I hate this carping about taxes. Taxes will go up .. and premiums will go down! So this may work out to be a win for most workers.

Oy.

"Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."

At first glance, this whole approach strikes me as a deeply canny way of getting past the political obstacles...

"Can evolve into single-payer" rates pretty high on my list of cool features.

All of the articles on google news have "Edwards plans to raise taxes to pay for healthcare" or "Edwards health plan means higher taxes" or another variant. Give me a freaking break. That's all they have to say about it? Not "Edwards plans to cover the uninsured" or even "Edwards plan might fix broken health system" or anything like that? Tells you how deeply Republican talking points are ingrained in our mindsets.

Just remember:

Community rating with no age-rating means an average premium of $2000/month for a 2-parent, 2-child family.

That's among the sillier things I've heard. It may interest you to know that a variety of states have already instituted various types of community rating, and none have seen that outcome.

Ezra,

I'm trying to be fair. (So if my calculations are wrong, correct me--I'd like some re-assurance.)

Mean income is about $40k/year, and is less than per-capita GDP.
Health care costs about 15% of GDP.

So 40000*.15*4/12 gives me a monthly average spending on healthcare of $2000 for 4 people.

cool- so it would allow competition between the private sector and public to see which can really produce a better outcome, or am I misunderstanding it?

it puts the onus of the responsibility for funding health coverage on employers, a decision I don't quite understand.

Sounds like he sees it as part of his economic justice thing--(rich) employers should help foot the bill.

This American solution will reward the sector that offers the best care at the best price.

The public sector "competes" with what are easily portrayed as unfair advantages. Harry and Louise may oppose the plan just for this part of it.

Indeed, the plan satisfied every plank of my progressive health reform test from last week.

So you're confident that the employer participation requirement doesn't violate at least part of your first condition: An End To Employer-Based Health Care? Will there remain advantages to getting insurance through employers that won't be available to the self- or unemployed? The employer requirement ought to have some implications, depending on the details.

woohoo! community rating required, and public/private sector competition!

I'll take one of those, please, maybe.

But what about prescription drugs being included in the plans (and associated formulary issues)? This crucial issue is not mentioned anywhere in the plan. Modern medicine is largely based in drug treatments, and they are very expensive.

I'd bet Hillary sez we can't afford the tax increase and competition from the public sector is bad because Blue Cross/Shield and United Health say so. I'd bet the Dem. candidate's health-care proposal auction is low-bid from all the others - especially on drugs.

While we are dreaming of sugar-plum fairies, maybe Obama will propose extension of Medicare to all with drugs as a public sector choice as well. (I'm not so excited on state plans 'based on' Medicare). Reform should place responsibility and administration at the Federal, not state level. If not, states will compete in the run for the bottom to attract new businesses to their state.

Now, if Edwards would just get his head straight on mideast war, he'd get my heart throbbing (instead of being broken by his squirrelly position on Iran).

And tangentially...

Has Edwards had a good weekend or what?

I love that Taegan Goddard can see the light:

After speaking with John Edwards over the weekend, it struck me how he's the "straight talk" candidate in the 2008 presidential race. Like Sen. John McCain in 2000, Edwards seems to have little interest in dancing around tough issues and finessing his answers. Instead, he seems compelled and driven to speak his mind.

...

Edwards' appearance on Meet the Press yesterday also showed his new style. From repudiating his Iraq war vote to pledging to raise taxes to pay for universal health care, he comes across as a very different kind of politician. It's worth watching.

His style is certainly being picked up by odd places in the media- they had a clip of him yesterday on NY 1 of all places.

Yesterday, watching MTP, when Edwards was asked if he planned on raising taxes to pay for health care and he answered, "Abosolutely" (a clip we'll see a million times if and when Edwards is the candidate) I had the feeling that Edwards had helped to usher in a new, honest, and progressive era in American politics.

That said, I agree with Ezra, I always thought one of the big problems with health care was that it was hinged to employment. Doesn't Edwards's plan pepetuate the problem, or am I missing something?

