Preparing for “Medicare for All”

As discussed in this article about “Medicare for All”, physicians should take note of possible coming changes to reimbursement and income.

There should be no doubt that the imposition of national Medicare will drop physician and hospital income.  Medicare reimbursement is already at the bottom of most health care providers’ pay schedules, and removing private payors will have a large impact.

Remember that if you have an office overhead of 50%, a 10% drop in income might actually drop your income by 20% unless you can effectively trim overhead significantly.

Hospitals that increasingly employ physicians already are using their leverage to drop salaries in many locales.  Decreased reimbursement to hospitals nationwide should be expected to increase pressure on employed physicians’ income.

I’m not saying this will pass-but that as physicians we should recognize the threat.  What should we do?


First, I suggest educating patients on the many negatives of a government-controlled health care system.  How many of your patients would like to have all their health care only at the VA?

Second, physicians should be saving money aggressively-keeping their options open towards financial independence, retirement optional.

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Steven Podnos MD, CFP

Steven Podnos MD CFP attended the University of Florida College of Medicine and trained in Internal Medicine, Pulmonary and Critical Care Medicine at UT Southwestern in Dallas Texas. He moved back to Florida with his physician wife (ENT) and raised a family while practicing Pulm/CC medicine for over twenty years. During that time, he also started and ran a Hospitalist program for several years. In 2002, Steve began a slow transition towards having a Fiduciary Fee Only Financial planning practice-at first just for friends and family. As the practice grew, he transitioned out of full time medical practice to full time financial planning. Dr. Podnos joined the US Air Force Reserve in 2008 as a critical care physician and flight surgeon. He deployed twice to Landstuhl Army Hospital in Germany as an intensivist during the Afghanistan war in 2009 and 2010, and as a critical care air transport (CCATT) physician in Okinawa in July 2018. His firm, Wealth Care LLC now serves approximately 100 physician families nationwide and another fifty non physician families with both financial planning and wealth management. He is a staunch advocate of independent medical practice, believing that the corporatization of medicine and Electronic Medical Records are both harmful to physicians. 

  6 comments for “Preparing for “Medicare for All”

  1. Pat
    November 10, 2019 at 9:44 am

    Quite a lot of physicians have discovered this work isn’t fun, and only do it to make a living. Remove the remaining incentive to work, and …?

    Docs that can, should follow Doug’s example and go DPC, as a way to separate themselves (if only for awhile) from M4A stupidity.
    In any case, docs should try lessen/eliminate debt, save, and try to plan for scaling back, if unable to retire. Or, some of us might embrace the system and have ourselves declared “disabled” on grounds no less funny than the majority already so honored.

    Those young enough should develop alternate skills, unlike those of us who foolishly put all our eggs in a rotten basket. Those not yet in this profession should seek more honest, happier work.

    In any case, the onslaught of M4A will see me working less, and fishing a lot more, albeit drinking a cheaper brand of beer.

  2. Steve O'
    November 10, 2019 at 8:51 am

    The horror has not hit the populace yet, and it is far more serious than insisting on Medicare for All. The economic engine that drives America is failing, and approaching end-stage. Wealth is no longer created by efficiency nor diligent attention to profitability in any particular occupation. Wealth is manufactured by the Government; but it is not true wealth. It continues only as long as everyone thinks that it has value.
    Each child born today in America is assessed with $6,000,000 worth of indebtedness in the future. Everyone who retires with six million dollars worth of wealth that they have created in their working career, raise your hand. There are sports figures, entertainment stars, and many Wall Streetwalkers.
    The motor that runs America is broken, and we are coasting to a stop based on the inertia of the flywheel and the mass of the vehicle.
    Medicine is failing because the economics of the society are failing. How can patients who earn nothing, offer anything of value to a doctor? They can only steal, from the doctor or someone else, or obtain what they need by panhandling. For doctors to stay in business in ten years, they will have to be looters, or moochers.
    I have been fairly indifferent to “Obamacare” or “Medicare for All” or single-payer or insurance-payer. These are all impossibilities that simply cannot work. You ain’t fitting into that old wedding dress, America.
    People need to understand that optimism alone, is only good for finding the best solution. If something absolutely cannot exist, there is nothing to be achieved by optimism and hope.
    Medicare-for-all? Sure, bring it on.

    • Pat
      November 10, 2019 at 4:05 pm

      Best take yet.

    • Sir Lance-a-lot
      November 11, 2019 at 10:39 pm

      “… we are coasting to a stop based on the inertia of the flywheel and the mass of the vehicle.”

      I would submit that we are gliding, mistaking the sound of the air rushing past the non-feathered propellers for the sound of running engines, while the pilot and the co-pilot snort coke off of the cockpit iPad, and the few souls in First Class have already taken the only parachutes and bailed out.

      It’ll be a pretty smooth ride until we finally hit the ground and stop.

  3. Sir Lance-a-lot
    November 10, 2019 at 6:42 am

    There are plenty of things that I can do well that would pay me a fraction of what I earn as a doctor, and that I would enjoy doing a whole lot more, and I suspect this is true of may others as well.

    Should the fecal matter strike the rotary ventilation device, I suspect that I, and many other current doctors, would opt for those other ways of earning a dignified living with less stress and more satisfaction, and the “system” would find itself hard pressed indeed to care for the sudden flood of “customers” demanding “free care.”

    The voters should be careful what they wish for.

    • Steve O'
      November 10, 2019 at 8:54 am

      Thanks to the rules of my state, Lance, I can return to work for the state in any capacity, and each year of employment adds $1600 a year onto my retirement. That doesn’t sound like much, but if I take a job as a janitor, and not a very good janitor either, with the State, my retirement increases at the physician retirement rate. Go figure.

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