How a single-payer system would affect spine care: 5 surgeons weigh in


Many surgeons believe a single-payer healthcare system would decrease spine payments toward current Medicare rates and payments and limit access to care. Here, five surgeons share their thoughts on how a single-payer system would affect spine practice.

Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): A single-payer, government-run system, or so-called "Medicare For All," would be a disaster to our system, in my opinion. This approach has only pressed a two-class system in most places and would be unacceptable to most Americans. It would severely limit access and quality that we are so accustomed to.

Thomas Loftus, MD. Austin (Texas) Neurosurgical Institute: Based on single-payer systems that exist in markets in other countries, it seems that single-payer insurance would hurt spine practice. To allow absolute control of healthcare delivery by a single payer restricts patient access to care and severely affects and limits decision-making by the actual physician. The small advantage of not having to deal with multiple insurance companies would be greatly offset by the complete disruption of who makes the actual healthcare decisions. It would be bad for patients and bad for their physicians.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: My passion remains to be able for folks to keep their private insurance and to have the commercial payers play by their own rules. It is my dream to hold them accountable — connect authorization to payment, to stop sending fraudulent or delay-directed letters to buy them time, and to legislate rules to make them pay on time and correctly. I believe healthcare should be accessible to everyone, but a single-payer system will cause intolerable and perhaps tragic delays in care.

Domagoj Coric, MD. Carolinas Medical Center (Charlotte, N.C.): It would almost certainly harm spine practice. In fact, it has the potential to be disastrous to patients with spinal disorders and to the practice of spinal surgery. A single-payer system would likely limit patient access to spine specialty care as well as hinder the development and implementation of new technology.

Erich Anderer, MD. NYU Langone Hospital-Brooklyn: I'd like to think that the practice of spine surgery — and all surgery for that matter — is payer agnostic. Some payers have adopted approval criteria for spine surgery that make it difficult to account for nuances in disease presentation. If these types of processes become the norm via a more centralized insurance system, it could make it even more onerous for people that really need surgery to get approval to have it done. 

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