History Forum / General / British History / February 2007

Well, a.shole punk, it was already described in the articles I referenced,
a.shole.

Another indication of your incompetence, just like in the food borne illness
discussion, a.shole.

http://www.citizen.org/pressroom/release.cfm?ID=1623
Jan. 14, 2004

Study Shows National Health Insurance Could Save $286 Billion on Health Care
Paperwork:

Authors Say Medicare Drug Bill Will Increase Bureaucratic Costs, Reward
Insurers and the AARP

A study by researchers at Harvard Medical School and Public Citizen to be
published in Friday’s International Journal of Health Services finds that
health care bureaucracy last year cost the United States $399.4 billion. The
study estimates that national health insurance (NHI) could save at least
$286 billion annually on paperwork, enough to cover all of the uninsured and
to provide full prescription drug coverage for everyone in the United
States.

The study was based on the most comprehensive analysis to date of health
administration spending, including data on the administrative costs of
health insurers, employers’ health benefit programs, hospitals, nursing
homes, home care agencies, physicians and other practitioners in the United
States and Canada. The authors found that bureaucracy accounts for at least
31 percent of total U.S. health spending compared to 16.7 percent in Canada.
They also found that administration has grown far faster in the United
States than in Canada.

http://www.rwjf.org/portfolios/resources/grantsreport.jsp?filename=036617.htm&ia
id=132

Administrative costs for health care in the United States significantly
exceeded those in Canada in 1999. Researchers at the Cambridge Medical Care
Foundation found that administrative costs per capita were $1,059 in the
U.S. and $307 in Canada; these costs accounted for 31 percent of health care
spending in the U.S. versus 16.7 percent in Canada. The Robert Wood Johnson
Foundation provided $139,381 to support this study from July 2000 to January
2003.

To a large extent, you stupid punk, it's attributed to something called
efficiency, largely arising from lack of cost shifting, a.shole.

This moron thinks private insurance doesn't entail paperwork.

What an a.shole.

Take you insults and shove them up your punk a.s.

You haven't answered any of the points raised because you can't, you phony
punk.

Sounds phony - nothing apparent comes up on a Google search.

participates in a variety of contracted

Assuming this isn't a totaly false organization you claim, with a strange
name for a health plan -  you get paid for nothing.

It's already been pointed out that large credible studies have been done
that analyze efficiencies in which the US private system comes out poorly
with excessive expense.

You can do nothing but pretend its propaganda and blabber about governement
paperwork, ignoring the paperwork and ineffeiciencies also present in the
private system.

Does private sector always perform better than government?  All anyone has
to do is think about Haliburton in Iraq doing things the military used to do
for itself to answer that one.

You're a third rate hack who tries to bully people and make claims of false
authority.  In short you're a punk.

Peer reviewed economic studies out of major universities have a lot more
credibility than blathering punk like you.

You are a phony and a punk and you can take your insults and shove them up
your as, punk.

Here shitface- something else for you to learn from the New England Journal
of Medicine.

http://www.pnhp.org/publications/a_national_health_program_for_the_united_states.php

A National Health Program for the United States: A Physicians' Proposal
Abstract:
Our health care system is failing. Tens of millions of people are uninsured,
costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms
succeed only in exchanging old problems for new ones. It is time for basic
change in American medicine. We propose a national health program that would
(1) fully cover everyone under a single, comprehensive public insurance
program; (2) pay hospitals and nursing homes a total (global) annual amount
to cover all operating expenses; (3) fund capital costs through separate
appropriations; (4) pay for physiciansÕ services and ambulatory services in
any of three ways: through fee-for-service payments with a simplified fee
schedule and mandatory acceptance of the national health program payment as
the total payment for a service or procedure (assignment), through global
budgets for hospitals and clinics employing salaried physicians, or on a per
capital basis (capitation); (5) be funded, at least initially, from the same
sources as at present, but with payments disbursed from a single pool; and
(6) contain costs through savings on billing and bureaucracy, improved
health planning, and the ability of the national health program, as the
single payer for services to establish overall spending limits. Through this
proposal, we hope to provide a pragmatic framework for public debate of
fundamental health-policy reform. (N Engl J Med 1989; 320: 102-8.)

