No governmental business can claim efficiencies over the private market. Show me one. I will show you financially failing Medicare, Medicaid, the U.S. Postal Service, Social Security, etc. All are going broke and politicians are unwilling to make the hard decisions because of the potential effect on their own re-election and monies from lobbyists.
A single-payer system—government or private—does eliminate some of the administrative hassles potentially, but does not attend to the drivers of our healthcare cost trends. It is not administrative costs (15%) that make us the most expensive in the world, it is in the expenditure of funds in the provision of insured medical care (85% of the cost). There are many drivers of the care trend, the major ones being the absence of a rational medical liability policy, the rapid diffusion of cutting edge and expensive technology (imaging, Rx, etc.) in an non-evidence-based fashion in our technology-driven culture, and absence of a primary-care-centric delivery system.
A single-payer system has some merits, but does not attend to any of the major drivers of cost. If you don't know the cause, your remedy will certainly fail.
Incidentally, the cost to administer Medicare and Medicaid per capita is about equal to commercial plans that have many more programs to administer. Administration rate is a ratio metric that has no merit since it is simply the cost to administer divided by the cost of healthcare (premium), which is large in governmental plans and thus falsely lowers the "rate." It nearly costs the same everywhere to adjudicate a claim.
Robert Forster, M.D.
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