Be careful with that Zicam. It's worked for me, but after learning that class-action lawyers are in the process of forming a class of users who lost their sense of smell after using the nasal gel, I've begun searching for a safer Zinc-delivery mechanism.

On community rating: Health spending is not all, or even nearly all, premiums.

On employers: What Edwards' plan does is incentivize employers to put their employees in health market plans. I don't know how heavy that incentive is, and I don't know he doesn't just do it from the outset (a la Wyden).

Thad: I'm using the mouth spray. Is that dangerous too?

Sorry, Ezra--I'm still not understanding.

If everyone has comprehensive health insurance, wouldn't "money spent on health care" = "money paid in health care premiums." (There are some copays/deductibles, but they are minimal; there are some profits, but that woudl increase premiums, not decrease them).

Or are you saying that currently, lots of premiums don't go to purchase health care? I agree with that; that's why I'm basing my calculation on the cost of health care, not current premiums.

On antother topic--the best cold remedy I've found is hot ginger tea, with plenty of sugar, lemon, and rum (or bourbon).

I have two questions for Mr. Edwards regarding his healthcare plan.

1. Would the public plan modeled after Medicare be required to price its product high enough to cover its costs (including its administrative costs)? If not, it's grossly unfair to the private insurers.

2. How come you didn't have a single word to say about medical malpractice reform and the high cost of defensive medicine? Don't you think special health courts could resolve medical disputes more fairly and objectively than juries?

I know you're a trial lawyer by background, but I think you could enhance your credibility if you came up with something constructive to say about how to improve our malpractice system and the culture of defensive medicine it spawns.

Regarding Medicare, which you envision as a model for your public plan that would compete with private plans, it has a lot of room for improvement. Part B charges, for example, require a 20% patient co-pay with no out of pocket maximum which means sick people with high healthcare costs still face crushing out of pocket exposure unless they also have a good Medigap supplemental insurance policy. Furthermore, there is a $900 deductible associated with every hospitalization, which is considerable for those with lower incomes. Finally, Medicare Part D has the infamous donut hole because politicians preferred to sprinkle at least some benefits over as many voters as possible rather than create a sensible insurance plan with a higher but still manageable deductible.

Finally, with respect to affordability, moderate income people who make a little too much to qualify for your sliding scale subsidy will find it extremely difficult to afford coverage, especially if they need to cover an entire family.

Ezra, maybe you know something about the plan that isn't in the summary you linked to. It seems to me that it requires employers to subsidize employees' plans. If the subsidy required exceeds the subsidy available for the self- or unemployed (which will probably vary with income), then there is still a tie to employment of the kind I think you object to, isn't there?

My extensive research (on Google) suggests that the mouth spray is ok.

Edwards' plan seems like a great start, but something to keep in mind about the competition part: When you ask insurance companies to compete on cost, they're not going to compete by cutting their profit margins. They'll try to keep their rates down by cutting back on what they pay in benefits. But you won't find out till you're sick and need your procedures covered. It's hard to control.

I know the politics of the situation seems to require making a place in the solution for insurance companies, but I worry that will just perpetuate many of the problems we have today. OK, so they can't refuse to cover people. But they'll still be able to pay inadequately or not at all, if in their judgement the treatment isn't needed.

That's why the only thing that seems to make sense if a single-payer universal system. Still, I don't want to make the best the enemy of the good.

They'll try to keep their rates down by cutting back on what they pay in benefits. But you won't find out till you're sick and need your procedures covered. It's hard to control.

Well, I assume that all plans would need to pass a minimum standard of quality. That should get rid of the most egregious offenses, and many of the less egregious. The risk of getting screwed in the way you describe would decrease heavily in a switch from the current, less-regulated, non-universal program to Edwards' more-regulated, universal program.

Very few people seem to think that Medicare is too stingy with covering procedures. If the insurance companies can't beat Medicare, then people will head for Medicare.

