Pennies in a stream

I’d like to think that Obamacare is the thin end of the wedge, the first step towards single-payer. There’s a great Vox article on how Vermont is attempting to put in s single-payer system at the state level and how this mirrors the means by which Canada went single-payer — Saskatchewan did it in 1947, the rest of the country followed suit by 1961.

The amount of administrative waste in our current system is startling (and I don’t how much, if at all, Obamacare reduces it):

Vermont’s case for single-payer health care can be summarized in one number: $82,975.

That’s the amount a 2011 study in the journal Health Affairs found the average American doctor spends on dealing with insurance companies. Across the border in Ontario, doctors spend about a quarter of that amount — $22,205 per physician — interacting with the province’s single-payer agency.

38 replies
  1. 1
    EconWatcher says:

    Apologies for the same post on two threads, but I believe a great artist must be recognized in his own time. You all need to go–right now–to Tbogg’s site. He has posted his finest piece of writing ever, which is really saying something. I mean it. Go on, now. Git:…..azi-today/

  2. 2
  3. 3
    Comrade Jake says:

    The Thin Blue Cross Blue Shield Line.

  4. 4
    DougJ says:


    You know…I do think having an affair with a married staffer, then firing her when it comes to light, is in fact much worse than going to a prostitute.

    I don’t think Vitter should have had to resign but I think this guy should.

  5. 5
    Bob says:

    I like your optimism.

  6. 6
    EconWatcher says:


    I think so too, but for that I suppose they can always point to the Clenis as prececent.

  7. 7
    MomSense says:


    That was awesome.

  8. 8
    JPL says:

    @DougJ: The guy should have done the right thing and rant about impeaching the president. He could then divorce his wife, marry the staffer and bloviate on MSM about how the country is going downhill.

    This message was approved by Newt.

  9. 9
    Ash Can says:

    @DougJ: I agree that this is worse, but prostitution, at least where Vitter availed himself of it, is still against the law, while adultery isn’t. They both need to be out of any job that involves the public trust in any way, shape, or form.

  10. 10
    Belafon says:

    Yeah, but think of all those insurance adjusters that must be sitting on sidewalks in Canada begging for change.

  11. 11
    japa21 says:

    To the subject of the post, providers love to complain about the low reimbursement they receive from Medicare, but all except the most stubborn will tell you that, in terms of prompt payment and low overhead to process claims, etc., Medicare has everybody else beat by a mile.

    I am sure Richard will back me up on this (not really) but one of the reasons many physicans refuse to accept Medicare rates or a low percentage over Medicare rates is that the cost of doing business with insurance companies is so high.

    There are several factors, but the most prevalent are cost of appealing claims, cost of getting approval for procedures, and cost of dealing with issues related to coinsurance issues, verifying coverage, etc.

  12. 12
    JPL says:

    @japa21: There are some in the medical field who deal with elder care because of that reason. The office overhead is significantly lower.

  13. 13
    Betty Cracker says:

    Once everyone who remembers the Reagan presidency is dead, maybe a sane conversation about healthcare in the US can occur. Mind you, I don’t long for that day since I will be dead too (Reagan was president when I was in high school).

    But seriously, though many of us who remember the Amiable Dunce are capable of looking at the way the rest of the developed world deals with this problem and say — “DUH, I want that!” — the propaganda hook sank too deeply in too many others.

  14. 14
    Rob in CT says:

    I doubt the ACA does much about this, unfortunately. If you read the full article about VT in Vox, VT hospitals are saying they don’t expect much savings (if any) because the single-payer plan will obviously only cover Vermonters, and the hospitals get patients from neighboring states (primarily NH and NY), so they will still need to deal with the various private insurers and all the hassle that entails.

    A federal single-payer system would reduce the costs, because it would basically kill private health insurance (except, perhaps, for boutique coverage for rich people?), and there would be but one insurer: the government.

  15. 15
    Just Some Fuckhead, Thought Leader says:

    @Betty Cracker:

    (Reagan was president when I was in high school).

    Holy shit. I’m surprised you can remember back that far at your advanced age.

  16. 16
    Just Some Fuckhead, Thought Leader says:

    This is America. As long as there are massive amounts of money to be made off of the sick and dying, there will be massive amounts of money made off of the sick and dying. The good news is that Medicare and Medicaid are easier to rip off than private insurers so all the grift may eventually drift that way.

