By Charles Liu, MD, MS; Yusuke Tsugawa, MD, PhD; Thomas G. Weiser, MD, MPH; John W. Scott, MD, MPH; David A. Spain, MD; Melinda Maggard-Gibbons, MD, MSHS
JAMA Network Open, February 28, 2020

Abstract

Importance: Trauma is an expensive and unpredictable source of out-of-pocket spending for American families. The Patient Protection and Affordable Care Act (ACA) sought to improve financial protection by expanding health insurance coverage, but its association with health care spending for patients with traumatic injury remains largely unknown.

Objective: To evaluate the association of ACA implementation with out-of-pocket spending, premiums, and catastrophic health expenditures (CHE) among adult patients with traumatic injury.

Design, Setting, and Participants: Data from a nationally representative sample of US adults aged 19 to 64 years who had a hospital stay or emergency department visit for a traumatic injury from January 2010 to December 2017 were analyzed using the Medical Expenditure Panel Survey. Multivariable generalized linear models were used to evaluate changes in spending after ACA implementation. Additionally, 4 income subgroups were evaluated based on ACA thresholds for program eligibility: lowest-income patients (earning 138% or less of the federal poverty level [FPL]), low-income patients (earning 139% to 250% of the FPL), middle-income patients (earning 251% to 400% of the FPL), and high-income patients (earning more than 400% of the FPL). Data were analyzed from February to December 2019.

Exposures: Implementation of the ACA, beginning January 1, 2014.

Main Outcomes and Measures: Out-of-pocket spending, premium spending, out-of-pocket plus premium spending, and likelihood of experiencing CHE, defined as out-of-pocket plus premium spending exceeding 19.5% of family income.

Results: Of the 6288 included patients, 2995 (weighted percentage, 51.3%) were male, and the mean (SD) age was 41.4 (12.8) years. Implementation of the ACA was associated with 31% lower odds of CHE (adjusted odds ratio, 0.69; 95% CI, 0.54 to 0.87; P = .002). Changes were greatest in lowest-income patients, who experienced 30% lower out-of-pocket spending (adjusted percentage change, −30.4%; 95% CI, −46.6% to −9.4%; P = .01), 26% lower out-of-pocket plus premium spending (adjusted percentage change, −26.3%; 95% CI, −41.0% to −8.1%; P = .01), and 39% lower odds of CHE (adjusted odds ratio, 0.61; 95% CI, 0.44 to 0.84; P = .002). Low-income patients experienced decreased out-of-pocket spending and out-of-pocket plus premium spending but no changes in CHE, while middle-income and high-income patients experienced no significant changes in any spending outcome. In the post-ACA period, 1 in 11 of all patients with traumatic injury and 1 in 5 with the lowest incomes continued to experience CHE each year.

Conclusions and Relevance: Implementation of the ACA was associated with improved financial protection for US adults with traumatic injury, especially lowest-income individuals targeted by the law’s Medicaid expansions. Despite these gains, injured patients remain at risk of financial strain.

From the Discussion

Using nationally representative data, we found that implementation of the ACA in January 2014 was associated with decreased out-of-pocket spending among low-income US adults with traumatic injuries who were eligible for the policy’s Medicaid expansions and Marketplace subsidies. Implementation of the ACA was also associated with decreased odds of experiencing CHE, especially for the lowest-income patients earning 138% or less of the FPL. The decreases in spending were substantial in magnitude, ranging from an 18% decrease in out-of-pocket plus premium spending among low-income patients to a 30% decrease in out-of-pocket spending among lowest-income patients. Notably, these improvements in financial protection were not seen in middle-income adults eligible only for premium subsidies or high-income individuals ineligible for subsidies. Furthermore, our findings illustrate that strikingly high rates of CHE persist among patients with traumatic injury in the post-ACA period.

