Last summer, with Obamacare's initial troubles fading from view, The New Republic's Brian Beutler noted that certain problems with the healthcare overhaul won't ever go away because they're inherent to its architecture...
... The main problem, Beutler wrote, was that you have to re-enroll every year—and there's no guarantee that you can keep your plan, that rates won't go up, or that the government subsidy won't go down.
But a new study by a group of physicians and health-policy researchers in BMC Health Services Research highlights another problem with our complex healthcare system.
In 2012, billing and insurance-related administrative costs—bureaucratic paperwork and red tape, essentially—cost the U.S. economy around $471 billion, and 80 percent of that was due to inefficiencies in our multi-payer system.
That's how much administrative waste is embedded in our fragmented, dysfunctional system of paying for care,â€...
... The study found that the $375 billion saved annually with a single-payer system could be used to cover all of the nation's uninsured and upgrade coverage for millions of under-insured citizens...
@Tenebrae, BSN, RN But, I thought Obamacare was going to solve all that? What happened?
You folks do realize that the USA has a population of well over 300 million. Our population is significantly larger than that of any of other country offering single payer. As it is in England care is substandard( research it) and people with money pay out of pocket for quality care, so as not to wait 10 months for surgery.
As I said, who's going to pay for it and how do you as a healthcare provider expect to be paid under single payer?
People in england are actually physiologically identical to Americans. They don't have 5 hearts or 2 heads, so the costs shouldn't vary that much, at least not double. Having a larger population served by a single system should actually decrease the per-person overhead costs, not increase them, which is why we spend more than twice as much per person as they do. While it's certainly true they would probably be better of spending a bit more, it's not a difference of twice as much.
Why is it you think I wouldn't be paid under single payer?
@herring_RN Everyone(Republicans, Libertarians, Independents, etc...) that opposed the ACA bill said that administrative costs were too high. ACA is exactly what big govt bureaucracy is all about and what the Dems and those that wrote the bill intended.
Obamacare architect: We passed law due to ‘stupidity of the American voter'
Being that Obamacare continues to base our system on a fragmented, for-profit system I would agree that it continues to allow the excessively high administrative costs of private insurers that already existed, that's the point of the study. I'm not sure though that I've heard republicans, independents, and libertarians pushing for a system with lower administrative costs, ie single payer. In fact sticking with the private insurer system, even with the high administrative costs that goes with it, has long been a basic conservative health insurance platform. If you don't like the high administrative costs of private insurers (typically about 14% compared to medicare's 5%), and you don't want insurance that is publicly run, what would you prefer?
of private insurers (typically about 14% compared to medicare's 5%)
You're comparing apples and oranges. Medicare beneficiaries are 16% of the population, so of course there is less admin costs compared to the general population of privately insured.
The overall higher administrative costs are due to the IRS now being involved in healthcare. More govt bureaucracy = higher admin costs.
Also, what are you even talking about? In England NHS wait times for surgery can be up to 6 years. England only has a population of 53 million and can barely maintain care. Is that really the system you want the USA to emulate?
Stick to providing care, not debating socialized medicine though under single payer, you would be paid considerably less, so you might want to supplement your income on the lecturing circuit if single payer ever happens here.
Specializes in Critical care, tele, Medical-Surgical.
Socialized medicine is a system in which doctors, nurses and others work for and are paid by the government. Hospitals are owned and managed by the government.
The Veterans Administration and the Armed Services clinics and hospitals are socialized. The health systems in Great Britain and Spain are socialized.
In Canada, Australia and Japan they have socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private sector. This is similar to how Medicare works in the United States Doctors and hospitals are paid by Medicare.
In the United States care is rationed by insurance companies, because the deductible is too high, or because they don't have health insurance.
With Medicare for all nobody would have to do without healthcare. Health insurance companies don't provide any healthcare at all. Why should we pay for executive salaries and corporate advertising rather than for healthcare?
You're comparing apples and oranges. Medicare beneficiaries are 16% of the population, so of course there is less admin costs compared to the general population of privately insured.
The overall higher administrative costs are due to the IRS now being involved in healthcare. More govt bureaucracy = higher admin costs.