I agree that the insurance company model creates real problems, and that you present a good argument for an immediate switch to single-payer. However, I just don't see how an immediate switch is politically feasible, and so every workable plan will have to deal with the drawbacks of partly privately-run insurance. That's why it's so good that the Medicare-like plan competes with the private plans - unless the insurance companies avoid trying to fuck over the most vulnerable patients, they'll slowly lose business. It sucks that this shift has to come at the expense of those who will suffer in inadeqaute health plans, but this plan sure beats the crap out of (a) not requiring meaningful minimum standards of care and (b) not providing universal insurance.

Posted by: Madison Guy | Feb 5, 2007 12:37:19 PM

Edwards' plan seems like a great start, but something to keep in mind about the competition part: When you ask insurance companies to compete on cost, they're not going to compete by cutting their profit margins. They'll try to keep their rates down by cutting back on what they pay in benefits. But you won't find out till you're sick and need your procedures covered. It's hard to control.

The first control upfront, is whatever the coverage requirements are to be entered into the state menu of plans.

The second control, at the back, is the ability to transfer into the public plan, so that the person that loses the coverage from that insurance company does not lose coverage altogether. That means the pursuit of profits through "denial of service" leads to a steady reduction in the share of private insurance coverage and a steady increase in the share of public insurance coverage.

That means that the ongoing

DivGuy, it appears that Amanda has deleted your post.

Nope. No sooner said than it shows right up. Does this mean I have to apologize to Amanda too?

Posted by: SamChevre | Feb 5, 2007 10:09:59 AM

I'm trying to be fair. (So if my calculations are wrong, correct me--I'd like some re-assurance.)

Mean income is about $40k/year, and is less than per-capita GDP. Health care costs about 15% of GDP.

So 40000*.15*4/12 gives me a monthly average spending on healthcare of $2000 for 4 people.

But you are ignoring that fact that with medicare, the government is already providing coverage for a large cohort with per capita health care spending substantially above the economy wide average. Take that cohort out of the average, and the spending on health care services by the remaining cohort is substantially less than 15% of their per capita share of GDP.

Thad & Ezra,

I don't see why you would use any Zicam product, regardless of ill-effects. The makers claim their product is homeopathic, which is pseudoscience claiming that "like cures like" (zinc must cause colds somehow). According to homeopathy, then, the substance must be diluted thousands of times until no actual trace of the active ingredient exists; the water will "remember" the active ingredient. So while you'll be ingesting a completely ineffective solution, at least it's just water so it can't really harm you.

Zicam, however, only dilutes 1X, which is not enough to remove the active ingredient. Hence the nose irritation and now the lawsuit. Zicam is based on a magical and non-scientific premise which its makers didn't even carry out correctly. That should be enough to stop using the product altogether.

Feel better, Ezra.

My first criticism is linking the tax increase so tightly to universal heatlth care. Tax increases on those earning over 200 grand is tax policy, and general social policy, not specific to health care policy.

Since he is going to get tagged with the "raise taxes" meme, why not promote single payer as the more cost-effective plan?

As you say, Edwards plan is yet another variant of Mandated Care. Mandates came out of centrist-conservative-corporatist don't rock the boat too much, lets appease the disaster which is our health care coverage system without addressing the real problems sorta think tanks. It is truly sad that this is considered pulling the debate leftward.

To my mind, it is still Rube Goldberg care, the proverbial camel designed by committee: a little bit of expansion of Medicaid and SCHIP, an employer mandate plus an individual mandate, tax credits for lower-income individuals, and creating competitive insurance "health markets" that would include a government plan to trya dn appease us single payer advocates. The so-called "single payer option" in Edward plan is some sort of a publicly funded government insurance that people can buy into. Obviously that would not be single payer, that is a contradiction in terms since leaving in place the for profit insurers.

It is more expensive than need be since it still allows the for-profits to suck off the healthy and wealthy, while dumping the rest on us.

