qotd: Single payer as an issue for "Unpartisans"

posting from another Blog, forwarded with comments by McCanne @ Quote of the Day...i enjoyed it because i consider myself and independent or "unpartisan" as the author puts it...enjoy and follow the link to the full article, by clicking the title here...rw

The State.com Nov. 27, 2005
It's my party, and I'll vie if I want to
By Brad Warthen, Editorial Page Editor

Why is it so hard for partisans and ideologues to understand that we might hold our own values and positions even more passionately than they hold theirs, for the simple fact that they are ours. We didn't do what they did, which was to buy an entire set of attitudes off the rack, preselected and packaged by someone else, and chosen based on nothing deeper than brand name. ("moderates") ...are the people who take the independent risks that make things happen, from campaign finance reform to banning torture. Without them as pivots, giving ideas credibility by virtue of their own independence, we'd be forever in a state of stalemate, unable to settle any difficult issue. And those of us who support their like are the ones who decide elections - not the partisans, who can be taken for granted.

The best thing is to have no parties. But it's still fun to imagine what kind of party we who despise them would create if we were so inclined. ...for now, let's just call it the "Unparty." Every Unpartisan would have his or her own set of positions on issues, having worked them out independently. But to banish the thought that Unpartisans don't take strong stands, here would be some positions I would bring to the party table (and remember, this is just me, not the editorial board of The State):

* A single-payer national health care system - for the sake of business and the workers. If liberals and conservatives could stop driving a wedge between labor and capital for about five minutes, we could make this a reality. (His other positions are omitted from this message.) Such ideas are not left, right or wishy-washy. Admittedly, in my zeal to debunk the myth that we "moderates" (an inadequate word, really, for independents) don't take strong stands, I've deliberately chosen some ideas that are attractive to me but are too out there for my own editorial board.

Comment: Set aside the political divide that has paralyzed health care reform and see which model of reform would appeal to independent thinkers. This "Unpartisan" editorialist claims his right to express his passionate support for his own values and positions. His independent thinking has led him to conclude that single payer is the health care position that he would bring to the Unparty table. Many conservatives now recognize that there are many benefits to the single payer model.

Reduction of administrative waste is a good thing, even if it is the waste of private insurance bureaucracies and the burden they place on the health care system. Conservatives recognize that laissez faire market forces have not been able to harness run-away, detrimental high-tech excesses that are a major contributor high-cost, low-value health care. Many conservatives reject the inhumane notion that we must now turn to the market principle that costs should be controlled by making care unaffordable precisely for those who have health care needs.

Most conservatives do believe in the fundamental insurance principle of pooling risk, and they are chagrined by the insurance industry's success in dumping risk on others while avoiding their obligation to provide financial security for those with needs. Liberals support the fundamental concept that health care should be affordable and accessible for everyone, but many of them reject the most effective model - single payer - on the basis that it isn't politically feasible.

Perhaps it is time for the left to relinquish their exclusive claim to the single payer model. They don't have to turn it over to those on the right. They could turn it over to the Unpartisans who might welcome input from recovering Democrats and Republicans. An Unpartisan approach does not imply a process of compromise or "meeting in the middle." The truth in the health policy science behind the single payer model allows it to stand on its own.

Presumably, the Unpartisans would place truth above partisanship. - QOTD

Health Affairs - Nov-Dec 2005

The Cost Of Health Insurance Administration
In California: Estimates For Insurers, Physicians, And Hospitals

By James G. Kahn, Richard Kronick, Mary Kreger and David N. Gans

Estimates of administrative costs in the U.S. health care system have been the subject of considerable controversy during the past decade. Single-payer analysts Steffie Woolhandler, David Himmelstein, and their colleagues have argued that moving to a Canadian-style system would reduce U.S. administrative costs by 10-15 percent of total health spending. The hypothesis suggested by Woolhandler and colleagues, and supported by common sense, is that the complexities of a highly fragmented, multiple-payer system account for the "excess" administration.

To inform discussions of reform-related cost savings, it is valuable to document the portion of administrative costs attributable to the U.S. system of paying providers.

Administrative costs account for 25 percent of health care spending, but little is known about the portion attributable to billing and insurance-related (BIR) functions. We estimated BIR for hospital and physician care in California. Data for physician practices came from a mail survey and interviews; for hospitals, from regulatory reporting; and for private insurers, from a consulting company. Private insurers spend 9.9 percent of revenue on administration and 8 percent on BIR. Physician offices spend 27 percent and 14 percent, and hospitals, 21 percent and 7-11 percent, respectively.

Overall, BIR represents 20-22 percent of privately insured spending in California acute care settings. In comparison to the health care systems of other advanced economies, it is difficult to argue that the United States has an efficient health care system: Its high level of clinical health care spending does not seem to be matched by superior outcomes. To the extent that competition does not foster cost control and quality improvement, and to the extent that a simpler system with fewer insurers would allow a reduction in BIR, then reductions in BIR are an attractive target for reform initiatives.

Comment: This landmark study supports prior evidence that the United States wastes a tremendous amount of resources on health care administration. What is particularly noteworthy in this study is that it breaks out the administrative costs that are specifically due to billing and insurance related functions for health care covered by private insurance plans in California, a microcosm of health spending in the United states. Let's state that again.

Billing and insurance related functions represent over one-fifth of privately insured spending.

Is that clear?

The billing and insurance administration functions of private insurers combined with the resultant billing and administrative burden placed on physicians and hospitals constitute over one-fifth of privately insured spending. How many times have you heard that, even if the administrative waste is real, the U.S. health care system is so complex that you could never recover those costs with a single payer system? Do not ever again let such a statement go unchallenged.

Under a single payer system, much of the billing and insurance related functions would disappear. This study confirms the enormity of the savings that would ensue.