Full Text:

OUR health care system is failing. It denies access to many in need and is
expensive, inefficient, and increasingly bureaucratic. The pressures of cost
control, competition, and profit threaten the traditional tenets of medical
practice. For patients, the misfortune of illness is often amplified by the
fear of financial ruin. For physicians, the gratifications of healing often
give way to anger and alienation. Patchwork reforms succeed only in
exchanging old problems for new ones. It is time to change fundamentally the
trajectory of American medicine - to develop a comprehensive national health
program for the United States.

We are physicians active in the full range of medical endeavors. We are
primary care doctors and surgeons, psychiatrists and public health
specialists, pathologists and administrators. We work in hospitals, clinics,
private practices, health maintenance organizations (HMOs), universities,
corporations, and public agencies. Some of us are young, still in training;
others are greatly experienced, and some have held senior positions in
American medicine.

As physicians, we constantly confront the irrationality of the present
health care system. In private practice, we waste countless hours on billing
and bureaucracy. For uninsured patients, we avoid procedures, consultations,
and costly medications. Diagnosis-related groups (DRGs) have placed us
between administrators demanding early discharge and elderly patients with
no one to help at home - all the while glancing over our shoulders at the
peer-review organization. In HMOs we walk a tightrope between thrift and
penuriousness, too often under the pressure of surveillance by bureaucrats
more concerned with the bottom line than with other measures of achievement.
In public health work we are frustrated in the face of plenty; the world's
richest health care system is unable to ensure such basic services as
prenatal care and immunizations.

Despite our disparate perspectives, we are united by dismay at the current
state of medicine and by the conviction that an alternative must be
developed. We hope to spark debate, to transform disaffection with what
exists into a vision of what might be. To this end, we submit for public
review, comment, and revision a working plan for a rational and humane
health care system - a national health program.

We envisage a program that would be federally mandated and ultimately funded
by the federal government but administered largely at the state and local
level. The proposed system would eliminate financial barriers to care;
minimize economic incentives for both excessive and insufficient care,
discourage administrative interference and expense, improve the distribution
of health facilities, and control costs by curtailing bureaucracy and
fostering health planning. Our plan borrows many features from the Canadian
national health program and adapts them to the unique circumstances of the
United States. We suggest that, as in Canada's provinces, the national
health program be tested initially in statewide demonstration projects.
Thus, our proposal addresses both the structure of the national health
program and the transition process necessary to implement the program in a
single state. In each section below, we present a key feature of the
proposal, followed by the rationale for our approach. Areas such as
long-term care; public, occupational, environmental, and mental health; and
medical education need much more development and will be addressed in detail
in future proposals.

COVERAGE

Everyone would be included in a single public plan covering all medically
necessary services, including acute, rehabilitative, long-term, and home
care; mental health services; dental services; occupational health care;
prescription drugs and medical supplies; and preventive and public health
measures. Boards of experts and community representatives would determine
which services were unnecessary or ineffective, and these would be excluded
from coverage. As in Canada, alternative insurance coverage for services
included under the national health program would be eliminated, as would
patient copayments and deductibles.

Universal coverage would solve the gravest problem in health care by
eliminating financial barriers to care. A single comprehensive program is
necessary both to ensure equal access to care and to minimize the complexity
and expense of billing and administration. The public administration of
insurance funds would save tens of billions of dollars each year. The more
than 1500 private health insurers in the United States now consume about 8
percent of revenues for overhead, whereas both the Medicare program and the
Canadian national health program have overhead costs of only 2 to 3 percent.
The complexity of our current insurance system, with its multiplicity of
payers, forces U .S. hospitals to spend more than twice as much as Canadian
hospitals on billing and administration and requires U .S. physicians to
spend about 10 percent of their gross incomes on excess billing costs.1
Eliminating insurance programs that duplicated the national health program
coverage, though politically thorny, would clearly be within the prerogative
of the Congress.2 Failure to do so would require the continuation of the
costly bureaucracy necessary to administer and deal with such programs.

