According to this study healthcare administration costs account for the bulk of the difference between US and Canada healthcare spending. 34% of 18% of US GDP (=6% GDP) vs 17% of 11.6% of Canada's GDP (=2% of GDP). https://www.healio.com/primary-care/practice-management/news...

Other studies looking at only hospital costs put it at 1.43% of GDP. https://www.commonwealthfund.org/publications/journal-articl...

That is a much higher estimate of admin overhead than other sources, covers both payer and provider administrative expenses, and implicitly attributes all provider administrative expenses to billing/coding.

But we don't have to litigate this in the context of the Lancet article. That article derives much higher savings from pharmaceutical price reductions than from administrative savings. We know with some certainty what percentage of overall spending comes from pharmaceuticals, and it is a low number.

> It's not huge.

It's massive. Healthcare is byzantine on purpose. It's opaque to patients so that providers can prevent shopping around and adjust charges per patient, and it's opaque to providers from insurers to help prevent having to pay claims.

You're saying "it's massive" and, in, like absolute terms, sure, it is; everything we do is massive, we're a huge country. But in relative terms? No. It's not massive. It's a small fraction of our total costs. The total benefits we can reap from minimizing it? Not that great. Ambitious plans based on minimizing those costs? You should be skeptical. You should be asking: how are we going to solve this huge problem by zeroing in on such a small fraction of the total problem? Maybe the answer will surprise you, but you should start by needing to be surprised by the answer.

Yes, in relative terms it's a large percentage. I work in this business, I see it every day. It's a HUGE chunk. Nationwide out of the 3.5 trillion we spend on healthcare, it's about 800 million.