We did not observe decreases in CHE among low-income and middle-income patients despite their eligibility for ACA Marketplace subsidies, which may be because of several reasons. First, these groups had higher rates of insurance coverage before implementation of the ACA than the lowest-income subgroup, so gains in insurance coverage following ACA implementation were correspondingly smaller. Second, Marketplace (and private non-Marketplace) insurance plans have higher copayments and deductibles than Medicaid, and states are permitted to charge premiums to Medicaid beneficiaries earning more than 150% of the FPL, so the types of coverage gained by these subgroups did not lower spending as much. Third, because of lower ACA subsidies and higher income, middle-income individuals in particular may have tended to purchase less generous Marketplace plans, exposing them to higher out-of-pocket costs in the event of trauma. For example, during the 2018 Marketplace open enrollment period, individuals earning 100% to 250% of the FPL selected silver-tier or gold-tier plans over bronze-tier plans 82% to 18%, while those earning 251% to 400% of the FPL selected bronze-tier plans over silver-tier or gold-tier plans 51% to 49%. (Platinum and catastrophic plan enrollment was not released in these data.) Fourth, low-income and middle-income patients in our study had employer-sponsored insurance more often (40% and 66%, respectively) than the lowest-income patients (9%). Underinsurance has grown substantially among Americans with employer-sponsored insurance over the past 15 years, possibly blunting gains in financial protection from ACA-related increases in Medicaid and Marketplace coverage.

Finally, we found that even after ACA implementation, nearly 1 in 11 of all US patients with trauma and 1 in 5 with incomes of 138% or less of the FPL continued to experience catastrophic health care spending. Among patients experiencing CHE in the post-ACA period, one-fifth remained residually uninsured, and nearly three-fourths were insured (half with private insurance and one-quarter with Medicaid) but continued to experience CHE, indicating that they are underinsured. This may be because of variable implementation of the ACA in different states, lack of awareness of program eligibility, or plan-specific factors, such as out-of-network billing. There remains a critical need for policy solutions to address this crisis of affordability among low-income patients struggling with the dual misfortunes of traumatic injury and high-burden health care costs.

https://jamanetwork.com…

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Comment:

By Don McCanne, M.D.

Although this study confirmed that “Implementation of the ACA was associated with improved financial protection for US adults with traumatic injury, especially lowest-income individuals targeted by the law’s Medicaid expansions,” the authors also found that “these improvements in financial protection were not seen in middle-income adults eligible only for premium subsidies or high-income individuals ineligible for subsidies. Furthermore, our findings illustrate that strikingly high rates of CHE (catastrophic health expenditures) persist among patients with traumatic injury in the post-ACA period.”

Further, “Among patients experiencing CHE in the post-ACA period, one-fifth remained residually uninsured, and nearly three-fourths were insured (half with private insurance and one-quarter with Medicaid) but continued to experience CHE, indicating that they are underinsured.”

Single payer Medicare for All would eliminate uninsurance and underinsurance. Yet many politicians reject this model of reform in preference for us being allowed to keep the insurance we have in spite of the fact that tweaking the current system and adding a public option will increase health care spending while still falling far short on the goals of reform. In contrast, single payer Medicare for All would reduce total health care spending while meeting the goals of universality, comprehensiveness, affordability, accessibility, and choice of health care professionals in a system that is equitable for all.

It’s past time to quit celebrating an overpriced system that isn’t working for far too many of us and get to work establishing what would be the premier system in all the world – the single payer model of an improved Medicare for All.

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By Diane Archer
The Hill, February 24, 2020

The evidence abounds: A “Medicare for All” single-payer system would guarantee comprehensive coverage to everyone in America and save money.

Christopher Cai and colleagues at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine. Every single study predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S.

All of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. Even the Mercatus Center, a right-wing think tank, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage.

Medicare for All is far less costly than our current system largely because it reduces administrative costs. With one public plan negotiating rates with health care providers, billing becomes quite simple. We do away with three-quarters of the estimated $812 billion the U.S. now spends on health care administration.

Administrative costs are so high because thousands of insurance companies individually negotiate benefit rules and rates with thousands of hospitals and doctors. On top of that, they rely on different billing procedures — and this puts a costly burden on providers.

Administrative savings from Medicare for All would be about $600 billion a year. Savings on prescription drugs would be between $200 billion and $300 billion a year, if we paid about the same price as other wealthy countries pay for their drugs. A Medicare for All system would save still more with implementation of global health care spending budgets.

Even more savings are possible in a Medicare for All system because, like every other wealthy country, we would have a uniform electronic health records system. Such a system generates additional savings because system problems would be easier to detect and correct. A uniform claims data system helps reduce health care spending for fraudulent services. In 2018, total U.S. health care costs were $3.6 trillion, representing 17.7 percent of GDP.

