HEALTHCARE
July 11, 2019

Doctors Arguing for a Single-Payer System

It takes about 13 minutes to process billing and insurance for a typical 20-minute doctor visit, one reason why 12 percent of your insurance premiums goes to administrative overhead.

Single-payer medicine isn't just an option for the United States, it's a necessity, according to an article by two doctors published in JAMA, The journal of the American Medical Association.

Billions of dollars are involved, and the sheer size can make it hard to wrap our minds around the issue. So the authors help out by offering some smaller scale comparisons that are easier to understand.

“The $11,559 per capita that the United States spends on health care could provide high-quality care for all or it can continue to fund a vast health-managerial apparatus — it cannot do both. ”

They cite the example of a study of a medical practice in North Carolina that employs over 1,600 physicians. In 2016, doctors there spent $99,581 and 243 hours — over 10 full days — on billing, time that could have been spent seeing patients instead.

The North Carolina study also estimated that the total time for processing billing and insurance purposes of a typical primary care doctor visit was 13 minutes, in an age when the 20-minute doctor visit has become a standard.

The cost associated with processing the visit was over $20. The study describes its findings for both time and cost as conservative estimates.

In all, this kind of administrative overhead is estimated to siphon off about 12 percent of insurance premiums, at least among among people who have medical insurance. That's compared to 2.2 percent for Medicare and 1.6 percent for Canada's single-payer system.

High overhead adds up to a lot of healthcare dollars that aren't being spent on healthcare. It's also one reason why, despite spending over $11,000 per person on healthcare, people in the United States have a shorter lifespan than people in many countries that spend less.

“The United States has fallen behind other nations in measures of life expectancy and access to care,” the authors point out. “Drug prices in the United States, already twice those in Europe, continue to increase, compromising patient adherence to vital medications, such as insulin. Twenty-nine million US residents remain uninsured, and co-payments and deductibles force many individuals with insurance to choose between skipping care and incurring overwhelming debts.”

Yes, there will be problems in making the switch, but the status quo is no longer acceptable, the authors, Steffie Woolhandler and David U. Himmelstein, both of the School of Urban Public Health, City University of New York, Hunter College, New York, New York; and Harvard Medical School, Boston, Massachusetts, believe. “Halfway measures are politically attractive but economically unworkable. The $11,559 per capita that the United States spends on health care could provide high-quality care for all or it can continue to fund a vast health-managerial apparatus — it cannot do both.”
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