Also, what are you even talking about? In England NHS wait times for surgery can be up to 6 years. England only has a population of 53 million and can barely maintain care. Is that really the system you want the USA to emulate?
Stick to providing care, not debating socialized medicine though under single payer, you would be paid considerably less, so you might want to supplement your income on the lecturing circuit if single payer ever happens here.
NHS waiting times are at their worst level for six years, official figures show, as 3.2m are waiting for treatment it has been admitted
You're the one comparing apples and oranges. The percentages of healthcare spending devoted to administrative costs is a percentage of each healthcare dollar spent, not a per capita figure. The number of individuals in either population has nothing to do with that figure.
Also, the much higher administrative costs within the private insurance sector have been going on for decades and have nothing whatsoever to do with "the IRS now being involved in healthcare" -- although I admire your attempt to blame that on the ACA, it just doesn't work.
And where did you come up with the NHS wait times for surgery being up to six years? I read the article you linked and it said nothing about six year waits for surgery. It does say that that the wait times are the longest they have been over the last six years, but nothing about anyone waiting six years for surgery. Do you have some other reference to support that claim?
Specializes in Critical care, tele, Medical-Surgical.
A couple years ago my husband had a hernia repair. There was a 14 week wait because the surgeon only operates on one day of the week and the surgery center didn't have an opening until then.
Because he has Medicare and a supplement he likely could have gone to another surgeon and had surgery sooner. He wanted the surgeon recommended by our family practice physician.(He wore a truss while waiting)
With Single Payer (Medicare For All) it would also be possible to go to another surgeon.
You can pine away for single payer, it won't happen in a free America. Vermont recently tried and failed. It's more expensive(for people that actually work and pay taxes) in the long term.
Vermont is saying a sad goodbye to its hopes of enacting America's first single-payer health care system. The reason the state says it won't pursue the plan is that it's just too expensive. Even Democratic Gov. Pete Shumlin, who hoped the system would be a highlight of his political career, agrees that the tax hikes necessary to fund the system would have been prohibitive.
The plan, which would have worked under an Obamacare waiver, has been in the works for years, but for much of that time backers of the plan struggled to identify a financing mechanism. And as soon as they did, it became clear that it wasn't going to work. The financing plan, announced only recently, would have required an additional 11.5 percent business payroll tax as well as a 9.5 percent income tax on top of the state's existing income tax. As the Burlington Free Press notes, Shumlin was concerned that small business would be hit with both, calling the financing plan "detrimental to Vermonters" as soon as it was released
You can pine away for single payer, it won't happen in a free America. Vermont recently tried and failed. It's more expensive(for people that actually work and pay taxes) in the long term.
Vermont is saying a sad goodbye to its hopes of enacting America's first single-payer health care system. The reason the state says it won't pursue the plan is that it's just too expensive. Even Democratic Gov. Pete Shumlin, who hoped the system would be a highlight of his political career, agrees that the tax hikes necessary to fund the system would have been prohibitive.
The plan, which would have worked under an Obamacare waiver, has been in the works for years, but for much of that time backers of the plan struggled to identify a financing mechanism. And as soon as they did, it became clear that it wasn't going to work. The financing plan, announced only recently, would have required an additional 11.5 percent business payroll tax as well as a 9.5 percent income tax on top of the state's existing income tax. As the Burlington Free Press notes, Shumlin was concerned that small business would be hit with both, calling the financing plan "detrimental to Vermonters" as soon as it was released
In the UK everyone who receives a salary/wages above a certain threshold is subject to a deduction from their paycheck (National Insurance Contribution), which covers contributions to the National Health Service. This contribution comprises the majority of funding for the NHS. A friend of mine who lives and works in the UK, and who is well paid by national standards, told me many years ago that one third of their pay check went towards the National Health Service. Everyone who works, and earns income above a certain level, contributes to the health care of everyone who, for whatever reason, does not/cannot contribute towards their own health care. This friend lives in an area that is comparatively well served by doctors and hospitals, and has not complained of receiving poor medical care. In another area of the country, family members have complained of their medical records being lost multiple times; they have waited literally years before even receiving an appointment with a consultant and suffered irreversible serious medical consequences in the meantime. After necessary surgery for which they waited years, a family member suffered complications which, in spite of their efforts to obtain treatment, they continue to wait many, many months after surgery, and have given up trying to secure treatment and resigned themselves to living with the consequences.