Savings are in part a function of the benefits Medicare for All covers. The Mercatus report and others projected savings, even with the elimination of deductibles and out-of-pocket costs. Under both Sen. Bernie Sanders’s (I-Vt.) Medicare for All bill and Rep. Pramila Jayapal’s (D-Wash.) Medicare for All bill, patients would not pay deductibles or coinsurance when they receive medical care. Their bills also provide for vision, hearing and dental care, as well as long-term services and supports, such as home care and nursing home care.

No matter how you design a single-payer public health insurance system, it would have lower overall health care costs, so long as for-profit private health insurers no longer exist to drive up health care costs. Yes, it’s true that some other wealthy countries rely on “private insurers” to provide benefits and spend far less than we do on care. But, these insurers do not operate in any way like health insurers in the U.S.

Other wealthy countries dictate virtually every element of the health insurance people receive, including what’s covered, what’s paid, and people’s out-of-pocket costs — all identical for everyone. The insurers operate like claims processors or bill payers. They follow the coverage and payment rules set by the government, nothing like the private health insurers in the U.S. which revel in product diversity (read: complexity and confusion).

And, if you’re thinking that having the federal government guarantee coverage to all Americans is a big deal, it’s actually not. The government already pays for about two-thirds of health care costs. Among other things, it pays for Medicare, Medicaid, VA, TriCare and a wide range of state and local health care programs, along with private insurance for government employees and tax subsidies for private insurance.

Whether you call it single-payer or Medicare for All, it isn’t some socialist pipe dream. It’s a sensible, efficient, and effective way to guarantee excellent health insurance to everyone.

Diane Archer is a senior adviser at Social Security Works.

https://thehill.com…

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PLOS Medicine, “Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses” by Christopher Cai, Jackson Runte, Isabel Ostrer, Kacey Berry, Ninez Ponce, Michael Rodriguez, Stefano Bertozzi, Justin S. White, James G. Kahn

PDF version can also be downloaded at this link: https://doi.org…

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Comment:

By Don McCanne, M.D.

We continue to hear that single payer Medicare for All costs too much, and we cannot afford it. Although the PLOS study mentioned above was covered in a previous Quote of the Day, the link is provided again since it is a highly credible summary of prior single payer analyses that shows that single payer actually saves money after the initial transition from our current system.

The article above by Diane Archer is useful because it explains the model in terms that most audiences can understand. Although the PLOS article is technical, it is also useful for those who need to understand in greater detail how the conclusion of savings was reached.

It is particularly important to understand that analyses that were omitted used various assumptions or model variations that disqualified them as bona fide single payer models for the United States. S1 Appendix lists the studies excluded and the reasons for that. This should refute the claim of those who say that these studies were cherry-picked to obtain a desired result.

Those supporting the addition of a Medicare-like public option are the most outspoken in claiming that single payer Medicare for All costs too much. Yet it is their model that leaves in place our overpriced system while adding the costs and administrative complexity of yet another plan – the public option (for those who want it). Do not let them dismiss single payer with the glib comment that we don’t know how to pay for it. We do; we would pay for it with progressive taxes which would make it affordable for absolutely everyone and at a total cost that the nation can afford – a total cost lower than what they propose by merely tweaking our current system and adding a public option.

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By Jeff Lagasse
Healthcare Finance, February 27, 2020

Physician anesthesiologists are being forced out of network as insurance companies terminate their contracts, often with little or no notice, according to a new national survey from the American Society of Anesthesiologists.

Initial results find 42% of respondents had contracts terminated in the last six months, while 43% of respondents experienced dramatic payment cuts from insurers — both mid-contract and at renewal — in some cases by as much as 60%. Some of the impacted contracts were signed less than six months ago.

The informal, non-scientific survey, which was distributed earlier this month, received responses from 76 practice groups in 33 states. It confirms anecdotal complaints that proposed surprise medical bill legislation has coincided with a significant number of insurance contract terminations and unilateral lower payment adjustments by health insurance companies.

While the timing alone suggests insurance companies are motivated by factors related to anticipated legislative changes on surprise medical bills, some survey respondents reported they were specifically told by insurers this was the case.

The responses also indicated that UnitedHealthcare was noted as the insurer most associated with these changes, but Aetna, Cigna and Blue Cross Blue Shield also were mentioned.

https://www.healthcarefinancenews.com…

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Comment:

By Don McCanne, M.D.

Patients who have been diligent in making sure that their hospitals and surgeons are in their insurers’ provider networks, often they find that the anesthesiologist is not and thus they may be exposed to surprise medical bills.

