You may not eliminate the Medicare paperwork, but now you don’t have to also deal with the Aetna paperwork, the United Healthcare paperwork, the Cigna paperwork, und so weiter.…
I really have no idea how many man-hours (person-hours?) that would eliminate, but if each company’s paperwork is on the scale of the Medicare paperwork, each with their own coding rules, then the savings could be substantial, couldn’t it?
I’m aware that Medicare generates paperwork and I acknowledged as much, but as I explained, that’s only because it’s structured much like private insurance which it has to coexist with. This is simply not the case in single payer in Canada. There’s nothing ambiguous or contentious about the fact that I’ve never even seen a health care form or claim. Complaints about insurance bureaucracy and paperwork is the major thing I hear about from those who have relocated to the US from other countries – it’s kind of the distinguishing trademark of US health care.
The only thing about US health care that makes it “more complex” than Canada’s is the vast plethora of different and often overlapping insurance systems that health care providers have to navigate. The productive work of actually providing health care is exactly the same, and therefore the per-capita costs of providing that care should be similar if similarly managed. The size of the system has nothing to do with it, and indeed economies of scale should make per-capita administrative costs even lower. Yet it’s a fact that the US has the highest health care administration costs in the world by a wide margin, and it’s also a fact that it’s the only country in the world where the majority of health care coverage is provided by private businesses operating in what is largely a free-market environment.
Check out some of these cites and see if you still believe that; rough estimates suggest that around $550 billion is wasted every year on unnecessary administrative costs that don’t exist in other countries, and that for every 10 physicians in the US, there are 7 staffers employed solely for billing administration:
A widely cited study published in The New England Journal of Medicine used data from 1999 to estimate that about 30 percent of American health care expenditures were the result of administration, about twice what it is in Canada. If the figures hold today, they mean that out of the average of about $19,000 that U.S. workers and their employers pay for family coverage each year, $5,700 goes toward administrative costs.
Bureaucracy in the health care system accounts for about a third of total U.S. health care spending – a sum so great that if the United states were to have a national health insurance program, the administrative savings alone would be enough to provide health care coverage for all the uninsured in this country, according to two new studies.
In a 2003 article in The New England Journal of Medicine, researchers Steffie Woolhandler, Terry Campbell, and David Himmelstein concluded that overall administrative costs in 1999 amounted to 31 percent of total health care expenditures or $294 billion—roughly $569 billion today when adjusted for medical care inflation. A more recent paper by Woolhandler and Himmelstein, which looked at 2017 spending levels, placed the total cost of administration at $1.1 trillion.
Some employers would love to get out of the health insurance business, and leave that to the exchanges. It’s a big cost to companies, and a hassle to manage. Large companies are often self-insured, too.
Please let us note that “public” does not equal “basic”. In Spain, while there areas where some fancy machine or other happens to be in a private clinic/hospital, most of the fanciest ones are in public hospitals; people choosing private care are often surprised to have their doc send them to the public system for certain tests.
One of the issues I had when I was a TA in the US, a long, long time ago, was that the insurance I received from my regional government wasn’t considered acceptable by my US uni: the uni was expecting the kind of detailed coverage list in tiny print that US policies include; my insurance covered “all costs of medical care, except for elective procedures (i.e., anything which would be covered in Spain’s public system)”. It was a lot wider than the coverage I had to pay for locally (for example, any costs associated with pregnancy and delivery would have been covered except for artificial insemination), but it wasn’t a language the Americans understood.
What is this “billing” you speak of? Spanish private clinics working for the public system work on the basis of estimates, not itemized billing. Periodically the clinic and the regional healthcare administration get the list of “procedures done in the last period which aren’t elective and which the patient didn’t pay for out of pocket”, and use that as the basis to define payments for the next period. Adjustments are done only if the lists of “stuff done” turn out to be extremely different from the previous period (situations such as a clinic opening a whole new wing, for example).
If, somehow, Bernie or Elizabeth W became President, they could not simply declare the end of private insurance and usher in the new age of Medicare for all. I sincerely doubt that they would find enough support even among their fellow Democrats in the House and Senate to ever make it fly. Furthermore, I think they both know that. That is a big reason I like Joe. He is not promising anything he does not have a reasonable chance of fulfilling. No, he is not the most progressive liberal in the pack. That, to me, is a big reason why he is who we need in the Oval Office next time round. Anyone too far left of center, in my opinion, will over-correct the skid we are in thanks to Orange Doody Head. Now, if you’ll excuse me, I have to use the Trump.
I am honestly curious here: How do you imagine “billing” happens in systems outside the US? In the public sector I mean. Serious question. How do you imagine it?
Cool. I’ve been your guinea pig. I’ve been on Medicaid. It’s really nice having negligible co-pays, like a couple dollars. It’s not nice that I don’t seem to have access to certain specialists in my area, but that seems like a physician shortage, which is possibly a training issue.
If you really want to see what’s possible, look at Canada, Australia, France…
My spouse was on Medicaid the last six years of his life.
During that time, all his daily medications were paid for, no or negligible co-pays. There diabetes meds, high cholesterol, depression/chronic pain meds, and antibiotics for recurrent urinary tract infections. Also two rounds of fungal medications for fungal urinary tract infections, the second of which was administered by PICC line and home infusion. All paid for.
His cancer treatment, from initial hospitalization and diagnosis, a round of chemo, two more hospitalizations and four trips to the ER all paid for. His month in a “rehab” facility paid for - in fact, we had a choice of three different ones. His final two weeks in a hospital on “comfort care” all paid for.