I have received medical care under both the UK system, and the US system, and while the UK offers much greater access to care for the whole population (if you cannot afford to pay for care you still are entitled to receive it), I have received far better quality of care in the US, that I have been fortunate to access through decent health insurance. In the US lawyers willing to take medical malpractice cases are more prevalent, and this, combined with the greater inclination in the US versus the UK among the general public for filing law suits, contributes to the high cost of health care, but I believe the greater likelihood of law suits in the US is one of the factors that contributes to the generally higher quality of care.
I agree with the principles of single payer health care. But my personal experience, and that of my family (other family members in addition to the ones I mentioned above) has been that (in the UK) while access to primary care is not difficult, one of the big problems is receiving timely, effective, specialty care. This situation is documented in a recent study that involved multiple countries, where the UK scored virtually last on a list of quality indicators in regard to timely, effective, care.
The ACA has many flaws, but I believe it is an improvement on the previous US system (various states have restricted the ACA's provisions, but that is not the fault of the ACA), and I am hopeful that with more time more people will benefit from the ACA, and that it will be a good compromise between single payer and the previous system which excluded many people from care and/or quickly bankrupted many people. I don't agree with the "all the traffic will bear" extreme "for profit" mentality of US health care, however, in the UK the doctors who work for the NHS are paid well and have a final salary pension scheme and NHS nurses are included in the final salary pension scheme.
You're comparing apples and oranges. Medicare beneficiaries are 16% of the population, so of course there is less admin costs compared to the general population of privately insured.
Are you try to say that Medicare costs are lower because 16% is a lot or a little?
The overall higher administrative costs are due to the IRS now being involved in healthcare. More govt bureaucracy = higher admin costs.
The overhead costs as a percentage of total costs were actually from before Obamacare. The only role the IRS plays is to figure out who isn't buying at least basic insurance who should be, which is determined by your tax return, making the IRS the obvious department to figure that out. The IRS does not have any involvement in healthcare, it's still only responsible for determining what people's income and dependents are.
Also, what are you even talking about? In England NHS wait times for surgery can be up to 6 years. England only has a population of 53 million and can barely maintain care. Is that really the system you want the USA to emulate?
As Elkpark pointed out it they don't wait six years. They do have a problem with people waiting more than 18 months for non-life-threatening care. And yes, we'd be fortunate to have the better healthcare outcomes that the UK, and every other industrialized country has compared to the healthcare outcomes of the US. If the suggestion is that only reason they pay so much less per person is that they cut costs by having longer wait times, then the cost of relieving those wait times should account for the cost difference. We pay $8500 per person in the US for healthcare annually, in the UK it's $3400, an $5100 difference. The UK is relieving their 18 week wait time for some services by spending an extra $250 million, or about $4 per person, there's still $5096 in additional spending in the US that's left to explain.
Stick to providing care, not debating socialized medicine though under single payer, you would be paid considerably less, so you might want to supplement your income on the lecturing circuit if single payer ever happens here.
NHS waiting times are at their worst level for six years, official figures show, as 3.2m are waiting for treatment it has been admitted
As herring pointed out, single payer is not socialized medicine. You still go to a non-government run doctor, hospital, etc under single payer. You do realize we already have single payer, right? That's what medicare is. Maybe you could explain why you think I'd be paid less under single payer? What single payer does is take the amount we're already paying for healthcare, including my pay, and processes it through a different administrator, who pays the same bills but takes less off the top for themselves.
Specializes in Critical care, tele, Medical-Surgical.
Saturday, January 10, 2015
What Happened in Vermont: Implications of the Pullback from Single Payer
Gov. Peter Shumlin's Dec. 17, 2014, announcement that he would not press forward with Vermont's Green Mountain Care (GMC) reform arose from political calculus rather than fiscal necessity.
GMC had veered away from a true single payer design over the past three years, forfeiting some potential cost savings.