It is still more complicated than need be... for the same reason.

It still puts too much of burden on employers... for the same reason.

As you say, it is not even as good as Wyden's version of Mandates. Sheesh.

Here is hoping that Obama or Clark will do something real.

Curious given Union support for HR-676, why Edwards supposedly the Union candidate did not come up with a better plan?

I'm a bit too woozy to go in for serious wonkery now, but the essential answer to your question, Sam, is that not all that spending is paid for by premiums, and not all premiums are paid by individuals. In this system, like in the current one, a certain percentage will be picked up by employers, businesses, and government. And to answer the specific concern about comm rating, it isn't that the uninsured or uninsurable don't get point-of-crisis treatment -- we still pay for them now, in ERS -- it's just that they're not profitable for any particular insurer to take on.

SamChevre:

I'm having a hard time believing mean income for a family of 4 is roughly $160k/year. Wikipedia says median annual household income is just over $46k.

As Ezra mentions, premiums are not the only component of health care expenditures. This Kaiser survey estimated average annual premiums (both employee and employer contributions) of about $11,500 for family coverage in 2006. On the other hand, the OECD estimate that the US spent about $5700 per capita on health care in 2003.

Why shouldn't age be a consideration in deciding on premiums?

I'm sorry, but no one should have to purchase anything when it comes to receiving health care. This plan sounds like a water down Ira/Hillory plan.

Being state involved also allows the problem of lack of portability. No one should have to worry about moving. State involvement means at least 50 separate payors...a waste of duplication.

Raising taxes will not be the only issue. The issue will be tax code changes that shift income such that people can afford the purchases. IOW, getting the company to pay the help more vs. pocketing the savings as has happened in the productivity gains.

As for taxes? Pre 1981 personal to corporate was 1.9 to 1. Since 1981 it has been 4.94 to 1. There is a lot of room to rebalance the tax load regardless of how we finance health care.

BC: "Would the public plan modeled after Medicare be required to price its product high enough to cover its costs (including its administrative costs)? If not, it's grossly unfair to the private insurers."

Boo hoo hoo. Fuck the insurance companies. They're worthless parasites, and if this plan puts them out of business, that's a feature, not a bug.

Yeah! Destroying a major industry and its many jobs would be a good thing.

I wonder if anybody knows the answer to this: Does Mr. Edwards's plan call for government reinsurance? I don't quite understand how community rating is supposed to work without it. You can mandate community rating all you want (I for one think it's a must for any plan that attempts to be truly universal and relies on private insurance companies to play a major role), but the insurance companies -- unless they're relieved of financial exposure via government reinsurance -- will still have an enormous incentive to cherrypick. And, being the rational and clever people they are, you can be sure they'll find ways to do so, regardless of what the government says.

First, on the issue of community rating, a given insurance company would not be able to reject a particular customer who happens to have above average healthcare costs. Instead, risk scoring techniques exist (and will probably improve over time) that can adjust payments to individual insurance companies both up and down depending on how the risk of the overall pool that each company winds up with compares to a benchmark level. Medicare already does this with its Medicare Advantage program.

Second, for single payer advocates, the cost of the Medicare and Medicaid programs have been rising as fast or faster than total healthcare costs. Neither program has demonstrated any ability whatsoever to control utilization of services. Medicare has plenty of data that show huge regional variations in practice patterns but has done nothing to attempt to narrow those variations. Getting rid of deductibles and co-pays (to save administrative costs) would only make matters worse. Then, to suddenly create 47 million new customers with health insurance without any increase in the supply of doctors, hospitals or any other service providers will further exacerbate the problem, especially in the short run.

I've said before that healthcare costs are higher in the U.S. mainly because doctors and other providers earn considerably higher incomes here, we provide more heroic services at the end of life and the very beginning of life even when the prognosis is poor, and our litigious society and jury based malpractice system fosters a culture of defensive medicine among doctors. Other countries control costs through devices like global budgets and explicit rationing via QALY metrics. The global budgets force long wait times for many elective and non-life threatening procedures while QALY metrics make certain drugs, devices and procedures unavailable, at least to some people, usually based on age and/or prognosis.

