There are a few reasons why the U.S. spends so much more on health care than other wealthy countries, and gets less for it. One of them is that we spend far more on administrative costs -- about $750 per person per year. That's your money.
The ACA actually limited administrative costs for commercial health plans to 15%, although they have ways of evading that. But Medicare's administrative costs are only 5%, according to the linked article by Dr. Kocher. (I've actually read that it's even less, but I'll let that go for now.) And on the other side, providers spend huge amounts of money on administration, mostly figuring out how to bill for their services. Why can Medicare be so much more efficient? And why do providers spend so much?
Insurers spend on marketing, negotiating with providers to bring them into their networks, develop and manage payment rules and systems, and oh yeah, make a profit. Medicare doesn't have to do any of that. On the provider side:
The costliest administrative task for payers and health care organizations is payments. According to an analysis from a single academic medical center, an estimated 62% of administrative costs were for billing and insurance.2 The study also calculated that billing costs were $20.49 for a primary care visit, $61.54 for an emergency department visit, and $215.10 for an inpatient surgical procedure. As a percent of revenue, primary care physicians spent 14.5%, emergency departments spent 25.2%, and hospital surgical departments spent 3.1%.2 Administrative costs in medicine are approximately 3 times higher than in other professions, such as law and accounting.4
,
Why spend so much? Because they have to figure out how to bill multiple different health plans, and they also spend money to game the system to extract as much money as they can. This is all waste. We could eliminate it and cover everybody, with good comprehensive insurance, for less money. It's easy.
We need universal, comprehensive, single payer national health care.
And do note: Doctors and hospitals will still be private enterprises. It's only insurance that changes. Like that totalitarian dungeon, Canada.
19 comments:
Seems to me you've covered this ground before. Perhaps there are additional details in today's blog. However, I appreciate your persistence; it needs to happen.
Keep sending the message till enough people get it!
Would you rather your kids went to private schools or public schools?
Would you like to attend a public university or a private one?
Would you rather go swimming in a public swimming pool or a private one?
Would you rather play golf at a public course or a private course?
Would you like to see your parents in a publicly funded nursing home or a private one?
While the argument for universal public healthcare is academically appealing, these correlations of other services keep bugging me.
Why would Healthcare be different?
To answer AD's questions truthfully:
1) Public or private; depends on the school.
2) Public.
3) Public.
4) Public.
5) Private. This will change with universal, comprehensive, single payer national healthcare.
I suspect AD has not had my experiences, and I've heard his comment out of a different mouth. My response, when this particular person said, "Do you want the GOVERNMENT taking care of your health?" was, "That's PRECISELY what I want!"
It worked in Canada when I worked and lived there (have you lived there, AD?).
It worked in Europe when I worked and lived there (have you lived there, AD?).
I commonly hear people who have no experience of government-provided education and health care berating it. It's like people who pronounce their dislike for certain books and movies that they've neither seen nor read.
So to answer AD's final question: Hopefully, healthcare wouldn't be ANY different, and would be just as effective and available as public pools (especially in the past--Cass Tech right near me in Detroit), golf courses, and universities. And when we learn to eliminate the middle man in healthcare and people see what great, affordable and free care they get, they'll be more open to eliminating the for-profit cancerous insanity (that's you, Betsy DeVos) that destroys the efficacy of our schools, and of our elder care facilities.
It's always the people who are afraid of what they don't understand that question and even mock its value, whether we're talking about healthcare or our solar-centric planet system. I always find myself thinking, "None so blind as they who will not see." AD's world is not the world of the imagination; it's the world of limited, incontrovertible knowledge. Learn to think outside what you already know. Because most things, you don't know.
AD's world is not the world of the imagination; it's the world of limited, incontrovertible knowledge.
Clearly, Don is just better than everyone else. He's plainly saying that.
Back to the questions at hand, I doubt if most people would answer those five questions as Don did. I think most would believe there's a reason why, with public institutions, private institutions that provide essentially the same type of services thrive.
It's usually a difference in quality of those services. It's not a secret.
Nope. It's exclusivity. People don't join the country club because the golf is better there. Some people don't like to go to public pools because the wrong kind of people might be there. As a matter of fact, famously, many public pools in the south were closed when segregation became illegal. There's nothing wrong with a URI education but Brown is more prestigious.
Anyway, this is irrelevant because, as I say, single payer health care doesn't mean doctors and hospitals don't remain private. They do.
