Letter to the Editor
The New York Times, Nov. 20, 2011
To the Editor:
Ezekiel J. Emanuel lowballs estimates of the current costs and potential savings on medical bureaucracy, and raises vain hope that health reforms short of a single-payer system will realize substantial savings (“Billions Wasted on Billing,” Sunday Review, Nov. 13).
Peer-reviewed studies in The New England Journal of Medicine by two colleagues and me document that administrative costs account for 31 percent of health spending in the United States versus 17 percent in Canada. The 14 percentage-point difference translates to $380 billion in potential savings in 2011. Other researchers have reached similar conclusions.
A single-payer reform could realize these savings by eliminating insurance middlemen and radically simplifying payments to doctors and hospitals. The lesser measures that Dr. Emanuel champions — computerized and standardized billing — won’t do the job.
Hospital billing has been computerized for decades, and bureaucratic costs have skyrocketed since the adoption of the standard hospital billing form in 1982.
Combat over who pays and who profits underlies health administration’s overgrowth. A nonprofit single-payer system makes those issues moot.
STEFFIE WOOLHANDLER
New York, Nov. 14, 2011
The writer, an internist, is a professor of public health at the City University of New York.