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  • Free Markets are Destroyed by Congress, Not Created January 30, 2015
    By Jane M. Orient, M.D. When people clamor for Congress to pass a “free-market health plan,” they are forgetting two things: Congress only does laws, which restrict freedom. We need fewer laws, not more. And the free market is by …
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 3 January 26, 2015
    MediBid is the free market answer to rising healthcare costs. Employer-sponsored plans, as well as self-insured individuals, make up most of MediBid’s customers. On MediBid, a patient makes a procedure request which gets sent out to physicians and facilities around …
  • Medical Debt Still a Problem for Those With Health Insurance January 23, 2015
    by Adrienne Snavely Medical debt can affect anyone of any age in any state in any income bracket. Medical debts account for more than half of debt collections on credit reports. One in three Americans struggle to pay medical bills, …
  • Q&A with Direct Pay Physicians January 22, 2015
    Direct pay physicians answer colleagues’ questions about third-party-free medical practice. From January 9, 2015, New Orleans AAPS workshop.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 2 January 21, 2015
    The pitfalls of Obamacare are that it makes healthcare affordable to the employee, yet unaffordable to dependents. Some plans cover children, but not spouses. This means less options for families. The independent physicians are being bought out by hospitals and …
  • Cash and out-of-network: good for medicine as free agency is for sports January 21, 2015
    Andrew Schlafly, J.D., General Counsel, AAPS, opens the 21st Thrive, Not Just Survive workshop held Jan. 9, 2015 in New Orleans, LA.
  • Opting Out of Medicare January 20, 2015
    Lawrence Huntoon, MD, PhD, presents via Skype at the AAPS 21st Thrive Not Just Survive Workshop on Third Party Free Practice, January 9, 2015
  • Say Goodbye to 3rd Party Medical Payments January 19, 2015
    Obamacare is increasing costs, restricting access to care, and putting Medicrats in charge. Out of this adversity comes innovative physicians who are changing the world of medical care. Doctors know what is best for their patients, so they must be …
  • My Direct Pay Practice January 19, 2015
    Brenda Arnett, MD http://arnettmd.com, talks about why and how she launched a third-party-free internal medicine practice. From January 9, 2015.
  • AtlasMD: Direct Pay Primary Care better for patients and physicians January 18, 2015
    Dr. Josh Umbehr, founder of http://atlas.md speaks at AAPS XXI Thrive Not Just Survive Workshop, January 9, 2015 in New Orleans, LA.
  • Epiphany Health, Affordable, high-quality direct primary care January 17, 2015
    Lee Gross, MD, Founder, Epiphany Health http://www.epiphanyhealth.net & President, Docs 4 Patient Care Foundation http://www.d4pcfoundation.org addresses the AAPS Thrive Not Just Survive XXI conference, January 9, 2015, in New Orleans, Louisiana.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 1 January 16, 2015
    Wayne Brough of FreedomWorks interviews MediBid’s CEO, Ralph Weber, about Obamacare and Weber’s book MediCrats. Weber has found innovative ways to bring the free market to healthcare. MediCrats, by definition, are medical bureaucrats who add administrative burdens and increase costs. …
  • Third Party Free Specialty Practice January 16, 2015
    Gerard J. Gianoli, M.D., F.A.C.S. of The Ear and Balance Institute, Covington, Louisiana, http://EarAndBalance.net speaks at the AAPS Thrive, Not Just Survive workshop held January 9, 2015 in New Orleans.
  • Stop the Interstate Licensing Compact January 15, 2015
    Dr. Ken Christman explains how the FSMB’s proposed compact is a backdoor for MOC and MOL. January 9, 2015, New Orleans, LA.
  • Update on AAPS Legal Initiatives in War on Doctors and Patients January 15, 2015
    Andrew Schlafly wraps up Thrive XXI with a look at ongoing and future AAPS legal initiatives to protect patients and their physicians.
  • The Answer to American Medicine is NOT Coming from DC January 15, 2015
    … it is coming from physicians who are kicking ObamaCare and insurance OUT and working directly with their patients, explains AAPS Executive Director, Jane M. Orient, MD. From AAPS Thrive, Not Just Survive XXI, Jan. 9, 2015, New Orleans, LA.
  • The End of the 10-Minute Doctor’s Appointment January 14, 2015
    The patient-physician relationship should be balanced, not one-sided with physicians skimping on visit time and not allowing patients to ask enough questions or explain their symptoms well. Eighteen seconds is the average time a patient is allowed to talk before …
  • The Physicians Declaration of Independence in 2015 January 14, 2015
    We need a critical mass of truly independent doctors and core who will pass along the art of medicine to the next generation, explains AAPS President Richard Amerling, MD on January 9, 2015 at talk to colleagues in New Orleans, …
  • Physicians & Patients: Take Your Power Back January 14, 2015
    Dr. Elaina George explains that it is crucial for patients and physicians to work together outside of ObamaCare and insurance-dominated system. She discusses alternatives to ObamaCare such as health care sharing programs like Liberty HealthShare: http://LibertyOnCall.com
  • Self-Funded Awareness & The Movie “Dune” January 7, 2015
    by G. Keith Smith, MD “The sleeper has awakened.” Anyone who has seen the movie “Dune” knows the scene where Paul Atreides proclaims his new awareness. Having recently attended the annual meeting of the Self-Insurance Institute of America I was …

Medicare vs. Private Admin Costs: Let the facts stand

By Ralph Weber CFP®, ChFC®, CLU®, REBC®, and Dave Racer, M.Litt*

health care and medical care for the uninsuredMany health care reformers cite Medicare’s administrative cost as a reason to drop private insurance and move to a government-managed health care system. Depending on who makes the claim, Medicare’s administrative cost estimates range from 1.5% to 12%. In much the same breath, these reformers claim that private insurance companies spend 10% to 50% on administration.