Unless we are prepared to try to force down provider payments materially or impose one or more of the rationing techniques used in other countries, we will not save any money. Any administrative savings are likely to be swamped by much higher utilization, especially if deductibles and co-pays are eliminated and even more so if we try to cover long term care. To quote P.J. O'Rourke, "If you think healthcare is expensive now, wait until you see what it costs when it's free!"

Yeah! Destroying a major industry and its many jobs would be a good thing.

Yes it would! Many of these jobs fall in the "dead weight costs" basket. For example, I'd like to see many fewer smart folks get private-sector actuarial jobs where they'll be figuring out the most effective ways to screen off sick people and deny them coverage. I'd much rather see them do useful things like become doctors and scientists and teachers. If you like cutting needless bureaucracy and streamlining business, you'll like single-payer health care.

if that industry can compete then it won't be destroyed. It strikes me that only way the private insurance industry would be destroyed is if it produced a weaker product at a higher price. it's interesting to see definitions of competition that not only favor the private sector, but favors it over what competition it meant to accomplish. Which is not just keeping around outdated industries but making sure they work.

bc

link to the stats to back up your claims. thanks

we provide more heroic services at the end of life and the very beginning of life even when the prognosis is poor

Makes you proud to be an American, doesn't it?

Neil, I doubt many 45-year-old actuaries will become doctors. You may think putting thousands or tens of thousands of people out of work and destroying the investments of hundreds of thousands of people will have good consequences on the whole, but that doesn't make the negatives of that themselves a good thing, no more than when US jobs are shipped overseas to save us money at Wal-Mart.

Whether private insurance provides a good worth keeping is an open question. Markets have their advantages.

Akaison, if we give private insurers tax exempt status and back them with congressional funding should they need it, I'm sure they'll compete with Medicare just fine.

BC
The question of utilization controls is distinct from the issue of who insures. Single payer is perfectly compatible with copays and deductibles.

I am waiting for the first compelling argument explaining what exactly we get in return for allowing private insurers to turn a profit. Every penny of that is waste.

Anyhoo, the single payer good/bad debate may not be the most productive use of our time. Since we are all for universal health care and community rating, why don't we discuss some mobilization alternatives.

Since I am only interested in dialogue and cooperation among supporters of UHI and comunity rating, I will refrain from pointing out that if supporters of private insurancce really believed that it had something to offer other than misery and risk selection, they would be chomping at the bit to put into a competitive framework with Medicare, instead of carping that it is "unfair to private insurers" to run a Medicare buy-in at a loss. :)

RW, I think you've heard this before, so it must not impress you, but profits aren't waste. They're (in theory) the incentive and reward for innovation and superior products. That's how markets work.

a competitive framework with Medicare, instead of carping that it is "unfair to private insurers" to run a Medicare buy-in at a loss

I'm confused. You're talking about competition with an agency that can operate at a loss? How would it be competition?

If it runs at a loss, it imposes a cost that the political system can choose to bear or not to bear. I can stand to take a closer look at the Edwards plan, but no doubt the private insurers will be benefitting from subsidies to low income Americans who purchase their plans, no?

Imperfect competition is still competition. Private and public insurers would compete for people based on whether the insurer actually paid for the care as promised. Based on whether the providers had an easier time with the paperwork, and based on whether the overhead boosted the premiums.

The notion that profits produce innovation is quite impressive in reasonably well-functioning markets. What isnt impressive about it in the insurance setting is that realigning the client base and escaping liability seems to be the kind of "innovation" that produces the most profits to individual insurers. What other kind of tangible innovation in the industry is there, really? Logos?

Anyhoo, look, we are all people of goodwill here, and supporters of UHI and community rating to boot. How bout I do a search of op-eds that have weighed in on the issue and we divy up some letter writing duty?