According to this survey from the American Society of Anesthesiologists there has been a relatively abrupt move on the part of private insurers to either demand payment cuts of up to 60% or force anesthesiologists out of the insurers’ provider networks. This certainly does not benefit the anesthesiologists, and it potentially exposes patients to surprise medical bills. So who does benefit? It is likely that the legislative proposals to end surprise billing that are being considered by Congress will primarily benefit the insurers. The government will control fees without need for the insurers to negotiate contracts with the providers.

This will work particularly well for the insurers if the legislation protects the patients from the surprise bills and the principle is established that the government can control fees in the private sector and not just in government programs such as Medicare and Medicaid. The insurer gets the equivalent of contracted rates without having to negotiate contracts. Arbitration has been proposed but it is administratively burdensome and costly and may result in higher fees, so the insurers do not want that. Congress has been very friendly to the insurance industry, and it is likely that this abrupt trend in contract cancellations signals the fact that the final surprise bill legislation will be written by the insurance lobbyists.

Can those politicians who keep telling us that we want to keep our private insurance plans explain to us why we would? Maybe we could find out their true motivations by checking out OpenSecrets.org.

Yes, fees would be controlled under single payer Medicare for All, but they would be determined through negotiations with representatives of the physicians, ensuring that they are fair for the physicians and fair for the taxpayers who fund the system. As it is now, we may soon find that our urgent care centers are staffed by former anesthesiologists who now work by the clock.

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By Phil Galewitz
Kaiser Health News, February 25, 2020

For five years, Rasha Salama has taken her two children to Dr. Inas Wassef, a pediatrician a few blocks from her home in this blue-collar town across the bay from New York City.

Salama likes the doctor because Wassef speaks her native language — Arabic — and has office hours at convenient times for children.

“She knows my kids, answers the phone, is open on Saturdays and is everything for me,” she said.

But UnitedHealthcare is dropping Wassef — and hundreds of other doctors in its central and northern New Jersey Medicaid physician network. The move is forcing thousands of low-income patients such as Salama to forsake longtime physicians.

Across the nation, business and contractual disputes are separating patients from longtime doctors. This often occurs when doctors don’t want to accept the rates insurers are willing to pay. It sometimes occurs when insurers’ business plans require having a narrower network of doctors — doctors whose practice patterns may be easier to control.

But in this case, the cause of the exclusion goes to even deeper business connections: Wassef and other doctors say the insurer appears to be trying to shift patients to Riverside Medical Group, a 20-office physicians’ practice owned by Optum, a sister company of UnitedHealthcare, both of which are subsidiaries of UnitedHealth Group. UnitedHealthcare is essentially forcing patients to transfer to doctors it controls, the doctors allege.

Indeed, several patients said the health plan directed them to Riverside when informing them their doctors were being dropped.

Lawrence Downs, CEO of the Medical Society of New Jersey, said he estimates UnitedHealthcare is trying to remove hundreds of doctors in central and northern New Jersey from its network. That is the same area where Riverside Medical operates, he noted.

“It seems like they are steering patients away from small, community-based doctors to large groups that they own,” he said.

But further complicating matters, many Medicaid and Medicare managed-care programs are contracted out to private, for-profit insurers such as UnitedHealthcare. They are looking to create returns for shareholders. With surging enrollment in government programs, UnitedHealthcare has enjoyed rising profits and a stock price that has soared tenfold since 2010.

UnitedHealthcare gained millions of new customers after the Affordable Care Act led New Jersey and 35 other states and the District of Columbia to expand Medicaid and states turned to private insurers to handle the business.

The company operates New Jersey’s second-largest Medicaid health plan, with 418,000 members. (The state Department of Human Services has blocked UnitedHealthcare from enrolling any additional Medicaid members, a severe and rare penalty. That move — which is not related to the termination of doctors’ contracts — stems from complaints related to care management and discharge planning, the health plan’s call center and other issues.)

https://khn.org…

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Comment:

By Don McCanne, M.D.

Who is in charge of preserving the sanctity of the physician-patient relationship? The private insurers? No, they are in charge of the flow of funds. Under their business model the physician-patient relationship is expendable.

Think of that the next time that someone tells you that we don’t want Medicare for All because we’ll lose the right to have private insurance. (Be sure to read the last paragraph excerpted above to understand the ethical plane on which these insurers operate.)