The real administrative cost of Medicare and private health insurance relies on how one defines administrative expense. The estimated cost of administering Medicare, for instance, often excludes overhead items that are not only common to private health insurers, but to all businesses. These different ways of accounting confuse an honest evaluation of the government’s Medicare administrative cost.

So what constitutes an administrative expense? Where can one find real, honest numbers with which to make an intelligent comparison?

Governments across the country have turned to HMOs and managed care to resolve health system problems. Yet, do the most common administrative cost measurements include the high cost of administering managed care, compounded by CPT codes and other billing codes, the cost of billing a host of different insurance companies, and all the other normal business accounting practice cost? These additional – and unnecessary – costs add tens of billions of dollars to the health care bill; a sorry waste of money when there is a less costly, workable solution available (and it is not Medicare).

The best way to measure administrative cost is also the simplest: Take the total dollars spent on health care and subtract how much actually gets to the providers (doctors, hospitals, etc.). The difference is administrative cost.

The health care spending “bible” is the endless set of statistics from the Centers for Medicare and Medicaid (CMS). CMS tables provide a detailed, line item description of how each dollar is spent.

One spending line item on the CMS tables is tiled “Government, Administration and Net Cost of Private Health Insurance.” This is the line item so often quoted out of context when proponents of government medicine are trying to understate the costs of government administration. For private insurers, this line item includes the cost of administration, marketing, research, premium taxes, facilities, equipment, insurance and reinsurance losses, as well as profit.

The CMS data for government spending include additional line items that fall below the “Administration” line: “Government Public Health Activities, Research, and Structures and Equipment” (see Table 1). If CMS separated these same costs for private insurers in the same manner as it does for government plans, it would be a fairer way to compare the two; but it does not, and that fact goes ignored.

Table 1

      Private Insurance Government 

Healthcare

 
Non Patient Care costs        
  Government Administration and Net Cost of Private Health Insurance   x x
  Government Public Health Activities   x
Investment  
  Research   x
  Structures and Equipment   x

 

To shed light on real administrative cost of public versus private health care requires computing the actual per capita cost in absolute dollars. Table 2 shows such a comparison.

Table 2

Costs as percentage of expenses   Private Insurance Medicare Medicaid   Government Grand Total
Number of enrollees   201,991 41,375 39,554   91,884 299,106
Total cost in millions   775 431 329   1,036 2,241
  Cost per Capita   3,837 10,422 8,328   11,272 7,493
Patient care costs   680 410 304   851 1,878
  Medical Loss Ratio   87.79% 94.99% 92.29%   88.32% 86.67%
Non Patient Care costs   12.21% 5.01% 7.71%   11.68% 13.33%
  Government Administration and Net              
  Cost of Private Health Insurance   12.21% 5.01% 7.71%   5.74% 6.95%
  Government Public Health Activities           6.19% 2.86%
Investment              
  Research           3.68% 1.89%
  Structures and Equipment           2.26% 4.49%

 

If one assumed from Table 2 that Medicare administrative cost is just 5.01%, compared to 12.21% for private insurance, it might seem that Medicare is administered at a significantly lower rate. However, comparing the percentage of cost for activities not directly related to patient care paints a far different and truer picture: Private insurers’ non-patient care costs are 12.21% compared to 11.68% public healthcare. Yet, this still leaves out vital data.

Table 3 shows the cost of care in dollars per capita and leads to the truth. Considering “Government Administration and Net Cost of Private Health Insurance” in isolation, the net cost of administering Medicare is 11% greater than that of private insurers on a per capita basis. Including all non-patient care cost indicates that public healthcare administration is 281% greater than that of private insurance administration. This assessment still does not include the cost of collecting taxes, nor does it include the providers’ cost of complying with insurance billing and collection requirements.

Table 3

Per capita in absolute dollars   Private Insurance Medicare Medicaid   Government Grand Total
Number of enrollees   201,991 41,375 39,554   91,884 299,106
Total cost in millions   775 431 329   1,036 2,241
  Cost per Capita   3,837 10,422 8,328   11,272 7,493
Patient care costs   3,368 9,900 7,683   9,257 6,280
Non Patient Care costs   468 522 642   1,317 999
                 
  Government Administration and Net   -          
  Cost of Private Health Insurance   468 522 642   648 521
  Government Public Health Activities   - - -   698 214
Investment   - - -   - -
  Research   - - -   415 142
  Structures and Equipment   - - -   255 337

 

Americans have always been mistrustful of the concept of “government efficiencies” (the ultimate oxymoron). The idea that government can manage health care more effectively and more efficiently is counter-intuitive, and for good reason: The facts show it is not true.

Let the facts stand, and in so doing, let us quit considering the nonsense of a government-run health system. Instead, let us move toward the kind of reforms that will unlock the power of American consumers, and watch effectiveness and efficiencies fall into place.

About the authors

Ralph Weber is a Canadian expatriate, now a Tennessee-based health insurance design consultant, and CEO of Route Three Benefits, Inc. Also the founder and CEO of MediBid Inc., A free market online medical shopping portal for transparency in pricing.

Dave Racer is a speaker, writer, publisher and co-author of Your Health Matters: What you need to know about US health care (Alethos Press LLC, 2006), FACTS: Not Fiction – What really ails US health care (Alethos Press LLC, 2007), and Why health care costs so much: The solution – Consumers (Alethos Press, 2009).  See Alethos Press.

—-

Notes:

CMS expenditure data taken from Table 4, and table 6, National Health Expenditures, by source of funds and type of expenditure: Calendar year 2007. Last accesses January 18, 2009

Enrollment data taken from CPS Annual Demographic Survey Table HI01. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2007. Last Accessed January 18, 2009

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