> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
If there are no other options for clients, it's essentially the government telling doctors how much their services are worth.
On a more serious note - education and skills tend to pay off.
Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c.
Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)
Part of this loan (methinks ~30%) is converted into a scholarship once you pass your exams, thus leaving you (very roughly) $50,000 in debt after six years in med school.)
There's already so many factors distorting the health care market that it is imho hardly an argument against single payer that doctors would have to negotiate compensation against a powerful customer. (It would, after all, at the same time remove a number of other distortions from the mix - while unlikely to leave doctors in the gutter in the process.)
External circumstances change in a lot of professions all the time; for instance, I do not expect the government to help me out (working in the petroleum industry) now that oil prices are more than halved from their peak - that's life. Better adjust to it.
Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.
Also, doctors aren't the only thing we should be talking about. That's probably the easiest subject to think about.
It's much, much more difficult to talk about drug and device prices. Should the government dictate how much a new drug or device costs? What are the risks and downsides of doing that?
Consider it the physcians version of labor globalization. Or workers labor negotiations vs ever larger corporations. Only this time its for a public good.
Look at other countries, where taxes are higher, but total income expenses (tax, plus healthcare costs) are lower (with better level of care).
Another issue here is termination shock - if a provider comes up under the current system, getting into massive student debt in anticipation of a highly remunerative medical career, how will price controls effect him?
To me what we have already doesn't feel like a market. It's not like I feel doctors are being paid net/15 and that is why they get a discount. Or that they invest in their health care networks so costs are reduced for them in the long run. Insurance company hedges their bets so that they have the money to pay, but then when you get to a certain age you are chucked to the curb and then society has to pay for it. I just don't see where insurance companies are being fantastic middlemen or support networks for medical professionals or linking those who need care and appropriate medical professionals and producing value above and beyond what a single-payer system provides elsewhere. They just seem to complicate the costs significantly and do not create a market where resources feel distributed efficiently.
To me the biggest weirdness of health insurance is why they are a for-profit industry or largely for profit in the non-competing model they have right now. I want the employees of a insurance company to be smart, paid well and distribute all the resources in a smart way, but instead the goal is making money. If the market was competitive like it is for car insurance and other insurances that is fine because there are actual competitors but the whole equation doesn't work because most individuals making health insurance purchasing decisions have effectively the same amount of choice as whether or not you have Comcast.