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By Laura Tollen, Elizabeth Keating, Alan Weil
Health Affairs Blog, February 20, 2020

In 2018, Health Affairs launched the Council on Health Care Spending and Value, a nonpartisan, expert working group that will, over the course of three years, develop recommendations about how the US could take a more deliberate approach to moderating health care spending growth while maximizing value. Led by Senator William Frist, MD, (R-TN) and Margaret Hamburg, MD, this group of 22 experts has begun its work with fact finding, studying the literature to identify areas of health spending—and spending growth—that are “excessive” and may therefore be appropriate targets for policy intervention. This post, the first in a series, provides a view into the council’s discussions, starting with its inquiry into administrative spending.

The Research

In 2018 testimony before the US Senate Health, Education, Labor, and Pensions Committee, council member David Cutler of Harvard University cited a range of estimates that place administrative spending at 15 percent to 30 percent of total health spending—three times what the United States spends on cancer care every year.

In a 2003 paper, Steffie Woolhandler and colleagues analyzed published data—including NHEA, surveys of physicians, employment data, and cost reports—to develop estimates of the administrative costs of health insurers, employers’ health benefit programs, hospitals, practitioners’ offices, nursing homes, and home care agencies. Their work represents possibly the broadest, most inclusive definition of administrative spending in the literature. They estimated in 1999 that the US spent $294.3 billion on health care administration, or a little more than 24 percent of total health care expenditures that year, as reported in the NHEA. The most-often cited figure from that study, however, is that “after exclusions, administration accounted for 31.0 percent of health care expenditures.” The authors explain that they arrived at this figure by excluding “from both the numerator and the denominator expenditure categories for which data on administrative costs were unavailable: retail pharmacy sales, medical equipment and supplies, public health, construction, research, and ‘other.’” In 2017, by trending their findings forward, the same authors wrote that administration accounted for $1.05 trillion that year.

A 2018 article by David Cutler also supports the idea that while the administrative workforce in health care is relatively large, spending in this area has not grown disproportionately in recent years.

So, Is Administrative Spending A Problem?

Given that administrative spending is high but does not seem to be rising faster than the rest of health care spending, is this a fruitful area for intervention to moderate spending growth? Below, we summarize highlights of the council’s discussion on this matter. This post captures the flavor of the conversation but does not represent consensus, nor should specific opinions be attributed to any individual council member.

Administrative Spending Is Literally The Price We Pay For Choice

Reflecting on the fact that OECD countries with more centralized health care decision making tend to have lower administrative spending, several council members suggested our robust administrative workforce is a substitute, in our market-driven health system, for the greater degree of government control over health care found in many other nations. In other words, our spending on administrative workers is literally the price we pay for diffuse decision making or, more pointedly, for choice.

At a high level, our system’s defining characteristic is choice. Insurers choose markets, providers, and their own priorities for quality improvement. Employers choose insurers and levels of benefits, beyond required minimums. Providers choose where and how to practice, what care to provide, and often what to charge. Patients choose everything from insurance plans to providers to procedures, and whether to obtain insurance at all—with the important caveat that many have few choices in these matters.

Each of these choices comes with its own price tag in terms of the administrative complexity needed to support it, and each type is valued differently by different stakeholders. The key question is whether there are some types of choices that are both relatively costly and add little value. For example, much of the administrative noise in our health care system—although we don’t know exactly how much—would disappear if everyone had the same benefit plan, or a variation on a standard plan, similar to the A through J variants of Medicare Supplemental benefits. Would a critical mass of stakeholders—for example, large employers and the third-party administrators who manage their benefits—be willing to give up flexibility in benefit design (and the ability to determine their year-to-year premium increases) to save administrative costs? Perhaps.

To pick another example, administrative spending would be significantly reduced if everyone had access to the same providers and treatments at standardized prices using standardized quality reporting. Would stakeholders be willing to make that trade-off? It seems less likely.

Progress on determining if such exchanges of uniformity for lower cost would be palatable depends upon a better understanding of preferences, values, and the financial cost of choice than we currently have evidence to support. But failing to act because we don’t have that evidence means the default is a proliferation of choices—and their attendant costs—without adequate consideration of their value.

Finally, some council members suggested that, while our level of administrative spending is high, we should not be too quick to label it as excessive. Not only does this spending support the choices noted above, but in some cases it may serve as an investment that results in reduced spending elsewhere in the system. For example, care coordination and integration—generally seen as desirable—require a certain degree of investment in administration and data systems. A decrease in these investments could actually result in a net increase in total spending.

