James Clay Fuller

Things We're Not Supposed to Say

Monday, February 23, 2004

Socialized medicine? Bring it on!

Let’s run government like a business! That’s the crappola we get from the rightists at every turn, repeated as though the phrase had magical qualities. Yet anyone who ever has had to deal frequently with both private and public sectors knows that there’s scarcely a government agency in these United States that comes close to the average corporate bureaucracy for inefficiency, rigidity or waste of money.

Remember the outcry – and the millions and millions of dollars of advertising – when the Clintons talked seriously about the possibility of a national health care system? That was all about private vs. government efficiency and, of course, choice of doctors. A government system would eat up all the money with administrative costs, the big insurers and pharmaceutical companies and other sponsors of those ads said. And we wouldn’t be able to choose our own doctors.

Sadly, a large percentage of our ignorant populace bought the lies. And our health care “system,” has continued to rot. Year by year, more people are without basic health insurance, many working people simply go without health care, and increasing numbers of children and the elderly forgo medications because they and their caregivers don’t have the money to pay for them. And, I need to point out, HMOs tell a large and growing portion of the public which doctors they can see when and how often. The only thing systematic about what we have now is the screwing the public gets at every turn.

Well, now. There’s an interesting report on health care administrative costs in the February 2004 issue of the Public Citizen Health Research Group’s newsletter, the Health Letter. The same material apparently was reported in the August 2003 issue of the New England Journal of Medicine, but most of us lay folks missed that – and our local press ignored it. Too busy researching and writing articles on cosmetic surgery, I think.

The NEJM piece was written by Dr. David U. Himmelstein. No author is named on the Health Letter piece, but it cites the same research, done by Himmelstein and another Harvard Med School professor, Dr. Steffie Woolhandler. One caveat: The authors/researchers obviously believe the time has come for some sort of a national health care program. They could, therefore, be open to attacks on their research. My own inclination is to trust the numbers they provide, but it’s true that some opportunity for fiddling was there, if they chose.

To reduce the suspense: The study says health care bureaucracy sucked up $399.4 billion in the United States last year. It estimates that the country as a whole could save “at least” $286 billion annually on paperwork if it had a national health insurance program. That is, the authors noted, enough to cover all of the uninsured and to provide full prescription drug coverage for every resident of the United States.

Those conclusions are based on an extensive analysis of health care administration – including data on administrative costs of health insurers, employer health benefit programs, hospital, nursing homes, home care agencies, physicians and other practitioners in this country and Canada..

Bureaucracy accounts for at least 31 percent of total U.S. health care spending, the authors say, compared with 16.7 percent in Canada, which has a national (single payer) health care system.

Some other conclusions:

* The recent Medicare bill, backed by the AARP and other conservative groups, “will only increase bureaucratic spending because it will funnel large amounts of public money through private insurance plans with high overhead.” Medicare’s overhead now is less than 4 percent, the study noted, but all of the new Medicare money – $400 billion – will run through private insurance plans that have an average overhead of 12 percent. The insurance companies will grab off $36 billion from the Republican-pushed law.

* The savings in administrative costs if this country had a national health insurance program – $286 billion annually – would pay the estimated $80 billion to cover U.S. residents who are now uninsured.

* A national system would cover all out-of-pocket prescription drug costs for everybody ($53 billion last year).

* It would fund retraining and job placement for insurance company employees and others who would lose their jobs with the establishment of a national insurance program. (Estimated cost, $20 billion.)

* It would make substantial improvements in coverage and quality of care for people who already have health insurance.

Another way to look at it, according to the Health Letter: Savings in administrative costs would be equal to $6,940 for each of the 41.2 million people who were uninsured in 2001, the last year for which figures were available when the study was done. That is more than enough to pay for health coverage for those people.

There’s more, but you get the idea. Our private-insurance/no insurance setup is criminally costly and inefficient. We could cover health care and medications for everybody in the country without spending a dime more than we now spend if we went to a national health insurance program. And that doesn’t even take into account the enormous amounts we now pay because people don’t have health care coverage – costs for emergency room use, care of people with catastrophic illnesses that could have been avoided with normal health care, loss of work time and so on. Being citizens of the Bushies’ America, we won’t mention the stress and emotional pain our present screw-the-public system costs so many of us.

You can subscribe to the Health Letter by writing: Health Letter, Public Citizen Health Research Group, 1600 20th St. N.W., Washington, D.C.20009. One year cost is $18. The Health Research Group’s Web site is http://www.citizen.org/hrg/