  17. 17
    Wag says:

    It all comes down to Medical Loss Ratios–the percentage of premiums that are paid out for actual medical services. The MLR for Medicare is 96%, meaning that 96% of the money paid into the system goes to providing care, and 4% goes to bureaucratic overhead. Under the ACA, the lowest allowable MLR is 80%. this is a significant increase in spending. Before the ACA, some insurance companies had an MLR of 60%, inother words, 40% of the premiums went to insurance comapny bureaucracy.

    Physicians fighting a well funded bureaucracy are forced to spend an inordinate amount of money on thier overhead, leading to a bureaucratic death spiral.

    The best thing we could do as a country is to follow VT’s example.

  18. 18
    japa21 says:

    @Rob in CT: Actually, that isn’t true. For example, there are many, perhaps most of those who receive Medicare that also have additional supplemental insurance to cover what Medicare doesn’t by paying the copays, deductibles, etc. This is a big business for insurance companies.

    In a single payer system, where there are those samecosts to the patient, you would see insurance companies who would write policies just as they do for Medicare recipients. And as you note, for the extremely wealthy, there would be the boutique policies.

    Would the private insurance company be drastically different? Yes. But it would not go out of existence.

  19. 19
    mikeyes says:

    Reagan was the one who started the “administrative cost” (I say that because this so-called cost is really a part of the profit for private insurers even if all they do is manage plans) problem when he de-regulated medical insurance. Prior to this time all insurers had to use one claim form, the Medicare form, and after that a physician went from one form to over fifty forms, some of which went on for pages. The upshot was that the insurance companies didn’t pay out as much and it cost doctors more to process.

    As of this year insurers are mandated to use simpler easier to fill out forms under the ACA. This is not the same as one form fits all, but it is a significant improvement in the paperwork and should result in savings and fewer processing costs.

  20. 20
    Elizabelle says:


    Yeah. Well done by TBogg. Some writing chops.

    I don’t think either Vitter or McAllister belong in the Senate or Congress, and it has nothing to do with their sexual activities. It’s that they’re shabby men with mean political ideology.

    Props to TBogg for bringing up the Mike Ensign case. Yup.

  21. 21
    Mnemosyne says:


    As I understand, most countries that have universal healthcare systems also have some private insurance, but it’s mostly there to cover extras (like a private room if you’re hospitalized) and not what kind of care you can receive.

  22. 22
    Stella B. says:

    @japa21: Exactly. France’s single payer plan is an 80/20 fee for service plan. Almost everybody has a supplemental insurance, often provided by their employer. There are multiple health insurance companies in France.

    The VT estimate seems low. A few years ago the Robert Wood Johnson Foundation had an even higher estimate. I know that when I worked, we had a whole staff of people in their own building doing nothing but battling for payment. That’s why we liked Medicare and Medi-Cal. Medi-Cal paid us X dollars per year and assigned us Y patients, most of whom were children who needed minor illness and well child visits.

  23. 23
    C.V. Danes says:

    Part of this equation is understanding that we don’t have a health care system in this country. What we have is a health care business. And a particularly nasty business predicated on producing the absolute minimum possible service for the absolute highest possible cost.

    Also, you know, getting people hooked on the reoccurring costs (e.g., drugs) instead of keeping them healthy by natural means (e.g., exercise).

  24. 24
    Wally Ballou says:

    I believe “Moonlight in Vermont” is still the only popular song whose verses not only don’t rhyme, but are composed in haiku form.

  25. 25
    burnspbesq says:

    Vermont has a border with Ontario? Every map of the US and Canada ever published is a lie? Why haven’t Snowden and Greenie told us this?

  26. 26
    burnspbesq says:

    @C.V. Danes:

    Also, you know, getting people hooked on the reoccurring costs (e.g., drugs) instead of keeping them healthy by natural means (e.g., exercise).

    Not to put too fine a point on it, but I could hop on my bike and ride 50 miles every day, and my diabetes ain’t going away. Your faith in the power of exercise is touching, but misplaced.

  27. 27
    C.V. Danes says:


    Not to put too fine a point on it, but I could hop on my bike and ride 50 miles every day, and my diabetes ain’t going away. Your faith in the power of exercise is touching, but misplaced.

    Both my parents were type 2 diabetic, and I have flirted with it myself. Two words for you: diet and exercise. Made a far bigger impact than any drug could have, with no side effects.

    Also, if you are type 1, then two words for you: diet and exercise. Won’t make up for a bum pancreas, but it will keep your blood sugar stable and allow you to use much less insulin.

