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Post by Deleted on Jun 19, 2019 13:02:39 GMT -5
Interesting analysis by Kevin Drum recently-- with troubling charts that help explain why I retired early.
Among other things, I was tired of having to constantly fill out forms and/or call "managed care" companies and their contracting pharmacies to get "authorizations" for prescriptions and patient appointments.
(I'm only re-printing one chart below-- to conserve Wally World digital space.)
Join Me On a Dive Down the Rabbit Hole of U.S. Health Care For-Profit "Administrative" Costs
June 15, 2019
I went down a rabbit hole last night, so today I’m going to torture you by telling you all about it. It started on Twitter, where I learned that various versions of the chart below are extremely widespread:
Two things immediately struck me. First, the number of administrators suddenly skyrocketed between 1993-96. I can’t think of any good reason for this. Second, it shows the number of physicians growing by only 150 percent, and I know that’s not right. In reality the number has more than tripled. So that got me curious: where did this chart come from?
The number of physicians is pretty easy to get. Right now there are a little more than 1 million physicians and surgeons in the US. It’s also pretty easy to get numbers for the entire health care sector: about 16 million. The hard part is figuring out how many administrators there are. Of the sources cited in the chart, neither the BLS nor the NCHS is going to help with this, so I went searching for Himmelstein and Woolhandler. They are prolific writers, but the closest I found to this chart was this one that goes up to 1987:
This matches the original chart through 1987, though it’s worth noting that H&W are forced to make a lot of assumptions to get here.¹ The reason is simple: there is no remotely reliable measure of the number of health care administrators in America. In fact, I can’t figure out where H&W got theirs. It’s allegedly sourced to the 1989 Statistical Abstract of the United States, but I sure can’t find it there and I have no reason to think the federal government has ever tracked this. But let’s plow ahead anyway.
In 2003, H&W estimated that per capita health care administration costs (not personnel) had increased from $450 in 1987 to $1059 by 1999—and this is a very broad number since they include things like the time doctors spend on admin chores. Adjusted for inflation and population growth, that’s an increase of about 80 percent. But the chart that kicked off this post shows an increase of around 4x during that period. The H&W number is far more believable. I suspect that the 4x increase is an artifact of some kind, perhaps due to a reclassification of job functions. Or maybe it was just a mistake. In any case, it’s been carried over in every chart since.
This takes us to 1999. But what about now? Here’s a page from the Bureau of Labor Statistics for 2018:
Everyone here is a practitioner or a medical assistant, not an administrator. It adds up to 13 million. With a total of 16 million people in health care, that leaves 3 million unaccounted for. Those are the administrators, receptionists, billing clerks, etc. Insurance adjusters and other outsiders add about 2 million to the total, all of them administration, which gets us to roughly 5 million administrators out of 18 million total, or 28 percent. H&W estimated that administration and clerical workers made up 27 percent of the health care labor force in 1999, increasing at a rate that would get us to 30 percent by today. So the right number is probably between 28-30 percent. Let’s call it 29 percent.
Put that all together and it suggests that the number of administrators has increased about 30-40 percent since 1999.
So what should our chart really look like? I have three different suggestions. The first just puts together the data points that I’ve outlined so far:
The second comes from the federal government, and it’s their estimate of government admin costs plus private insurance admin costs. This does not include hospital billing clerks, IT departments, and so forth, but it still ought to provide us with a benchmark of sorts for the growth rate of administration:
Finally, here’s a chart based directly on figures from Himmelstein and Woolhandler (Table 2 here):
This is nowhere near the 3000 percent growth on the original chart, but it’s still pretty high. It’s probably safe to say that health care administration has grown somewhere on the order of 1000 percent over the past 50 years. But why?
This is what brings us to the final, most correct chart. Here’s the thing: fifty years ago we didn’t have MRI techs or transplant hospitals or routine ultrasounds or proton beams for cancer patients. Four years ago I spent a couple of weeks at City of Hope to treat my cancer; the treatment I got—not to mention the entire campus in its current form—didn’t even exist in 1970.
In other words, the main reason that administration has gotten bigger is because medical care has gotten bigger. Since 1970, adjusted for inflation, health care spending has gone up about 600 percent and the number of health care workers has gone up about 500 percent. It’s only natural that the number of administrators would go up at least that much as well.
