davida_usa

I am regularly amazed by your show's ability to tell fascinating stories about science using radio, a very challenging medium for this subject matter. (And any science show that features "They Might Be Giants" deserves kudos regardless of the media).

My question is, what relative importance do you place on reaching those with no science background versus covering issues that are scientifically significant?

Why do so few pundits and other so-called health care experts understand that major factors inflating health care costs are 1) pricing that is severely restricted by the coding required by third party payors, 2) the administrative overhead created by third party reimbursement, and 3) the lack of consumer stake in the cost of health care?

Almost half of total health care spending is for primary care services. We agree that the overhead of private insurance is 13-15%, but the overhead of primary care practices is also considerable -- employing people and systems to verify insurance at each appointment, requiring physicians to code each service and often obtain approval for ordering tests, limiting prescriptions to a formulary and the necessity of people and systems to bill and collect from insurance companies, as well as from the patient for coinsurance and deductibles -- it is easy to see that more than one third of the cost of primary care is administrative.

Where we disagree is your assertion that "lack of consumer stake" is not material. In a market where consumers paid for their primary care directly, not all would choose the same level of care provided today because virtually all primary care physicians are reimbursed using the same CPT codes. Some would be willing to spend more money in order to take time talking with their doctors. Others would be willing to sit in a spartan waiting area without an appointment to see whatever provider becomes available because the cost is more important than time to them. Both doctors and patients would benefit from having a flexibility not afforded by the current health system that would enable them to spend an appropriate amount of time during an appointment to fully address the issues of that patient.

If primary care consumes 40% of our health care spending, one third of which is administrative overhead and another substantial percentage is inefficient because the care either does more than the patient needs or would be willing to spend if it were "their" money, or the care does less than what the patient needs or wants because it is not reimbursed under the CPT coding system, it is not hard to see that reforming this one aspect of health care could go a long way to solving our problem of health care costs.