You have to be able to see that the numbers do not add up, right? 200b is how much out of 3+ trillions? Also, just because Canadian adminstrative costs are hidden, does not mean they are proportionally lower than in the US

The Canadian comparison had nothing to do with my comment, or the GP post to which I replied. I cited a cost, and provided the source for it. You're assuming I was in some way affirming the other conclusions of that article: I was not, and did not consider them one way or another. The GP comment was about rising administrative costs. I gave the source & amount of those costs. That was all. I otherwise agree with you: administrative costs are not the prime culprit in understanding why US costs are so high.

What do you mean, the numbers don't add up? From the article: "Insurers’ overhead, the largest category, totaled $275.4 billion in the U.S. in 2017, or 7.9% of all national health expenditures, compared with $5.36 billion in Canada, or 2.8% of national health expenditures."

What I meant is that if insurance costs disappear completely, US healthcare will remain 5 times more expensive than Canadian. It is percentage based markup on already super overpriced system. Therefore, real reasons for why it is so expensive are elsewhere

Thanks. I've reluctantly come to agree with your conclusion. There is no silver bullet.

Repeating myself:

Another low hanging fruit is transition from free-for-service to rewarding wellness (capitation). Some are already doing this.

I'd like to understand if, how, why cost disease is a factor. https://en.wikipedia.org/wiki/Baumol's_cost_disease I have zero understanding, intuition about this. Feels like black magic. But some of the experts I've read say it's important.

There's no shortage of management efficiency and quality of care innovations to explore. In the spirit of Atul Gawanda's book Better, like specialized clinics for cystic fibrosis, diabetes, and whatnot. And whatever we're calling people traveling for procedures. Like USA people going to Thailand and Mexico clinics.

USA's R&D and regulatory overhead (FDA) carries the world. That first adopter expense might be easier to accept if the accounting was transparent.

Any way.

I designed, implemented, supported 5 regional healthcare exchanges. Even in our little corner of the problem space, there was so much room for improvement. Alas, most of it was prevented, because our participants were competitors, so the incentives were all wrong. A single payer system (or rough equivalent) completely moot most of those roadblocks.

One snare is that that a lot of overhead takes the form of jobs in the insurance industry. Any reasonable plan to reduce that overhead means eliminating all of those jobs.

1. FWIW this is a recognized problem under M4A plans those people would be taken care of.

2. Nobody has a right to earn a living by causing suffering to others.

1. That’s a good idea. I’m personally concerned about the political fallout of “m4a causes job losses”.

2. Is a good slogan, but understand that most of those people don’t think they’re doing a bad thing. Spending too much time demonizing the line level workers at insurance companies is probably counterproductive.

2. Yeah I have dealt with these people a lot as I and my wife have a chronic condition. I sympathize with them, most realize they have a horrible job and just need to make money to eat. Some are just bad people because systems like that everywhere tend to be selective over time for people who don’t care. (The ones that do try to leave.)

But the principal still stands, no matter how much I may sympathize with someone they don’t get any right to make income from causing other people suffering.

If they’re being “taken care of”, how is the plan to eliminate their jobs supposed to save money?

Well probably not by just giving them their salary anyway. I guess there are many other options so I imagine it would be one of those!

I think it’s important to have a solid answer to this question. When people believe that a plan is weak on the details, this is what they are talking about. It gives the impression that the promises of the plan stated upfront (we will save money by moving away from wasteful health care system) are some sleight of hand, moving costs from a well-defined bucket to a mystery bucket we don’t measure.

That sounds like a good thing.

It’s a political liability for the transition period.