So the real question is: how much has administration gone up above and beyond the overall growth in health care? Here’s the answer based on two of the estimates above:
Once you take into account the growth in health care generally, the share devoted to administration has gone up by 50-100 percent. That’s a lot! But it’s also not that surprising. In 1970, the health care industry spent approximately $0 on IT management. Today they spend a bundle, and all of that is admin overhead. Purchasing has exploded too, since there are far more things to purchase these days. Regulations have grown along with technology, so compliance offices have grown. Doctors and hospitals have always spent hours on the phone arguing with insurance companies, but that’s probably grown too.
I don’t mean for any of this to excuse the growth rate of administration, which might be higher than it should be. And there’s certainly no question that our absolute level of administrative overhead is insanely high. H&W estimate, for example, that the share of workers dedicated to administration is about a third higher in the US than in Canada. Needless to say, this is largely because Canada doesn’t waste boatloads of money on private insurance and all the overhead that implies.
Bottom line: the health care system has grown tremendously over the past 50 years, but that’s mostly not because we have a lot more doctors. It’s because we have MRI techs and ultrasound specialists and more kinds of nurses and more kinds of pills and enormous proton beams to cure cancer. (Those proton beams are massively expensive and require large staffs, but that doesn’t mean you need any more oncologists per patient.) To manage all this new stuff, we need bigger admin and support staffs. As a result, admin and support have grown about 50-100 percent on a relative basis. That’s the real number.
¹Note that their estimate include a huge jump between 1984-87. However, this makes some sense since the Reagan administration changed the Medicare payment system in 1983 in a way that might plausibly have led to a big increase in administration costs.
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Post by AlaCowboy on Jun 19, 2019 18:18:48 GMT -5
Put administrators AND physicians on an hourly rate. $15.00 per hour is the Liberal benchmark for salaries. Physicians charge way too much for doing little or nothing while their nurses and PAs treat patients. I have to ask my endocrinologist questions to get him to stay in the room. I'm ready to find another doctor.
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AMERICAN BY BIRTH. SOUTHERN BY THE GRACE OF GOD!!!
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Post by Deleted on Jun 28, 2019 15:49:50 GMT -5
Put administrators AND physicians on an hourly rate. $15.00 per hour is the Liberal benchmark for salaries. Physicians charge way too much for doing little or nothing while their nurses and PAs treat patients. I have to ask my endocrinologist questions to get him to stay in the room. I'm ready to find another doctor. Exactly! Doctors and lawyers should not be allowed to be rich. They should be allowed to make no more than $4000 a month. That's enough for them to live on. If we are going to have federal health insurance, then doctors should be required to be federal employees.
The Damnedocrats are gonna shut down pharma companies and gun makers, and steal everyone's guns, so there will be no need for all those dime a dozen ambulance chasers, either. |
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Post by Deleted on Jun 28, 2019 16:01:57 GMT -5
Put administrators AND physicians on an hourly rate. $15.00 per hour is the Liberal benchmark for salaries. Physicians charge way too much for doing little or nothing while their nurses and PAs treat patients. I have to ask my endocrinologist questions to get him to stay in the room. I'm ready to find another doctor.
They can start out at the Post Office Level 3 employee rate ------ $25,657 a year. They can move up if they have satisfactory job performance reports, and accrue years of service IN the system. |
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Post by Deleted on Jun 28, 2019 17:09:40 GMT -5
Put administrators AND physicians on an hourly rate. $15.00 per hour is the Liberal benchmark for salaries. Physicians charge way too much for doing little or nothing while their nurses and PAs treat patients. I have to ask my endocrinologist questions to get him to stay in the room. I'm ready to find another doctor.
They can start out at the Post Office Level 3 employee rate ------ $25,657 a year. They can move up if they have satisfactory job performance reports, and accrue years of service IN the system.Brilliant, Psycho Mutt. Just think of all the intelligent young people who will be willing to undergo 4 years of college + 4 years of medical school + 4 years of residency training in order to make $25,000. At that rate, it will take 40 years just to pay off their student loans! |
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Post by Deleted on Jun 28, 2019 17:18:46 GMT -5
If we are going to have federal health insurance, the doctors will have to be federal employees, with the equivalent Civil Service pay scales.
They can start out at the Post Office Level 3 employee rate ------ $25,657 a year. They can move up if they have satisfactory job performance reports, and accrue years of service IN the system. Brilliant, Psycho Mutt. Just think of all the intelligent young people who will be willing to undergo 4 years of college + 4 years of medical school + 4 years of residency training in order to make $25,000. At that rate, it will take 40 years just to pay off their student loans! That's what lieberals want. Go complain to THEM.