My-sister-the-doctor, at Mr. Broomstick’s request, reviewed his treatment as he was concerned that he was getting less than what other did because he was poor and on Medicaid. Dr. Sister said that he received the proper and standard treatment for his cancer and the stage it was in, the only difference being that Medicaid would not pay for a PET scan… but she pointed out that regardless of the test results the treatment would be the same (and, alas, so would the prognosis) so that made no difference, the other imaging modalities used would do just as well for staging the cancer.
Our total out-of-pocket cost: $25. For the co-pay for the first emergency room visit just before Thanksgiving.
Keep in mind - under Indiana rules we in fact DID pay a monthly premium for our Medicaid coverage. It was 2% of our gross income. A sum even we, as people below the official Federal poverty line, could afford to pay.
So… happy to be a guinea pig.
Because I am now financially better off I now have employer-sponsored private insurance. I pay significantly more, have substantial out-of-pocket costs, and if I have a cancer diagnosis myself those out-of-pocket costs will bankrupt me rapidly.
Give me UHC. Please.
FTR: I wasn’t speaking for myself. I was referring to people like the OP and my friends.
The US had decided that they’d rather use GoFundMe as their healthcare insurance plan. SMH.
After years of living in the UK and Japan, I shudder at the thought of having to live again under the US healthcare system. It’s such a joke, it’d be funny if it wasn’t so tragic.
US pays more, for worse outcomes, than the rest of the world - healthcare spending per capita is more than double that of Japan, the UK, Australia, France, Canada… what’s crazy is that even though the US doesn’t have UHC, it still spends more public money on health care than other countries, while covering vastly fewer people.
The US has higher rates of medical/lab errors than the rest of the world. The rest of the world on average has faster access to a doctor than the US. In the US, you’re more likely to use the emergency department in place of a regular office visit than in other countries. Administration costs account for around 8% of total healthcare costs in the US, vs…1-2% everywhere else.
I’ve experienced the health care system in the US, Japan and the UK. Only in the US do people seriously worry about the financial implications of a serious illness. My wife (Japanese) had colon cancer. The out-of-pocket cost for the entire process - diagnosis, surgery, follow-up visits, medication, over around two years - was less than $3,000.
We had two children while living in London - both free NHS care, including clinic visits and midwife visits to our home.
Seriously - anyone that looks around and thinks the US health care/insurance system is ok is delusional.
I’m really kinda hoping that Warren can find a compromise or plan B position to satisfy voters such as yourself, and I agree that hers is a risky position to take into a general election.
Having said that, I think a lot of people who love, love, love their insurance love it because they’ve never really, really, really needed it. Some, of course, really do have excellent healthcare plans through their employers…which they would lose if their health declined to the point where they were no longer considered valuable as employees. And you can’t just sign up for Medicaid the moment you need it.
Just a thought.
Warren is smart enough to know that there’s more than one way to skin a cat. We’ll see if she moderates her position on healthcare, because I honestly don’t think she thought this issue through as much as she typically does in most issues. It’s easy to scream about insurance companies and drug companies making “billions and billions”, and just play to the crowd and talk about eliminating an industry.
I like Biden’s view. He understands that alot of improvement can be made by building on the ACA. It’s practical, and it’s true.
Saying most Americans are satisfied with their current coverage is like saying 83% of Russian Roulette players are happy with the outcome.
That’s nonsense. Is your comment a variation of the “Americans are stupid and ignorant” point? I sure hope our Democrat politicians don’t use that line. If so, they’ll get killed in the election. Good Lord.
No, I believe he is saying that the people who are satisfied are mainly those who have never had to use it for serious medical emergencies.
Indeed. Catastrophic injuries and illnesses are essentially random (at least for relatively young people - the odds increase dramatically with age) so the majority who manage to evade them think, not unjustly, they’re doing fine.
But hey, feel free to get all offended if that floats your boat, surv.
I don’t think HIS comments are, but wait for it…
I DO think that when it comes to health care, health insurance, and health coverage (with a side of actual medical care) that the average actually IS ignorant. Along with misinformed, which only sustains the ignorance. Americans have been lied to on this issue all their lives and most, yes, are too stupid to research the topic in a truly rational manner, that is, by actually looking at what (literally) over a hundred other nations are doing and doing successfully: healthcare for everyone at less cost per person and better results.
Failure to recognize that the rest of the world is in fact doing this better is both stupid and cruel.
Yes unfortunately truth will not set you free here. Politicians sometimes have to lie to get shit done. Or to get elected.
The difference here is that Republicans and lie and other Republicans don’t give a damn. But a Democrat is raked over the coals for the least little inconsistency, even worse if there’s an actual lie.
As an asides, if you follow this subject on forums, it is not unusual for Americans to propose “solutions” to the healthcare problem that are clearly products of intelligent and reasoning minds. And that are basically a proto-version of the French or German, or Norwegian or whatever systems. Which they have come up with out of a desire to solve the issue without copying any other nations system, without single payer and without ever looking up how single payer or systems in other nations actually work.
This desire not to copy the best practice in the area, and to try to avoid it and avoid even learning what it is… its quite unique in my experience.
It’s because copying anyone else’s system is to admit they did it first and better… which is contrary to the line they’ve heard all their life that “We’re number 1!!!”
Most nations with UHC do not have true single payer. They have multiple payers, or they have a public payer which people can either opt out of or buy additional coverage on the private marketplace.
I’m not opposed to that. How do you feel about a system like Australia or the NHS in the UK? Over there they have single payer but if you want better health insurance, you can purchase it privately.
Or places like the Netherlands or Switzerland are good too. They basically have a much better run version of the ACA. There are exchanges to buy private insurance, premiums are capped as a % of income.
There are multiple paths to a working, humane, affordable UHC system. Single payer is only one. However single payer does seem to reduce costs more than any private system would, at least in the US.