Or something better?

Yes, private insurers will benefit from subsidies provided to low-income Americans.

The market must be properly structured to work, as you say. Incentives for cherrypicking can be substantially reduced by making it illegal, requiring community rating, etc. Innovation would come in the kinds of plans offered, and also in the kinds of relationships between insurers and providers. There has been some considerable innovation already in that connection, not all for the best. That is, it has provided some efficiencies through HMOs, for example, but not all efficiencies are welcome, so there is still plenty of room for further improvements.

Letter writing. Sounds interesting to me.

Posted by: R/W | Feb 5, 2007 11:06:12 PM

... Based on whether the providers had an easier time with the paperwork ...

If a Health Market has consolidated billing, why would there be different paperwork?

Indeed, I would think of the consolidated billing as part of the package for control of cherry-picking.

I'm in favor of universal healthcare, but I'm wary about employer given health insurance. What about the unemployed or those between jobs or those with jobs that don't pay well enough to buy healthcare? And what about the cost to businesses that we've seen have crippled the American auto industry?

just a quick note and link on medicare vs private health insurance - medicare has done much, much better at controlling costs than the private sector. comparing common benefits across medicare and private insurers, the compounded cost savings of the former relative to the latter is around 40%+ since 1970. here's one link, and, i've seen more recent data that i'll try to post sometime soon.

http://content.healthaffairs.org/cgi/content/full/22/2/230

josh bivens

Re: Ending the health insurance market.

If you think we should do more to keep jobs around that aren't economically efficient because they support workers who would be hard pressed to find other jobs, then you should probably vote Edwards anyway, as he is clearly the most protectionist of the major candidates, and the jobs lost to outsourcing are an order of magnitude greater than the workers involved in the health insurance market.

But you could just be trying to find holes in this plan, and not paricularly worried about job security.

Tony, Edwards' plan doesn't elimate private health insurance. It's universal single-payer that would do that (or close enough). Those supporting the preservation of private insurance job are in support of that feature of Edwards' plan.

Cain: I presume Zicam's manufacturers are calling it "homeopathic" because they think, correctly, that it's a word that sounds cool to a lot of people who don't really know what it means. But none of the proposed mechanisms for zinc's possible benefits have anything to do with homeopathy. (Just Google zinc + cold; I can't post links because Typepad thinks I'm a spammer.)

josh, thank you for the post. There are some who come here to make pronouncements , and you are good enough to do more by adding links. someone above actually argues exactly the opposite of your statement but offers no data to back up the assertion

Incentives for cherrypicking can be substantially reduced by making it illegal, requiring community rating, etc.

Actually, incentives for cherrypicking cannot be reduced by community rating -- only the ease of cherrypicking can be lessened. The incentive remains very firmly in place.

This is why, although I think mandatory universal rating makes a lot of sense if it is implemented properly, proper implementation will be a herculean task. What's to stop an insurer from exerting subtle pressure on its employees to give poorer service to those who are ill or have preexisting conditions (in the hope that they'll switch insurers)? What's to stop an insurance company from proactively wooing new customers from affluent zip codes and hiding from ones in poor neighborhood? Such tactics -- which will allow insurers to follow the letter but not the spirit of the law -- are sure to be used. I'm not opposed ideologically to the idea of having private insurance firms actively involved in the delivery of healthcare (and I think not involving them dooms any effort at substantive reform), but I just don't see how to square the knot and have truly universal coverage without a healthy dollop of reinsurance or, along similar lines, simply having the government insure high risk populations. We already do this with Medicare.

Why do we continue to insist on an opt-in system? Or, in other words, what the frack does thrusting people into a confusing and complex marketplace of "health plans" (insurance scams) have to do with providing universal coverage?

This "plan" (it's very vague, even the 7-page PDF) falls way short of what I'd like to see. It's got all the trappings of complexity (tax credits, etc), and none of the answers for the actual problems (a marketplace for insurance creates incentives that cut against the public well-being and create byzentine complexity in terms of how and what is covered) that plague us. Color me mightily dissappointed.

medicare has done much, much better at controlling costs than the private sector.