Nobody in real life gets rich on a gov't salary. If you want the gov't to control health care, make sure GOV'T doctors are used and compensated accordingly.
Actually, military doctors get paid pretty well, and VA doctors get paid better, while allowing veterans to die. I wish I was as poor as a gov't paid doctor.
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Post by Deleted on Jun 28, 2019 17:42:18 GMT -5
Brilliant, Psycho Mutt. Just think of all the intelligent young people who will be willing to undergo 4 years of college + 4 years of medical school + 4 years of residency training in order to make $25,000. At that rate, it will take 40 years just to pay off their student loans! That's what lieberals want. Go complain to THEM.
Nobody in real life gets rich on a gov't salary. If you want the gov't to control health care, make sure GOV'T doctors are used and compensated accordingly.
Actually, military doctors get paid pretty well, and VA doctors get paid better, while allowing veterans to die. I wish I was as poor as a gov't paid doctor.
The VA system is WAY too top-heavy with overpaid, Dr. Dolittle type administrators. Gold bricks. I could never work there. Working there for two months as a medical intern (in 1983) was enough to make me believe in capitalism. |
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Post by Deleted on Jun 28, 2019 18:38:33 GMT -5
That's what lieberals want. Go complain to THEM.
Nobody in real life gets rich on a gov't salary. If you want the gov't to control health care, make sure GOV'T doctors are used and compensated accordingly.
Actually, military doctors get paid pretty well, and VA doctors get paid better, while allowing veterans to die. I wish I was as poor as a gov't paid doctor.
The VA system is WAY too top-heavy with overpaid, Dr. Dolittle type administrators. Gold bricks. I could never work there. Working there for two months as a medical intern (in 1983) was enough to make me believe in capitalism.
Why should a person work hard to build a business and make millions of dollars, if your lieberal friends are going to steal 70% of his income? Why do you think they have the right to DESTROY the American Dream?
Should Oprah have 70% of HER income stolen from her?
How about Teresa Kerry, who is only worth $750 million net? She can get by on only $225 mil. She isn't entitled to the rest. That's what YOUR heroes think.
You need to Walk Away and come over to the good side. |
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Post by Deleted on Jun 28, 2019 19:44:46 GMT -5
The VA system is WAY too top-heavy with overpaid, Dr. Dolittle type administrators. Gold bricks. I could never work there. Working there for two months as a medical intern (in 1983) was enough to make me believe in capitalism.
Why should a person work hard to build a business and make millions of dollars, if your lieberal friends are going to steal 70% of his income? Why do you think they have the right to DESTROY the American Dream?
Should Oprah have 70% of HER income stolen from her?
How about Teresa Kerry, who is only worth $750 million net? She can get by on only $225 mil. She isn't entitled to the rest. That's what YOUR heroes think.
You need to Walk Away and come over to the good side. Capitalism works, but it has to be regulated by the state to prevent abuse and exploitation of the public. Think of the Gilded Age of unregulated, laissez faire capitalism in U.S. history. It was a public disaster. That's why the Trump/Koch GOP is fatally flawed. It is government of, by, and for the Robber Barons. Half of Americans today are barely scraping by-- despite working hard -- and they own less, collectively, than the 4 wealthiest people in the country! |
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Post by Deleted on Jun 28, 2019 19:56:03 GMT -5
You mean that same capitalism that your Damnedocrat heroes wont to destroy?
Why should a person work hard to build a business and make millions of dollars, if your lieberal friends are going to steal 70% of his income? Why do you think they have the right to DESTROY the American Dream?
Should Oprah have 70% of HER income stolen from her?
How about Teresa Kerry, who is only worth $750 million net? She can get by on only $225 mil. She isn't entitled to the rest. That's what YOUR heroes think.
You need to Walk Away and come over to the good side. Capitalism works, but it has to be regulated by the state to prevent abuse and exploitation of the public. Think of the Gilded Age of unregulated, laissez faire capitalism in U.S. history. It was a public disaster. That's why the Trump/Koch GOP is fatally flawed. It is government of, by, and for the Robber Barons. Half of Americans today are barely scraping by-- despite working hard -- and they own less, collectively, than the 4 wealthiest people in the country!
