The System is Sick

With all the other things going on to blog about lately I haven't made time to write anything about healthcare in a while. This NYT article reminded me that it might be time again.

I believe that the first successful moves towards a single-payer system in the US will come from businesses, already reeling from the increases in insurance costs for employees. One major culprit in rising health care costs is duplication of administrative effort. The NYT says that thirty cents of every health care dollar is spent on administration. Imagine what cutting that cost in half or even down to one-third could save all of us.

How complicated does this duplication of effort make things for patients?

"I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do," said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. "I can't figure out what care it was related to or who did what."

Even if you assume that some system that simplifies administration across the board and leaves intact the current patchwork of coverage could provide the same savings, there's little evidence that insurance companies or care providers would be willing to make the up-front expenditures to do so. Why? Because as it stands now, they don't pay the costs of duplication. Insured customers pay. Their employers pay. The government (i.e. you and I) pays when the patients can't.

But what's the cost of the status quo?

So overwhelming has the paperwork grown that Ms. Mayer has considered giving up and ceasing all treatment [for a rare type of gastrointestinal cancer] because of the bureaucratic hassle that accompanies it.

As it stands, some patients would rather give up their treatment, they'd rather stay sick - or die - rather than navigate the labyrinth of co-pays and paperwork. What does that say about the system? What does it say, setting aside the morality of leaving vast swathes of the country uninsured at all, that even those who have coverage would rather not seek the medical care they need because the paperwork is worse than the illness?