The average citizen, by the time he gets to choose ANYTHING about his health care is presented with a particular provider chosen by his bosses, and at best can choose either the company’s HMO or PPO plan – both of which come with rising salary deductions, rising copays, rising pharmaceutical copays and drug availability limitations, rising annual deductables and shrinking annual caps on some payouts. In addition, the consumer is forced to select from a limited in-network list of doctors and hospitals or, if your chosen doctor isn’t in the network, pay the bulk of your out-of-network costs.

The private health insurance system is NOT a free market (except between corporate insurance providers and corporate HR departments). The biggest threat to the current system is the public health option – which will allow healthcare consumers themselves to enter the market directly and make their own choices.

The health industry and some of its GOP handmaidens have predicted that up to 119 MILLION Americans will opt for the public health option. That’s an explicit admission that the product they are pushing is not one the consumer would choose in a real free market. And that’s much too much free market for the greedheads running their huge hydra-headed monopoly on health insurance.

It isn’t the threat TO the free market that scares them so much, its the threat OF a free market that forces them to compete directly for consumer business.

Blessings to all

Costs of health care administration in the United States and Canada
Authors: Steffie Woolhandler, Terry Campbell, David U Himmelstein
The New England journal of medicine. 01/09/200309/2003; 349(8):768-75.

BACKGROUND: A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs. METHODS: For the United States and Canada, we calculated the administrative costs of health insurers, employers’ health benefit programs, hospitals, practitioners’ offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars. RESULTS: In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-industry personnel.) CONCLUSIONS: The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.

i haven’t read it (just stuff they’ve written for the lay reader).

btw, woolhandler and himmelstein are coauthors with elizabeth warren on the medical bankruptcy studies, so if you think their work is flawed, i’d really like to know more.

Here we have a President doing townhalls last week and coming out strong for a public option, and his approval ratings go down this last week. The Noize Machine is ramped up and he needs every bit of backing he can get on this issue.

I feel the public option is a subversive way to get us single-payer faster than expected. Was confused by it at first, but now see it’ll use their own “framing” against them, since we know so many people will sign up for the public option, which will diminish the “scary government-run healthcare” talking point, and the noble (in their minds) competition will bring us single-payer or close approximation.

Yet, at this crucial and potentially historic moment in time in America, so many of the single-payer proponents (around here at least) are “pissed” and “depressed” while on the verge of getting it. Dianne Feinstein and the other DLC leftovers are lining up to scuttle it already. The old fissures are becoming clearer once again.

We’re at a “all hands on deck” moment. I hope more people will realize the stakes of where we’re at right now.

Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

Edie Magnus: When we pay a medical bill, how much of that bill goes to these kinds of administrative costs?

Uwe Reinhardt: Well, in general what you’ll find in our official statistics, we’re spending 7 percent on administration, but that only accounts for the insurers’ administrative costs and that includes Medicaid, which burns only two percent of its money throughput on administration. On the other hand, Medicare and Medicaid both cost the hospitals administrative costs that are booked as medical care, but it’s really administrative costs.

Steffie Woolhandler and David Himmelstein of Harvard did a study comparing Canada and the U.S. looking at what it costs employers, providers, doctors and hospitals and the insurance mechanism and compared Canada and the US, and they found that we in 1999, spent $300 billion on administration for all these three functions, and that was about 24 percent of national health spending there, but they say it was actually 31 percent because of the fraction of spending that they could actually identify and link to administrative costs. So they came to 31. So it’s somewhere between 25 and 30 percent that goes for administration and it doesn’t even include the patients’ time of billing. Anyone who has had anyone really sick in their family knows how much time you spend haggling over the bills and they have none of that in these systems.

Edie Magnus: I know that there’s some dispute about all those numbers, about what percentage of our spending the administrative costs represent, but you have said that with what America could be saving in administrative costs, that it could completely fund universal health care for all Americans.

Uwe Reinhardt: Oh yes, I’m totally convinced of that.

Docs, or that % of docs (some # less than 100) who support govt paid sys do so because private insurance sys is making it difficult for them to get paid.

When you have an industry that had market power, like the medical industry, the particular participants within that industry fight for the goodies. In the old days, the docs, courtesy of their specialized knowledge, were able to get the lion’s share. But over time the “insurance” companies (i.e. prepaid medical care) got market power & started lording it over docs. So now that docs are getting gored, they’re running to the govt.

http://news.yahoo.com/s/ap/200…..ital_error

Is “botched” a medical or journalistic. Watch for this one or others like it all over BigMedia in the next few weeks.

Of course, we’ll see no reports about the huge amounts of medical mistakes in the privately-run systems.

Regardless of preventive health measures, we are all ultimately going to die, and may or may not be able to pass from healthy to dead without a long series of complications. At some point, the only resolution would have to involve some sort of, to put it crassly, cost-benift analysis. Otherwise, I don’t know the answer to hip replacements for 85 year-olds with otherwise terminal illnesses. Rightly or wrongly, the government option gives some appearance of allowing those who can afford it to make those choices, rather than “beaurocrats” deciding. Perhaps it allows greater liklihood of public acceptance than what the right can portray as a stark transition to decision by some sort of committee reminiscent of the housing commissariat in Dr. Zhivago.

I’m not advocating. I’m just saying that I can understand the rationale for approach by a government option, rather than single payer system, at this point. To paraphrase Franklin, “It’s a government health program, if you can keep and expand it.”

Single payer universal health care is inevitable because it is the only way that the health care system will survive. It may not happen this year, it may not happen even five or ten years from now, but it will happen because the affordability crisis will only deepen as the years pass. The system is broken. It is filled with perverse incentives, which include those that are peculiar to all insurance models, but which extend to the manner in which doctors and hospitals are reimbursed, and that reimbursement model is divorced from
any relation to the patient’s ultimate health outcome.

I occasionally work with some cheap bastards from New Hampshire. Guys who live in New Hampshire and work in Massachusetts (where the jobs are) as independent contractors and pay no income taxes on their earned income to either New Hampshire and Massachusetts. These guys are hard core Republicans who would have voted for Bush a third time, and even these guys are now in favor of a public health insurance option or a universal single payer system because their wives, who work part or full-time and receive the family health care benefits, are now seeing those benefits reduced. These guys realize that it’s only a matter of time before those benefits are eliminated and they don’t want to be in the position of subsidizing the private health care insurers with their hard earned dollars.

By the way, Kay Hagan needs to be recalled if she runs to the right on this and other critically important issues. By all means let’s get a real Republican in there if she is going to be a DINO. Let’s make sure that if she fucks over her constituents and all other Americans that she gets fucked over in return.