Nowhere does the Constitution say the gov't has the right to steal from rich people to subsidize others.
Nowhere does the Constitution say you have the guarantee to own anything .......... EXCEPT guns. Isn't that weird? The founders knew how important it was to protect ourselves from fools and tyrants like you.
You of course have the right to ATTEMPT to be rich, own land, etc., but the gov't is under no obligation to provide such things.
Life isn't fair, Buckwheat. It never will be, and that's just how it IS. Deal with reality for once.
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Post by Deleted on Jun 28, 2019 22:54:57 GMT -5
Capitalism works, but it has to be regulated by the state to prevent abuse and exploitation of the public. Think of the Gilded Age of unregulated, laissez faire capitalism in U.S. history. It was a public disaster. That's why the Trump/Koch GOP is fatally flawed. It is government of, by, and for the Robber Barons. Half of Americans today are barely scraping by-- despite working hard -- and they own less, collectively, than the 4 wealthiest people in the country!
Nowhere does the Constitution say the gov't has the right to steal from rich people to subsidize others.
Nowhere does the Constitution say you have the guarantee to own anything .......... EXCEPT guns. Isn't that weird? The founders knew how important it was to protect ourselves from fools and tyrants like you.
You of course have the right to ATTEMPT to be rich, own land, etc., but the gov't is under no obligation to provide such things.
Life isn't fair, Buckwheat. It never will be, and that's just how it IS. Deal with reality for once.
Mutt,
You seem to forget that the Constitution was written for the express purpose of "creating a more perfect union."
It also grants Congress the authority to impose taxes and spend that tax revenue in accordance with its legislated objectives.
Thus, the government has, at its best, established programs like the FDIC, Social Security, and Medicare for the good of the American people.
Conversely, wealthy people and corporations have often hijacked Congress and the White House for the purpose of 1) reducing their own taxes, and 2) diverting government funds into their own pockets-- so-called, "corporate welfare." It's massive.
But, Buckwheat, there is nothing un-Constitutional or un-American about having a Congress and POTUS who primarily serve the interests of the American people, rather than the Robber Barons. In such a government, tax policy would emphasize increasing revenue to support vital, constructive expenditures that promote the good of the American people.
The Constitution doesn't stipulate that rich people have an inherent right to oppress and exploit the American people, while getting subsidized by "corporate welfare" from the government.
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Post by Deleted on Jun 29, 2019 8:31:03 GMT -5
Sorry. Nowhere does the Constitution guarantee you to be rich.
Nowhere does the Constitution say the gov't has the right to steal from rich people to subsidize others.
Nowhere does the Constitution say you have the guarantee to own anything .......... EXCEPT guns. Isn't that weird? The founders knew how important it was to protect ourselves from fools and tyrants like you.
You of course have the right to ATTEMPT to be rich, own land, etc., but the gov't is under no obligation to provide such things.
Life isn't fair, Buckwheat. It never will be, and that's just how it IS. Deal with reality for once.
Mutt,
You seem to forget that the Constitution was written for the express purpose of "creating a more perfect union."
It also grants Congress the authority to impose taxes and spend that tax revenue in accordance with its legislated objectives.
Thus, the government has, at its best, established programs like the FDIC, Social Security, and Medicare for the good of the American people.
Conversely, wealthy people and corporations have often hijacked Congress and the White House for the purpose of 1) reducing their own taxes, and 2) diverting government funds into their own pockets-- so-called, "corporate welfare." It's massive.
But, Buckwjeat, there is nothing un-Constitutional or un-American about having a Congress and POTUS who primarily serve the interests of the American people, rather than the Robber Barons. In such a government, tax policy would emphasize increasing revenue to support vital, constructive expenditures that promote the good of the American people.
The Constitution doesn't stipulate that rich people have an inherent right to oppress and exploit the American people, while getting subsidized by "corporate welfare" from the government.
You didn't have a problem with Hussein bailing out GM, and sucking the union's dick, did you?
You are wrong for supporting socialist lieberal ideas, but nothing will ever convince you otherwise. Keep living in your fantasy world. You are beyond help.
I quit.
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Post by Deleted on Jun 29, 2019 12:09:13 GMT -5
Mutt,
You seem to forget that the Constitution was written for the express purpose of "creating a more perfect union."
It also grants Congress the authority to impose taxes and spend that tax revenue in accordance with its legislated objectives.
