Penna Dexter

Proposals for single-payer healthcare depend upon deriving more productivity from a system that is already stretched thin. Medicare-for-All, which would nationalize the practice of medicine, already has 106 House co-sponsors.

Under Medicare-for-All, doctors would be salaried government employees. Hospitals and other medical facilities would be expected to provide care for all their patients within an allotted budgeted dollar amount to be determined annually and capped to keep costs down.

This pot of money will also have to cover the extra layers of bureaucracy we’ll add to administer the system. This would rely on a resource that, under our current healthcare system, never seems to be depleted: the dedication and professionalism of doctors, nurses, and other medical personnel.

Dr. Danielle Ofri, who practices at Bellevue Hospital in New York, says the current corporate system works because most doctors and nurses “do the right thing for their patients, even at a high personal cost.”

In her New York Times op-ed titled: “The Business of Health Care Depends on Exploiting Doctors and Nurses,” Dr. Ofri describes how this ethic “is being cynically manipulated.” Patients everywhere sense that the system is squeezed tight as it’s streamlined for greater productivity.

“But,” she writes, “one resource that seems endless — and free — is the professional ethic of medical staff members. This ethic holds the entire enterprise together. If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous.”

Today’s doctors deal with more chronic conditions and more medical complexity per patient than ever before. Plus, we now have the Electronic Medical Record. Dr. Ofri points out that, “Primary care doctors spend nearly two hours typing into the E.M.R. for every one hour of direct patient care.”

Right now, she writes, “in health care there is a wondrous elasticity — you can keep adding work and magically it all somehow gets done.”

Medicare-For-All will rely on this quality and stretch it to the breaking point.