Letter to the editor: Complex care

To the editor:

The Democratic debates centered on whether private insurance should be part of a universal health care system. An article by David U. Himmelstein in the Journal of the American Medical Association reflects on the question.

We spend twice as much per capita for health care as any other country. Much of this expense goes not toward health care itself but for the management of our overly complex system.

Insurance companies have to cover the cost of advertising and selling their product, negotiation and contracting with providers, administration of their complicated coverage and prior authorization rules, eight-figure executive salaries and, of course, profit, totaling about 12% of premiums. That compares with 1.6% in Canada’s

single-payer system and 2.2% in U.S. Medicare.

Of course that complexity must be matched on the provider side, where over 100 different insurance companies with differing rules may have to be dealt with and billed, along with thousands of patients. As a result, U.S. hospitals average 25.3% in administrative expense versus 12.4% in Canada, and U.S. physicians average 50-60% in office overhead versus 24.7% in Canada.

Consolidation of purchasing power would also restrain the fastest growing expense in U.S. health care, pharmaceutical costs, which are twice those of Canada.

In summary, the complexity of our system is no longer affordable. Halfway measures may be politically attractive but economically unworkable. The $11,559 per capita we spend on health care could provide comprehensive, high quality care for all — without deductibles and co-pays — or it can continue to fund a vast health care managerial apparatus; it cannot do both.

Steven C. Bruner, M.D.



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