Yet even the diluted plan on the table before Shumlin's announcement would probably have lowered total health spending in Vermont, while covering all of the state's uninsured....
... Decades of exemplary grassroots organizing (and strong labor union support) in Vermont put single payer on the agenda. During Shumlin's 2010 gubernatorial campaign, he promised to implement a single payer reform, which was a factor in the Progressive Party's decision not to field a candidate...
... After his victory, Shumlin and the legislature commissioned economist William Hsiao to study options for health reform in Vermont, including single payer. Rejecting a fully public single-payer plan, Hsiao instead proposed a public-private hybrid†model...
... An early signal of trouble was Shumlin's appointment of Anya Rader Wallack to chair the new GMC board. Wallack had deep ties to the private insurance industry, having held key positions (including the presidency) at the Blue Cross Blue Shield of Massachusetts Foundation...
... From the outset, Shumlin's team embraced an Accountable Care Organization payment strategy that would enroll most Vermonters in large hospital-based, HMO-like organizations that would be overseen by a designated entity†– presumably Blue Cross. To-date, ACOs have shown little or no overall cost savings, have increased administrative costs, and have driven hospitals to merge and gobble up physician practices. The consolidation of ownership triggered by ACO incentives has raised concern that regionally dominant ACOs will use their market power to drive up costs...
... The design for GMC incorporated several other features that increased the administrative complexity, and hence administrative costs of the proposed reform.
The plan never envisioned including all Vermonters in a single plan, instead retaining multiple payers.
Hence, hospitals, physicians' offices, and nursing homes would still have had to contend with multiple payers, forcing them to maintain the complex cost-tracking and billing apparatus that drives up providers' administrative costs...
... Vermont's November 2014 gubernatorial election had very low voter turnout, a circumstance that generally favors the right.
Gov. Shumlin – who had hedged on health reform during the campaign – eked out a narrow plurality, leaving the state legislature to decide between him and the Republican candidate and greatly weakening Shumlin's position.
A month later, while awaiting the legislature's decision (they elected him to a third term on January 9), Shumlin announced his pullback from reform...
... Even the administration's inflated cost estimates indicate that universal coverage under its quasi-single payer plan would cost somewhat less overall than the current system...
... Economist Gerald Friedman has estimated these overall impacts using the report's data, previous estimates of health expenditures in Vermont, and CMS figures on Medicare spending and expected health care inflation under the ACA.
He estimates that even the diluted reform proposed by the governor's team would cut overall health spending in Vermont by about $500 million annually...
... So why did Gov. Shumlin declare the reform unaffordable?
Many have noted that the $2.5 billion in new state expenditures required under the reform would nearly double the state's previous budget.
But these numbers are meaningless absent an accounting of the savings Vermont households would realize by avoiding private insurance premiums and out-of-pocket costs. As detailed above, these savings would more than offset the new taxes...
... It's a misnomer to label Vermont's Green Mountain Care plan single payer.â€
It was hemmed in by federal restrictions that precluded including 100 percent of Vermonters in one plan, and its designers further compromised on features needed to maximize administrative savings and bargaining clout with drug firms, and improve health planning.
But even the watered-down plan that emerged could have covered the uninsured, improved coverage for many who currently face high out-of-pocket costs, and actually reduced total health spending in the state – albeit far less than under a true single payer plan.
A true single payer plan would have made covering long-term care affordable, and allowed the elimination of all copayments and deductibles...
You can pine away for single payer, it won't happen in a free America. Vermont recently tried and failed. It's more expensive(for people that actually work and pay taxes) in the long term.
Once again you have your facts (or at least your terminology) wrong. Vermont didn't "try and fail." Vermont decided not to try it. There's a big difference. Plus, as already noted, the original concept had been modified far, far away from a true single-payer model.
MunoRN, RN
8,058 Posts
People in england are actually physiologically identical to Americans. They don't have 5 hearts or 2 heads, so the costs shouldn't vary that much, at least not double. Having a larger population served by a single system should actually decrease the per-person overhead costs, not increase them, which is why we spend more than twice as much per person as they do. While it's certainly true they would probably be better of spending a bit more, it's not a difference of twice as much.
Why is it you think I wouldn't be paid under single payer?