I have a buddy who is skeptical of single payer. His main question is:
"Under single payer, how would my fathers private practice work? Would they be government owned? How would they make money?"
It's a fair question I don't have a great answer to off the top of my head. How would I answer that? Is it as simple as government subsidies would cover it?
Why would the ownership of his practice be affected by a change to the insurance sector?
Nothing is changing about the healthcare itself, except for whose name is on the check they're being paid with.
Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not a private authority, nor a mix of both.
-ripped from the first section of the wikipedia page
To reiterate what other people have said and highlight a key point of the power of single payer, the private practice would work the same as it does now, but the government pays the practice for procedures performed. At least this is how it works in Canada.
So, the doctor can bill the government for every patient seen, every prescription, every referral, every procedure - at the rate agreed upon in the government billing rate schedule
This is where the power of comes into play. The government works with doctors to set reasonable costs associated with procedures etc., and then every practice, hospital, etc. gets to bill the government the same amount. And these prices are not set based on market rates but on real costs and take into account materials and salary and overhead.
This means that prices are standardized across all practices, and that billing is made simpler for practices and hospitals.
To start with, it would not be government owned, that's not on the table. Should it be? That's a discussion for another time.
Bernie coined the catchphrase "Medicare 4 All" for a reason. His plan basically extends Medicare coverage to everyone in the country instead of just old people. There are some refinements and adjustments that will probably need to happen along the way, but that's the jist of it.
If you have a private practice, you surely bill Medicare/Medicaid for some portion of your patients (possibly even a majority depending on your specialty). It's basically that same process, but with all of your patients instead of just the old/poor ones who are eligible. I've discussed this with people who work on the insurance billing side, and what I understand is that 10-20% of the effort is working with Medicare who basically says "we pay $$$ for [procedure]" and that's the end of it (just gotta get the paperwork sent over to them), while 80% of the effort is working with multiple private insurances to bill them, negotiate in-network pricing, forecasting what they may or may not pay in the upcoming few years and so on. That 80% pretty much gets done away with under a single-payer model, so you put a portion of those finance people to other work.
The Bernie-style M4A that we want is far more disruptive to medical insurance than it is to medical practice, though there will surely be friction points that will require further adjustment.