Thus, the government has, at its best, established programs like the FDIC, Social Security, and Medicare for the good of the American people.
Conversely, wealthy people and corporations have often hijacked Congress and the White House for the purpose of 1) reducing their own taxes, and 2) diverting government funds into their own pockets-- so-called, "corporate welfare." It's massive.
But, Buckwjeat, there is nothing un-Constitutional or un-American about having a Congress and POTUS who primarily serve the interests of the American people, rather than the Robber Barons. In such a government, tax policy would emphasize increasing revenue to support vital, constructive expenditures that promote the good of the American people.
The Constitution doesn't stipulate that rich people have an inherent right to oppress and exploit the American people, while getting subsidized by "corporate welfare" from the government.
You didn't have a problem with Hussein bailing out GM, and sucking the union's dick, did you?
You are wrong for supporting socialist lieberal ideas, but nothing will ever convince you otherwise. Keep living in your fantasy world. You are beyond help.
I quit.
Mutt,
Labor unions created the American middle class back in our prosperous Golden Age-- the 1950s and 60s. The decline of the American middle class during the past 50 years has proceeded in lock step with the Republicon Robber Baron's destruction of labor unions in the U.S. (See graph below)
The main reason that the American middle class has fallen so behind the middle class workers in other G-7 nations is that capitalists in Europe weren't able to destroy their labor unions the way American Robber Barons have destroyed our unions here.
Unions aren't perfect, but there has to be a balance of power in dividing our GDP pie.
Since 1980, the wealth of the richest 1% in America has increased by $21 trillion, while the wealth of the bottom 50% has dropped by $1 trillion.
All of the pie has gone to the 1%.
Get a clue, dude. You've been brainwashed by years of corporate GOP propaganda.
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Post by Deleted on Jun 29, 2019 18:05:32 GMT -5
There is no easy solution, but promising people everything for free, knowing full well it is economically IMPOSSIBLE, encouraging foreigners to flood the country while ignoring CITIZENS (again with no way to finance them), suppressing Christian values, wanting to disarm citizens, and wasting money on a fake science called "global warming" are NOT the way to run a country.
You didn't have a problem with Hussein bailing out GM, and sucking the union's dick, did you?
You are wrong for supporting socialist lieberal ideas, but nothing will ever convince you otherwise. Keep living in your fantasy world. You are beyond help.
I quit.
Mutt,
Labor unions created the American middle class back in our prosperous Golden Age-- the 1950s and 60s. The decline of the American middle class during the past 50 years has proceeded in lock step with the Republicon Robber Baron's destruction of labor unions in the U.S. (See graph below)
The main reason that the American middle class has fallen so behind the middle class workers in other G-7 nations is that capitalists in Europe weren't able to destroy their labor unions the way American Robber Barons have destroyed our unions here.
Unions aren't perfect, but there has to be a balance of power in dividing our GDP pie.
Since 1980, the wealth of the richest 1% in America has increased by $21 trillion, while the wealth of the bottom 50% has dropped by $1 trillion.
All of the pie has gone to the 1%.
Get a clue, dude. You've been brainwashed by years of corporate GOP propaganda.
You don't know what you are talking about. I was a member of THE MOST CORRUPT UNION IN THE UNITED STATES ..... Teamsters Local #5, "led" by Ed Grady Partin, a major thug who was heavily involved with Jimmy Hoffa and Carlos Marcello. He organized violent attacks against workers who would cross his thug picket lines. Hoffa and Marcello tried to pay Partin to fix the jury in Hoffa's trial.
Partin is known to have been involved in the disappearance of Hoffa.
Unions are nothing but legal strong-arm mobs. Long ago, they had validity. No longer. BTW, dickweed ---------- union leaders are VERY RICH. Their members are NOT.
Get a clue and shove your outdated 10 year old chart up your unlubricated ass sideways.
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Post by Deleted on Jun 29, 2019 18:54:42 GMT -5
Three questions for you to contemplate, Bryan.
1) What is the source of our U.S. GDP-- the "pie?"
2) How does our society (and other societies) "decide" on how that GDP "pie" is divided-- between workers, management, and capitalists?
3) Does it seem fair and reasonable to you that, in the U.S. since 1980, ALL of the increased (marginal GDP) "pie" produced in the U.S. has gone to the wealthiest 1 percent? (See Thomas Piketty's data)
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