  28. 28
    maya says:

    @Wally Ballou:

    I believe “Moonlight in Vermont” is still the only popular song whose verses not only don’t rhyme, but are composed in haiku form.

    It can also change into “Autumn in New York” at a moment’s notice.

  29. 29
    Paul in KY says:

    @C.V. Danes: Great point about it being a business rather than a system here in USA.

    Think that point could be made into a bumper sticker.

  30. 30
    James Hare says:

    I’ve got real high hopes for Vermont’s system. I moved up there when it was being debated but lost my job and had to return to the Washington, DC area. I helped set up a call center in Burlington this August for the ACA. The IT staff at that office were some of the sharpest folks I’ve had the pleasure of working with. If they’re indicative of the sorts of folks working to make single-payer a reality in Vermont things should go swimmingly.

  31. 31
    NorthLeft12 says:

    I believe this speaks to the efficiency of the Canadian bureaucracy [read “DEATH PANELS”] in denying treatment quicker than the insurance companies who beat about the bush and present a facade to the customer or Doctor by appearing to be sympathetic and helpful.

    I.AM.JOKING. The Canadian physicians and health care workers seem to be very well informed regarding what is covered and what is not. I am totally unsurprised that they don’t spend a lot of time and money on paperwork to get compensated.

  32. 32
    Tal says:

    The Kliff piece was good but it leaves out the fact that the entire movement for universal health care in Vermont was organized around human rights principles and the legislation establishing the creation of the single-payer system actually incorporates human rights principles inspired by international law. If folks are interested, I would encourage you to read this article for more information.

  33. 33
    Just Some Fuckhead, Thought Leader says:

    @C.V. Danes: Actually, I’d say portion control instead of diet. But even then, it’s probably a good idea to know if your liver is producing too much sugar or if your pancreas isn’t producing enough insulin.

    People who typically skip meals and go for long periods (12 hours or more) without eating may condition their liver to overproduce sugar. In these cases, eating three portion-controlled meals a day at regular intervals every day is likely to do more good than drugs or exercise.

  34. 34
    Keith G says:

    The amount of administrative waste in our current system is startling (and I don’t how much, if at all, Obamacare reduces it)

    Administrative waste is not the only issue. If you have a pre-existing condition requiring significant medical interaction and prescriptions, shopping for an appropriate plan in the ACA Marketplace can be a horrifying experience. As more people experience this, though be more and more pressure to change the system towards single payer.

  35. 35
    C.V. Danes says:

    @Just Some Fuckhead, Thought Leader:

    Actually, I’d say portion control instead of diet.

    Portion control is certainly important for losing weight, if you are eating high calorie, low nutrient foods. If you reverse the equation, and make a point of eating high nutrient, low calorie foods, like greens and beans and variations thereof, then you can eat nearly as much as you like, especially greens. When I switched to a mostly meat free, “beans and greens” diet, I saw a dramatic drop in my blood sugar, lost 25 pounds, and feel much, much better overall.

    Mostly, eat more greens and beans/legumes, less (or no) meat, stay away from processed foods and soda, get off the snacks, and make a point to walk further each day than from the sofa to the fridge and back. The Standard American Diet (SAD) will demonstrably kill you.

  36. 36
    Just Some Fuckhead, Thought Leader says:

    @C.V. Danes: It’s important to make clear there is no “diabetic diet” or magic foods. Yes, there are bad foods, but in very small doses, bad foods don’t have to have an adverse affect on one’s blood sugar. Also, losing weight doesn’t cure diabetes and people don’t have diabetes simply because they are overweight. Exercise is important to keep your body burning through any excess blood sugar, regardless of how it affects your weight.

    Portion control is the single most important thing you can do for your diabetes.

  37. 37
    Ramalama says:

    I had a friend who had a heart attack when he was visiting us in Quebec province. He was from out West, Canadia. We managed to bother the ER about what a big shot he was so he got to stay in a cushy ER room for about 4 days until they drop kicked him upstairs to a shared room with 3 other adults. The ER was cushy. The shared room, gloomy. If he’d had supplemental insurance he could have had his own room. Plus we started bitching about having to lay out cash money so he could watch a tv in his room, and the cost of the ambulance to take him to Montreal to get some tests and procedures done. But the actual total outlay was about $260. For a week’s stay in a hospital due to a heart attack. In Canada.


  38. 38
    Nathanael says:

    @DougJ: Vitter’s case ended up — somehow — with his madam being *killed*. Yes, I think Vitter needs to resign for that.

    Regarding Vermont single-payer: please please please please please, get it done, get it done, please

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