But Not All Administrative Spending Adds Value

Having duly noted and discussed the tradeoffs that would be inherent in drastically reducing administrative spending, council members nevertheless agreed that there are some areas of redundancy that truly serve no purpose. One such example is costs associated with non-standardized protocols for exchange of money and patient data. Council members drew an analogy to the banking industry, where these functions are highly standardized, yet consumers still maintain a great deal of choice. Some noted that the health care industry is unlikely to pursue such standardization voluntarily, as many stakeholders have a financial interest in keeping patient data siloed.

Another example of low-value administrative spending is the costs associated with redundant quality and pay-for-performance systems. Many have noted that the sheer number of quality measures to which providers are subjected is potentially counter-productive to quality. Council members generally agreed that some standardization and aggregation in this area would likely lead to a non-harmful reduction in administrative spending.

Finally, many council members noted—as have others before them—that the piecework, fee-for-service nature of health care drives an enormous amount of administrative spending in the form of documentation, coding, billing, and re-billing. Capitation and other forms of outcomes-based payment would reduce the need for these types of activities, but only once the system has reached a point where fee-for-service represents just a negligible sliver of the overall payment landscape. Until then, it will be necessary for providers to keep the administrative infrastructures to support fee-for-service, even as alternative payment models expand.

Next Steps

The council will continue to track which of these themes recur across its investigation. The next blog post in this series will focus on the council’s discussion of research on the role of prices and market consolidation in driving spending growth.

Disclaimer: This post is intended to provide insight into the council’s deliberations but does not represent consensus of the group, nor should specific opinions be attributed to any individual council member.

https://www.healthaffairs.org…

Council on Health Care Spending and Value:
https://www.healthaffairs.org…

Members of the Council:
https://www.healthaffairs.org…

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Comment:

By Don McCanne, M.D.

In the lead up to the Affordable Care Act, Celinda Lake conducted focus groups which she claimed showed that Americans valued “choice” very highly which she interpreted to mean choice of private health plans rather than being limited to a single government program. She even named the concept “Guaranteed Affordable Choice.” Dismissed were polls that showed strong support for “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” Totally ignored was the fact that the choice patients really want is that of their physicians and hospitals – choices private plans take away. The last decade has shown us that this diversion into choice has left virtually all of the deficiencies of our health care financing system in place.

The current campaign for the Democratic nomination for president is perpetuating this false concept that the preference for choice should dominate health reform. The single payer model of Medicare for All has proven to be popular which has caused the candidates opposed to single payer to claim that Americans want to protect their choice of private health plans instead. The media has bought into this, often stating that the candidate supporting single payer will lose to President Trump because Americans do not want to have their private plans they are enrolled in through work taken away from them (though many employees do not have employer-sponsored plans and 60 million leave their employment each year – hardly a stable source of insurance). In reality, the choices any individual has are quite limited based on factors such as income, employment, age, government service, and so on.

Though we have long needed comprehensive reform, our very high health care costs and the unacceptable failures of our health care financing system have made comprehensive reform an even greater imperative. Health Affairs – the leading health policy journal – has launched the Council on Health Care Spending and Value. In their initial deliberations they have considered the role of administration in the contribution to our high health care costs – a very appropriate starting point considering our egregiously high administrative costs when compared to other nations.

The committee found that administrative costs are high, but they did not conclude that they are excessive. Why? They suggest that this is the price we pay for having greater “choice” in our market-driven system as a replacement for more centralized health care decision making relied upon by other OECD nations. What? We are receiving greater value for this profound administrative waste?

It should be noted that a disclaimer has been issued that this view does not represent a consensus of the group nor should this view be attributed to any individual council member. They are now moving on to considering prices and market consolidation.

Wait. $600 billion in administrative waste could be recoverable with a well designed system (single payer), and they are not issuing any statement that they would endorse, but are providing this release that gives the concept of “choice” enough credibility to consider accepting these outrageous costs as a tradeoff in order to be able to perpetuate the market-driven dynamics of our system? It is worth that much money to be able to rank ideological views of political economy over sound health policy science?

We have to fix our system ASAP. The advantage of this preliminary report is that we know that we do not have to wait around until this committee completes its deliberations and issues a final report. Not offering any other proposals than one of tolerating administrative waste in order to perpetuate the market role in health care disqualifies this committee from being considered a productive resource. We need to exercise our choice to move on immediately with advocacy for the enactment and implementation of single payer Medicare for All. That’s the choice that really matters.

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