Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The financial sinkhole of health insurance complexity

James G. Kahn, MD, MPH
Policy
February 2, 2015
178 Shares
Share
Tweet
Share

We all know that the U.S. system of paying for health care is tremendously complex and inefficient: a multitude of insurers, thousands of insurance plans, innumerable medical bills, countless incorrect and denied claims.

But just how much do we waste on this administrative morass?

I led a research team that recently reviewed all the available evidence and published our findings. The resulting numbers are staggering.

Compared with countries that have a single health insurer (i.e., the government), we waste more than $375 billion per year in excess paperwork to pay medical bills.

That’s $1 billion per day. That’s more than $1 trillion every three years. That’s 15 percent of all health spending — 1 in every 7 dollars spent on health care — on excess paperwork.

Let me put these big numbers into perspective. This waste equals $1,200 per year for each and every person in the United States. It represents 89 percent of total state and federal spending for Medicaid, our health insurance for the poor. It amounts to 2.3 percent of the U.S. economy.

And this striking toll doesn’t even count the effort expended by employers for their employees’ health insurance or time spent by patients and families dealing with insurance and bills.

What does this third of a trillion dollars each year pay for? It funds the endless detailed steps required in the “multi-payer” insurance system:  designing health plans, contracting between insurers and providers, marketing health insurance, signing up subscribers, checking insurance status at each medical visit, collecting copayments, creating bills, sending out bills, processing incoming payments, disputing insurance claims, collecting unpaid bills.

We call this “billing and insurance-related” administrative waste, or BIR. In the dead of our current winter, I pronounce it “brrr” because it reflects a frightfully chilling reality.

Imagine what we could do, as a nation, with more than $375 billion.

We could pay for everyone to have high-quality health care. The massive savings from lower paperwork would be enough to cover all Americans with minimal or no deductibles or copays.

Are we speculating? No, we’re summarizing solid empirical evidence, something sorely missing from most health care reform discussions.

What’s the evidence? The U.S. is part of the OECD — Organization for Economic Cooperation and Development — the wealthy democracies. All of those countries have either a single-payer, or a single absolutely standard comprehensive health plan, with coverage of 98 percent of individuals or higher (compared to 87 percent in the U.S.).

All of them avoid BIR administrative waste. They also use the single payer to get lower prices on medications and durable medical goods like CT scanners, wheelchairs, and hearing aids.

So the $1 trillion over three years isn’t an abstract number. It’s a real savings we can achieve if we finally make the same decision that all of our counterpart countries have.

That should be our New Year’s resolution.

James G. Kahn is a health policy professor.

Prev

Mobile health: Just because we can do it doesn't mean we should

February 2, 2015 Kevin 1
…
Next

The sad, tragic road to meaningful use

February 2, 2015 Kevin 14
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Mobile health: Just because we can do it doesn't mean we should
Next Post >
The sad, tragic road to meaningful use

More by James G. Kahn, MD, MPH

  • A health economist acknowledges how financing experiments failed our health system

    James G. Kahn, MD, MPH

Related Posts

  • Here’s why health insurance is different from other insurance

    Joseph Crisp
  • Why is health insurance so unaffordable?

    Emily O'Rourke, MD
  • Think you have health insurance? Think again.

    Asser Shahin, MD
  • High deductible health insurance is bankrupting Americans

    Ben Aiken, MD
  • The skinny on skinny health insurance

    Mark Kelley, MD
  • COVID-19 shows why we need health insurance

    Jingyi Liu, MD

More in Policy

  • The realities of immigrant health care served hot from America’s melting pot

    Stella Cho
  • Healing the damaged nurse-physician dynamic

    Angel J. Mena, MD and Ali Morin, MSN, RN
  • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

    Mohammed Umer Waris, MD
  • Breaking down the barriers to effective bar-code medication administration

    Amy Dang Craft
  • The locums industry has a beef problem

    Aaron Morgenstein, MD
  • Canada’s health workers are sounding the alarm. We must act, now.

    Ivy Lynn Bourgeault, PhD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from gaslighting [PODCAST]

      The Podcast by KevinMD | Podcast
    • The pros and cons of using ChatGPT for your health care needs

      Liudmila Schafer, MD | Tech
    • Dr. Glaucomflecken for president!

      Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 19 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • How Did Pulse Oximeters Perform in Black Kids?
  • Coffee and Heart Function; Ionizing Radiation and CVD
  • Health Inequity Should Be Labeled as a 'Never Event'
  • Healing the Damaged Nurse-Physician Dynamic
  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from gaslighting [PODCAST]

      The Podcast by KevinMD | Podcast
    • The pros and cons of using ChatGPT for your health care needs

      Liudmila Schafer, MD | Tech
    • Dr. Glaucomflecken for president!

      Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The financial sinkhole of health insurance complexity
19 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...