Under our current system, providers (especially hospitals) are, to some extent, able to cost shift to private insurers if they believe Medicare and Medicaid are not paying them adequately. Of course, with a single payer system, this would not be possible. The question then becomes: what would be the impact on the quality and availability of care? For some insight into this, Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston, spoke to this issue on his blog on August 11, 2006 with a post titled, Single Payer. The nine comments include several from single payer advocates and a couple from Mr. Levy. It's an interesting read and can be found at http://www.runningahospital.blogspot.com. A dictated price is not necessarily an adequate price.

Jasper, reinsurance or a high-risk pool is fine with me. When I speak of reducing the incentive for cherry-picking, I mean to include whatever makes it more difficult, as a community rating requirement does. I'd also favor far more effective collection and dissemination of consumer information--which companies come through. Cherry-picking of most kinds would be very difficult if consumers knew who was doing it.

Which brings up part of Josh's point. Preserving private insurance will keep things more complicated, as they are now. Medicare D is a big mess because there are so many plans available. I hope there would be a sufficient market for Consumer Reports type agencies to pick out winners, and warn of losers. Buying a car is complex too (even if less important), but with the right information it's not that hard.

The US spends twice as much on health care per capita than most countries with universal coverage, yet we have 48 million uninsured.

Where does it all go? BC complained of high pay for US doctors, medical malpractice costs, and a "costs be damned, save the life" mentality. Nowhere does he mention the costs of administering the incredible complexity of our current system - there are something like 15000 different health plans in southern California alone! Nor does he mention the insurance company profits.

Where does it all go? BC complained of high pay for US doctors, medical malpractice costs, and a "costs be damned, save the life" mentality. Nowhere does he mention the costs of administering the incredible complexity of our current system - there are something like 15000 different health plans in southern California alone! Nor does he mention the insurance company profits.

According to the California Healthcare Foundation, administrative costs aren't anywhere near the factor you all think they are. I must admit, though, that I was surprised at how large out-of-pocket costs are (self-pay nursing home costs probably account for a good chunk, along with dental and vision costs which most health insurance policies don't cover). Anyway, for the full 26 page report, see here.

"According to the California Healthcare Foundation, administrative costs aren't anywhere near the factor you all think they are"

That may depend on how you define adminstrative costs.
http://content.healthaffairs.org/cgi/content/full/24/6/1629

I see very little difference between John Edward’s health care plan and Arnold Schwarzenegger's plan - they are both boons to private insurance. By forcing everyone to get insurance the insurance industry is the big winner and any reforms they are required to make (like offering insurance at group rates to individuals and taking people with pre-existing conditions) will be hugely offset by the sheer volume of new business. But, it doesn't address the problem of those who still can't/won't get health insurance (just like with car insurance) and who will still tax the system with visits to emergency rooms for primary care. It also doesn't guarantee people will be able to afford insurance or provide for the self-employed and unemployed. I also wonder if some will get better insurance than others who can't afford to pay more.
A politician who has come forward with a sensible plan to reform our failing health care system is California

State Senator Sheila Kuehl, author of California Senate Bill 840, a comprehensive, single-insurance plan that doesn't force insurance on anyone; instead it provides it for everyone - by redirecting the billions of dollars now being wasted by the insurance industry into actual health care. Currently the thousands of insurance companies spend fortunes on advertising to compete against each other, pay outrageous salaries to top executives and create unnecessary administrative costs due to the nightmare of trying to keep up with the hundreds of different plans. And I would like to point out that streamlining the insurance into a single payer system would have no effect on the private health care industry and doctors, how care is delivered or a patient's ability to choose. Actually, a patient would probably have more choice in providers since so many private insurance companies demand patients use doctors in their networks. ("Medicare for All” - the Conyers/Kucinich bill - would also operate as a single payer system.)

