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> So, you need administration, and lots of it. The system is so horribly fragmented that all hopes of efficiency are lost. You're misattributing the cause of the complexity. The cause of the complexity is not due to the existence of private insurance, but the fact that it's changed from being insurance, that insures you against catastrophic financial loss due to an expensive surgery (that is, risk pooling), to a subsidization layer that permeates all healthcare, including routine visits to the doctor. That is what causes the complexity, because then you're right, that change evolves a massive amount of paperwork that imposes huge burdens on small businesses. > Every single detail - multiplexed across thousands of insurers. This is false, intentionally or not. Smaller practices rarely interact with more than a dozen insurers or so insurers, by the very nature of the fact that they're small, so this is off by about two orders of magnitude. > A single-payer solution is orders of magnitude more simple, and thereby more efficient. ...and by "single payer" you mean the patients, right? I have several years of working with a large federal government. Unless you're referring to a small state like Finland, the idea that a large government managing healthcare payments will make things "orders of magnitude more simple" is so naive as to be beyond laughable. The government makes even the most simple things (filling out paperwork to be reimbursed for staying in a hotel for a single night) insanely complex, and take far longer, and use far more resources (funded by taxpayers), than it does in private industry. Yes, you're right that the interface between the medical practice and the insurance system becomes less complex when you have a single insurer, but the actual handling of claims becomes orders of magnitude more complex with the government, so the claim that it'll become "more efficient" is an extreme stretch. If you live in the US, it's already trivially false, as it's extremely easy to see how incredibly inefficient many of the federal agencies are (I'm not going to use non-Western countries as other examples). Those agencies perform necessary functions, which is why they still have to exist, but anyone remotely familiar with the US government knows how bad of an idea it would be for it to handle health insurance. If they manage to figure out how to manage bureaucracy at a large scale, then single-payer health insurance becomes feasible. But until then, any suggestion of it is either extremely naive or flatly malicious. |
I agree with you, but IMO it's completely unavoidable.
The concept of health insurance in strict terms of insurance was never possible. Not long term, anyway. Health is complex and chronic conditions cost a lot of money over a lifetime. The idea of insurance "just in case" doesn't work, period. Health is fundamentally different from car accidents or home hail damage.
> Smaller practices rarely interact with more than a dozen insurers or so insurers, by the very nature of the fact that they're small, so this is off by about two orders of magnitude.
Sure, but which dozen insurers they interact with isn't the same place to place. There's not a ton of knowledge transfer or business practice reuse here. You need billing specialists. So, across the entire industry of small private practices, it is thousands of insurers.
> The government makes even the most simple things (filling out paperwork to be reimbursed for staying in a hotel for a single night) insanely complex
Right, but the reason these tasks because insanely complex is because they're taken and split into 1 million pieces, which are then scattered across multiple levels of government, multiple agencies, multiple private contractors, who then have their own contractors, and multiple laws across multiple decades.
Our government, the US government, is not centrally planned where it matters. Every chance we get, we outsource as much as possible to the private sector. So one problem will become 1 thousand.
The simple reality is that the US has the worst healthcare system in the developed world, and it's not even close. Not only is our healthcare more expensive per person including taxes, it's also significantly worse with worse health outcomes across the board.
Every other developed country figured it out, and so can we. That doesn't mean it will be easy. But that's the truth - our system sucks, and it's because the private sector is far too involved in healthcare. We need to consolidate and collapse multiple parts of the system into one, and the complexity will go down.
The US has a poor government culture and mindset. We really thrive and actually want the inefficiency. It's the military shovel problem. We could produce a shovel for 20 bucks, but we want jobs, no? So we go ahead and outsource that to the private sector so we can get out 150 dollar military grade shovel, and it probably sucks, but we made a lot of people rich in the process. Each little hop from party to party represents a small increase in complexity and a little bit of cash shaven off the top. So naturally, we try to maximize the amount of parties involved. The best part is those contractors aren't even doing the work themselves - they're probably sub-contracting it out for god knows how many levels.
But, this can be fixed. It's not a foundational or necessary part of our government, it's a deliberate choice we make. Other countries don't make this choice, or do it much less.