Copayments and deductibles endanger the health of poor people who are sick,3
decrease the use of vital inpatient medical services as much as they
discourage the use of unnecessary ones,4 discourage preventive care,5 and
are unwieldy and expensive to administer. Canada has few such charges, yet
health costs are lower than in 1he United States and have risen slowly.6,7
In the United States, in contrast, increasing copayments and deductibles
have failed to slow the escalation of costs.

Instead of the confused and often unjust dictates of insurance companies, a
greatly expanded program of technology assessment and cost-effectiveness
evaluation would guide decisions about covered services, as well as about
the allocation of funds for capital spending, drug formularies, and other
issues.

PAYMENT FOR HOSPITAL SERVICES

Each hospital would receive an annual lump-sum payment to cover all
operating expenses - a "global" budget. The amount of this payment would be
negotiated with the state national health program payment board and would be
based on past expenditures, previous financial and clinical performance,
projected changes in levels of services, wages and other costs, and proposed
new and innovative programs. Hospitals would not bill for services covered
by the national health program. No part of the operating budget could be
used for hospital expansion, profit, marketing, or major capital purchases
or leases. These expenditures would also come from the national health
program fund, but monies for them would be appropriated separately.

Global prospective budgeting would simplify hospital administration and
virtually eliminate billing, thus freeing up substantial resources for
increased clinical care. Before the nationwide implementation of the
national health program, hospitals in the states with demonstration programs
could bill out-of-state patients on a simple per diem basis. Prohibiting the
use of operating funds for capital purchases or profit would eliminate the
main financial incentive for both excessive intervention (under
fee-for-service payment) and skimping on care (under DRG-type
prospective-payment systems), since neither inflating revenues nor limiting
care could result in gain for the institution. The separate appropriation of
funds explicitly designated for capital expenditures would facilitate
rational health planning. In Canada, this method of hospital payment has
been successful in containing costs, minimizing bureaucracy, improving the
distribution of health resources, and maintaining the quality of care.6-9 It
shifts the focus of hospital administration away from the bottom line and
toward the provision of optimal clinical services.

PAYMENT FOR PHYSICIANS' SERVICES, AMBULATORY CARE, AND MEDICAL HOME CARE

To minimize the disruption of existing patterns of care, the national health
program would include three payment options for physicians and other
practitioners: fee-for-service payment, salaried positions in institutions
receiving global budgets, and salaried positions within group practices or
HMOs receiving per capita (capitation) payments.

Here's another, punk.

Administrative Waste Consumes 31 Percent of Health Spending

PNHP Co-founders Drs. Steffie Woolhandler and David Himmelstein published
this definitive study of the administrative costs of the U.S. health system
in the August 21, 2003 edition of the New England Journal of Medicine. After
analyzing the costs of insurers, employers, doctors, hospitals, nursing
homes and home-care agencies in both the U.S. and Canada, they found that
administration consumes 31.0 percent of U.S. health spending, double the
proportion of Canada (16.7 percent). Average overhead among private U.S.
insurers was 11.7 percent, compared with 1.3 percent for Canada’s
single-payer system and 3.6 percent for Medicare. Streamlined to Canadian
levels, enough administrative waste could be saved to provide compressive
health insurance to all Americans.

Read “Costs of Health Administration in the U.S. and Canada” (pdf)

Government generally is least efficient, followed by non-profit, while
for-profit tends to be most efficient.

The problem with government is that incentives tend to be to be as
inefficient as possible, only becoming efficient in response to public
pressure.

Non-profits tend to be idealistic but stupid, hence inefficient,
barely scraping by at the balance point between income and expenses.

There is so much inefficiency to be wringed out of the non-profit
sector that for-profit business invariably cleans their clock, despite
the 20% or so profit margin. The problem with the for-profit sector is
spillover costs, again public pressure is needed to eliminate those
spillover costs.