, then it would pass.

Obviously, promoting a health care change of this magnitude would be very difficult considering politicians cannot get re-elected after being forced to limit a social program. And rest assured, this change would eventually limit health care to a degree previously unseen in this country. If you think this is untrue, look at the countries in Europe who are running out of cash: Portugal, Italy, Greece and Spain. These countries all have massive amounts of social unrest because they eliminated or decreased their social programs when they ran out of money.

But, have our collective views on single-payer plans changed over time? In 2008, more than half of physicians opposed a single-payer system, according to polling data at the time. Compare that against a recent survey by Merritt Hawkins that shows 56 percent of physicians now either strongly support or are somewhat supportive of a single-payer system. In less than ten years, we have come full circle on this idea. Where will this evolution put us in 10 more years?

single payer graph


It’s also important to ask ourselves what this change could mean for the average person like you and me. For starters, it would mean more taxes. If we examine most countries with nationalized health care, you’ll find the average citizen pays more taxes than the average American citizen. Everyone would have to pay this new tax, however, approximately 44 percent of the working people of this country currently pay no federal tax. If this change were to take place, this percentage would have to pay their fair share.

Consider the national income tax paid for a married couple with two children in the following countries:

National Income Tax for Married Couples
Australia 16%   Japan 24.9%
Belgium 40%   Norway 29.6%
Canada 21.5%   Portugal 26.6%
Finland 29.6%   Spain 33.4%
Denmark 38.4%   Sweden 42.4%
France 41.7%   United States 27.1%
Germany 35.7%   United Kingdom 11.9%
Greece 39.2%      


And finally, what would this change mean for physicians? Well, the majority of physicians would receive a lower income. However, there are options for private groups to make more money.

To get a better idea, let’s look at the current average salary for pathologists in some key countries with single-payer plans. (All currencies have been converted to US dollars for this exercise.)

Avg. Pathologist Salary
Canada $267,308
United Kingdom $77,235
Germany $207,616
Australia $298,710
Spain $123,643
Greece $152,796



The next president will use single payer as a national platform to get elected. It doesn’t matter what party, but I suspect it’s likely to be a Democrat if they can find a candidate who isn’t negatively polarizing. If some congressional seats are lost due to members not voting towards a single-payer system, that will send the message to Congress and the Senate that not backing single payer will get you ousted.

The insurance lobbies will work hard to back those against single payer by donating to their election coffers in an attempt to maintain the status quo. Once there is a general uprising against the current system, this will be the next big change in health care. It will affect more lives than penicillin or the EKG. It will also mark the beginning of the end for drug development, and will serve to launch healthcare rationing. (If we examine all the existing nationalized health care plans, you will see every country rations health care to some extent.)


So, what’s the potential timeline on to seeing a single-payer plan come to fruition? If the midterm elections are won by more politicians who push a single-payer idea, it would pave the way for a general election where the candidate who wins would likely have the clout push through a single-payer plan. If this plan is passed, however, it will take several years for it to be adopted. Bottom line: I’d expect that in eight to ten years the US will have some form of a single-payer plan, possibly even quicker if we see a reversal of the stock market.


We seldom stop and consider a long-term strategy. How will this change affect individual pathologists? How will it change pathology groups and labs? Will the trend of consolidation continue and what does it mean for you or your group?

Vachette President Mick Raich provides practice strategy and long-term planning for pathology groups across the nation. If you are interested in chatting, please call us at 517-486-4262 to set up an initial conversation, or email Mick at mraich@vachettepathology.com.

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