Many of the most famous golf courses in the U.S. are municipal courses, BTW, and six of them have hosted U.S. Open championships -- they are Pebble Beach, Pinehurst No. 2, Bethpage Black, Chambers Bay, Erin Hills, and the South Course at Torrey Pines
Sorry to burst your bubble, AD, but I didn't say it ... Einstein did. Don't project your hierarchical thinking on to me, please. So many great minds came out of public schools in the FDR era and after. How was it possible? Because there was tremendous equality of opportunity.
Regarding all of this, to quote A.E.:
"Imagination is more important than knowledge. For knowledge is limited, whereas imagination embraces the entire world, stimulating progress, giving birth to evolution."
He didn't think he was better than anyone else, and I don't feel that way, either. Don't make the mistake of placing yourself "above" or "below" others, not realizing that we're all the same. Same thing goes for public vs. private. It's simple math: greater opportunity for all comes with a leveled playing field, not exclusivity.
To continue with Einstein:
“A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.”
And finally:
“Our task must be to free ourselves … by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty.”
I'm all about process.
Sell it to the people and if they're on board, then great! If not, then it goes nowhere.
What I'm not interested in is elites deciding and then shoving it on the rest of us if it's not wanted.
And BTW, your opinions and explanations of public behavior are appreciated. I don't expect to agree with everyone. And I'm not going to beat you down if I don't.
I think it's a great discussion.
Well here's your answer: Medicare for All has the support of 70% of Americans. It is, in short, overhwelmingly popular.
Hey AD, I am 70 years old on traditional medicare. For the first time in my life I am satisfied with my health insurance.
I spent considerable time and resources managing health insurance for my modest technology company. After 30 years of navigating the private market I've had more experience with private insurers than most.
Your comment is disingenuous. The relevant public vs. private question regards health insurance. Restated, would one prefer a public health insurance option or a private insurance option. I'll sign up for public.
AD: It is a great discussion, you're right. I also want to see choice for people. I want to see an acceptable level of care available for everyone. If people want to opt out, or purchase supplementary insurance, that's cool, too. I suppose if someone just doesn't want to be insured, well, they don't have to use their medicare or whatever is available to him or her. When I worked at the local university in food services, I had to get flu shots because otherwise they wouldn't let me work on campus; I'd have my Covid-19 vaccine by now if I still worked there. Consequently, I'm waiting.
To sum up, I think it is important that everyone feels she or he has choice, and I think you'll agree with me there. I'm guessing that, given a free, fair and efficient public option, most people will opt for it.
OK, if the voters are truly behind medicare for all then they will elect those who will implement it.
I'm OK with that.
I'm OK with it as long as EVERYBODY participates. Currently, the professional ruling class exempt themselves and create a first class system apart for themselves.
Want medicare for all? Then Medicare for ALL. That should also include university and other private systems currently in place.
ALL
Without that, it will be a two tier system and you're back to square one.
Then there's the sticky question of Daniel paying into the system all his working life and new workers just now entering the system getting the same benefits.
That's a really good point about the "exclusive" system used by congress people. I believe we all should be entitled to whatever care they get.
It pissed me off that Shitler was out of the hospital with Covid-19 after five days with monoclonal antibodies for special treatment.
Pelosi, McConnell, Schumer et al receive the same thing. Be pissed at them as well.
Cervantes, your pic puts you at about the age to receive Medicare benefits.
Are you in that system or do you have private insurance?
As far as I know none of the Congressional leadership has been hospitalized with Covid-19 so I don't know about them getting special treatment.
Don't know why you ask about my own insurance but I had employer-provided insurance until a few months ago, then I went to working half time so I went on Medicare. I have a Medicare advantage plan which is about as good as the private insurance I had before.
I'm not pissed off at any of those respectable Democrats--who do their job instead of golfing and spreading conspiracy theories and inciting riots and subverting democracy.
I'm pissed off that the care Shitler got was BEYOND what any of them would have gotten. The guy we'd all be better off without keeps sticking around.
No senator or congressperson would have gotten the extreme care--ten doctors and special monoclonal antibodies--that Shitler got. The biggest piece of shit in the whole country was the president of the U.S.!
I thought this article is pretty important and informative; social media is a huge part of our problem now:
https://www.nytimes.com/2021/02/04/opinion/michael-goldhaber-internet.html?action=click&module=Opinion&pgtype=Homepage
Well, I feel better about you. I think you're genuine.
It's the same feeling you get when you're in a restaurant and see the staff eating the same food you're eating.
Appreciate that.
Thanks! I am. And I know you are too. I love the restaurant analogy, BTW. So true--seen it more than once.
Mo -- I appreciate the substance of your comment but I'm trying to discourage personal attacks. You know, keep the temperature down.
Post a Comment