I'm skeptical — to say the least — of "Medicare for All," but this is a weak and unpersuasive argument; certainly there are people willing to work as GPs for $150,000 per year.

And I'm particularly skeptical of "FTI Consulting"'s ability to use a crystal ball to decide that there would be 44,000 fewer physicians in 2050 than there are today. What is "FTI Consulting"? What metrics did it use? How the fuck would anyone know what the American health care system will look like 10 years from now, much less 30?

It also should be noted that Ms. Pipes is a public relations woman — which doesn't invalidate her argument, but does raise the reasonable question of who's paying her salary, as should every op-ed like this.

There are good arguments against Medicare for All. This is not one of them. I could fake a good argument for it in a day, using unprovable predictions and impressive-looking stats from groups like "FTI Consulting."

This is a press release in drag as a guest editorial.

How the fuck would anyone know what the American health care system will look like 10 years from now, much less 30?

Well, for one thing, there will be fewer Baby Boomers in 2050, although by then the leading edge of the Millennial generation will be in its 70s, so there may still be a strong need for physicians.

Secondly, the relatively new position of Physician's Assistant can be expected to handle a great many general medicine patients. Those will be your "people willing to work as GPs for $150,000 per year," but they're not doctors, surgeons, or specialists.

Third, you can look at other professions and see what happened when the average compensation was decreased and project that onto medicine. You can also look at what happened in the UK and Canada when those countries implemented universal single-payer healthcare.

Fourth, automation can be projected to handle a significant amount of general inquiries and even diagnoses.

Still, all of these methods lead only to conjecture. No one can say with a high degree of certainty that there will be exactly 44,000 fewer physicians in 2050. However, with declining pay, increasing automation, and a host of lower-paid substitutes, one can be fairly certain that there will be fewer. Who knows? By then we may have that Star Trek physician-in-a-flashlight thingie.

Kinda like those climate change models - they're conclusions based upon assumptions. And that's what kills you in any type of analysis - not the conclusions, but the assumptions upon which your model is based. For example, Malthus assumed no increase in farm production when he predicted a future world starving due to overpopulation. Farm production increased tenfold in that time.

Medicare for All cannot be what Medicare is today. If it is, we'll see FTI's predictions come true, and worse. Do you trust Bernie Sanders, or the people that will be empowered by his election, to devise a scalable system that puts patient care first? Look at the ACA. The roll-out was botched worse than the Iowa caucuses and the premiums cost more than a house payment to get the lowest coverage level.

Since Obamacare, there are certain medical fields that I (and other I've spoken with across the country) cannot find a single provider for who accepts insurance. I have been on a waitlist for 2 years for one who accepts insurance. I have also found that it is increasingly difficult to get new patient appointments for those who don't accept ANY insurance. We're talking psychologists, psychiatrists, occupational therapist, any kind of pediatric specialist, and increasingly dentists.

I can't imagine how useful it would be to have everyone be covered and no doctors willing to see them with that coverage... So will it force doctors to accept any the universal insurance? Even those who currently accept nothing? Because those will be the first to retire... And they're the only place you can get an appointment at all!

The first two things that would have to go are expensive medical schools and medical malpractice insurance. Then doctors can afford to make less.

My suspicions, specialists will relocate off shore, or in Mexico. To get immediate care for serious conditions, you will have cheap airlines running regular flights.

"I'm skeptical — to say the least — of 'Medicare for All,' but this is a weak and unpersuasive argument; certainly there are people willing to work as GPs for $150,000 per year."

$210,000 isn't as much as you might think, when you consider the hours that a typical doctor works, the cost of their schooling and training, and the cost of malpractice insurance. In high-cost areas like California, I'm not even sure that those wages put you in the upper half of the middle class. Look at it this way: You can find people who would be willing to be doctors at $50,000 per year. Do you want to go to such a doctor? Me neither.

People can choose their occupation. If wages in medicine are driven down far enough that it no longer becomes worth the hassle, compared to other professions, most people will choose something else. Socialized anything is, after all, all about rationing. And Isab is right: when a nation implements socialized medicine, specialists go offshore. Consider: The U.S. is "offshore" for Canadians looking for specialists.

Well, given that M4A will require at a minimum a doubling of the current federal budget, and possibly a similar doubling of state government budgets, $150K/year isn't all that if your taxes are raised to meet the challenge of an ever expanding government.

My suspicions, specialists will relocate off shore, or in Mexico.

Agreed. Which leads me to believe that FedGov will make medical tourism a crime. We've seen that in merry olde England.

Too many unanswered things in the avg salary numbers. Since some Drs are effectively their own business are the business expenses pre removed from the avg salary. Office rent and equipment depreciation. Staff salaries? Malpractice Insurance and paid back loans can be huge.

As long as you believe the BIG LIE, that public health care has to follow the "insurance" model (which it is not), you're setting yourself up to be victimized by people who will promise you an entitlement they cannot deliver.

You're sick? The clerk is not sick. Have you filled out the forms? Then, the system is working perfectly. We will call you when you may be seen. I am so sorry it hurts right now. No, you are not being denied treatment, it just isn't available right now. Go home, sir, you're making a scene!

Or you can set up something that's self-sustaining, on a credit model.

No deductible. You never pay for something you do not receive.

Government after government does things to its people, then forbids them under threat of force to find an alternative. There's no reason at all to think ours won't or doesn't do that.

Kevin: "...certainly there are people willing to work as GPs for $150,000 per year."

Probably, but GPs currently average $223,000, and there are not enough of them. At $150,000 there will probably be even fewer. Some nurses make $150,000 and there still aren't enough nurses.

Canada's unofficially two-tiered healthcare system has been an issue for quite a while.

https://www.cbc.ca/news/canada/manitoba/manitoba-mri-auditor-general-1.4059062

In Canada, to lessen the problem of long wait time for an MRI - around five months average, three weeks if it's urgent - some provinces are allowing a limited number of private clinics to operate. Patients who can't or don't want to wait a long time can pay cash out of pocket for an MRI. The private operators are required to provide one free MRI to someone on the wait list for every paid one they do. So patients paying out of their own pocket pay for two.

https://www.cbc.ca/news/canada/saskatchewan/saskatchewan-to-allow-more-private-mri-scans-for-paying-customers-1.3063849

I've needed to have several MRIs. The provider would call me at work when one was due. They'd say, "You're due for an MRI. Would you like to go ahead and schedule that?" I'd say, "Sure. When can that be done?" They'd say, "Would three-thirty be a good time?" I'd say, "I was thinking the day after tomorrow after work." They'd say, "What time will you be off?" I'd say, "Around five-o'clock." They'd say, "Ok, how about six-thirty on Thursday then?" Pre-obamacare, my medical insurance covered it 100%. Not so any more.

Maybe by the time we get Medicare-for-All there will be enough private operators in Canada for Americans to go to.

In a blog I saw where Canadians discussed the issue of wait times, most seemed to think wait times of six months or less were reasonable. They have no idea what good health care is.

"...certainly there are people willing to work as GPs for $150,000 per year."

Not that many; not when it takes eight to twelve years to be trained for the job. You can be a lawyer, a CPA, or an engineer and make that kind of money with half the training.

"You can be a lawyer, a CPA, or an engineer and make that kind of money with half the training."

AND you don't have to deal with icky people, who lie with confidence about their symptoms and their activities, and who are convinced that Obama is paying THEM for their health care - and that you, the lowly doctor, must do as they wish.

They, you see, are ENTITLED to your work.

Only time single payer didn't result in shortages was in the USSR. where people with aptitude were effectively conscripted into their vocations.