The biggest area of unnecessary cost is administrative costs. There are thousands of insurance companies, and they all have different rules, and that requires every doctor to have a staff of at least two people, plus a nurse, most likely. The two people spend almost all their time on filing paperwork. Well, it’s hard for a single doctor to afford this, and that’s why we are seeing so many practices merged together, and affiliating with hospital systems. This is less true in rural areas, but generally true everywhere.
Docs are no longer automatically getting rich. They are now, in most cases, employees, not small business people. They are being forced to see more people in fewer time. The assembly line is being speeded up. There is a doctor’s union. Expect to see more people joining it.
Some docs are trying to fight back by setting up these boutique practices. Folks pay $2000 per year and they can see the doc as much as they like, and get as much time as they like. In this way, the doc doesn’t need to handle insurance at all, and doesn’t need to hire administrative staff, except to handle medical records. If the doc goes digital with medical records, even that person may become unnecesssry. You’d still need an appointments secretary and a nurse or PA.
Anyway, administrative overhead would be nearly eliminated when you only have one insurer for everyone in the country. The savings from that alone would allow us to offer insurance to every person (not just every citizen). The benefits package would be larger than anyone currently has (it would fully cover dental, long term care, durable medical equipment, alternative medicine, mental health care).
The thing is, access to care would start driving down medical expenditures further. There a set of conditions called ambulatory care sensitive conditions; things like diabetes; where if you get care in a physician’s office early on, you save on a hugely expensive hospitalization, later, if people wait until they can’t ignore it any longer to go to the emergency room.
Good dental care, believe it or not, reduces heart disease, and is correlated with longer and healthier life spans. Free smoking cessation and exercise plans also reduce many health risks, and reduce the cost of medical care, overall. There are huge advantages to a healthy population: fewer days lost to sickness, fewer people worrying about how to care for elderly parents; less disease being transmitted in the workplace or at school if immunizations are “free” for everyone.
None of this is free, of course. It has to be financed via taxation. But the taxes would be lower than the amount you currently lose from your paycheck so your employer can pay for health insurance premiums. If your employer passes their savings onto you, you make out better under a single-payer system.
So, we don’t need to sweat the small stuff, like malpractice insurance and medical profits, and conspicuous consumption. There’s gonna be a lot of money for that. More than enough.
The only problem, of course, is the insurance industry. They do not like anyone meddling with their gravy train. But the way I see it, their profits are legalized stealing. I have no sympathy. And anyway, they can work for us, managing the system. They won’t have to lay off everyone. They just won’t get to play with premiums while they’re waiting to pay for health care.
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