I was supporting Edward’s for 2008 and he had been my favorite candidate in 2004. But, his health plan is so awful that if he doesn’t revisit it I will have to withdraw my support for his candidacy. I feel that strongly about the need for true universal health coverage and the only way to begin to repair our broken health care system is to address the real obstacle - big insurance that puts profit before people.

Single payer is still the best solution.

Big toe,

Thanks for the link. Very interesting study. After reading it, though, I'm not sure how to interpret it, and even the authors conclude: The net impacts of BIR are poorly understood."

I offer the following thoughts: (1) It would be useful to see what the administrative cost breakdown looks like for other systems – Canada, UK, France, Germany, Japan, etc. (2) The study did not speak to how much administrative expense could be eliminated under a single payer system. I was surprised to see that Medicaid's Admin % of premiums of 11.6% exceeded the Commercial figure of 9.9%. Medicare's low 4.5% is mainly a function of a very high average premium (3.67 times the Commercial figure) due to the much higher cost of covering the elderly. If looked at on a per beneficiary basis, it appears that Medicare's administrative costs are comparable to the Commercial insurers or even higher. (3) The analysis that relates to the physician sector suggests to me that the opportunity for savings are limited by the fact that there are some 800,000 or so physicians practicing in literally hundreds of thousands of physical locations. In any given location, there are comparatively few administrative staffers, and even if you could eliminate a few here and there, only the salary and benefits would be eliminated, but the infrastructure costs (office space, IT systems, etc.) would remain.

I note that the Lewin Group analysis of the Wyden plan (which is not single payer) projects administrative savings of $29 billion, I believe. Though, that's not nothing, it's not exactly a bonanza either in the context of financing care for the currently uninsured. If the potential administrative savings from a single payer system were so huge and so obvious, we would have seen the studies in Health Affairs by such luminaries as Alain Enthoven and Uwe Reinhardt who have been studying and publishing on health policy issues for decades.

As an aside, a significant portion of the commercial insurance sector is non-profit. Indeed, in Minnesota, where United HealthGroup is headquartered, non-profit insurers have a 100% share of the commercial insurance market by law.

Funny you should ask that. Check out this prior article.
http://www.prospect.org/csnc/blogs/ezraklein_archive?month=02&year=2007&base_name=why_does_american_health_care
Admin costs are part of the problem, though the largest hunk of inequity in comparison is doctor's compensation.

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Boo hoo hoo. Fuck the insurance companies. They're worthless parasites, and if this plan puts them out of business, that's a feature, not a bug.

Posted by: Firebug | Feb 5, 2007 7:53:38 PM

Yeah! Destroying a major industry and its many jobs would be a good thing.

Posted by: Sanpete | Feb 5, 2007 8:01:43 PM

Yeah, government programs to reduce stealing are bad because of the hardship they impose on thieves. And cigarette taxes and government ads against tobacco endanger the industry.

What an incredibly stupid argument. Thieves and the tobacco industry have employment alternatives, and so do the people who work in the health insurance industry. Ending the health insurance industry would be a good thing financially, even if it weren't one morally -- health insurance is theft, and produces much unnecessary death and suffering when payment for needed treatment is withheld.

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This is quite belated, so I do not know if it will be read, but I am compelled to comment, anyway.
I like the health care plan: at least there is a plan here. To BC, 2/5/07: While well-intentioned, your questions to Mr. Edwards are not quite as insightful or thought-provoking as you may have planned. Medical malpractice reform??????????? Have you had a family member harmed by poor medical practice? I hope not, but, until you've been there, you will probably buy into the medical profession's powerful propaganda about high insurance rates driving them out of the profession. I applaud Mr.Edwards for standing up for people. I do not think that people should get away with false claims, and they do hurt others in a "cry wolf" sort of way, but a special court for this is, perhaps, unconstitutional to the consumer. And make no mistake: every patient should act as a consumer, for that's what he is.

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