A Word About Health Care Spending

Most large companies presently self-insure when it comes to their employees’ health care plans. Frequently they hire erstwhile insurance companies to administer their plans. They do this for a reason: they save money relative to what they would otherwise spend.

How payments for a “Medicare for All” system would be structured is important. In all likelihood it would cause those companies to pay more than they do presently and many people who presently have insurance will end up paying more.

The U. S. health care system is very complex. There isn’t just a big pile of money labelled “health care spending”. There are tens of thousands or millions of little piles and how the money is shifted from pile to pile will make the difference between a program that can be passed and one that gets its proponents thrown out of office.

7 comments… add one
  • Andy

    This is an important point to those who say we can just use the private money we spend now to fund M4A. The distribution of that spending doesn’t match the distribution of revenue a M4A program would have.

  • Guarneri

    “There are tens of thousands or millions of little pilees and how the money is shifted from pile to pile..”

    That’s true of the market for any reasonably complicated good or service. That’s why letting “tens of thousands or millions” of market players sort it out works. The notion that a small group of overlords can write and administer the rules boggles the mind. It hasn’t worked yet.

  • Jimbino

    letting “tens of thousands or millions” of market players sort it out

    will only work if the market players have access to all the costs and fees charged in the healthcare market, something that insurers, hospitals, docs and big Pharma continue to fight tooth-and-nail. Sufficient would be to require that you publish your charges on-line if you expect to be paid and that you grant all comers with MFN status.

  • steve

    Bug plans that self insure save, as best as i can tell from the few studies done, about 7%-9%. Most of this appears to on savings from admin costs. Remembering the 2% spent on Medicare and 13% on private insurance, it looks like they capture most, but not all of that difference. So overall, M4A is likely cheaper. For any given company the savings could be much higher. Companies that are efficient at screening and dont hire any sick people could do quite well. For companies that do not take that approach, it still looks like M4A might be better.

    “The notion that a small group of overlords can write and administer the rules boggles the mind. It hasn’t worked yet.”

    Every other country in the world that has first world quality medicine costs a lot less than we do. They all have a lot more government involvement. It works everywhere else.

    Steve

  • steve

    Oops.

    http://www.wahcnews.com/newsletters/wa-mossadams-0313.pdf

    The Benefits of a Self-Funded Plan
    In addition to avoiding many state regulations and taxes that apply to insured benefits, multistate companies with self-funded plans can customize their offerings to create uniform plans across their locations, often increasing benefit levels in the process. And, in an era governed by HIPAA rules where insurance companies will not release utilization data for fully insured plans, self-funded plans can use their data to model and develop more effective health plans for the future. These benefits plus efficient administrative fees added to the reduction of insurer margins, profits, risk fees, and state taxes
    have allowed self-funded plans to historically save between 7 and 9 percent of their total cost compared to traditional plans.

  • Every other country in the world that has first world quality medicine costs a lot less than we do.

    Every other country in the world that has first world quality medicine has much lower costs of care than we do. More than the amount for which administration costs account.

  • walt moffett

    lets also add euros had a much longer time to work out their systems (since at least the 1880’s if not before), are willing to ration care and accept deaths will result, and accept the fact two tier medical care exists. All things American pols have problems with.

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