The op-ed by Drs. Joshua M. Sharfstein and Laura Herrera and Charles Milligan ("Caring about costs, too," Sept. 27) offers a compelling set of recommendations to improve the quality of health care while reducing costs. Unfortunately, they neglected to describe the best single evidence-based practice — eliminating private health insurance.
Private health insurance adds only costs, but no value, to the delivery of health services. A Cambridge Medical Care Foundation study found that 31 percent of health care spending in the U.S. — equal to more than $600 billion annually — pays for administration, marketing, and the profits of private insurance. In 2007, the Congressional Research Service reported that the U.S. spends seven times as much per person on administrative and insurance costs as do OECD (Organisation for Economic Co-operation and Development) countries, and with far worse health outcomes here.
Vermont is implementing a health care system that will save money while covering everyone in the state with the same high quality health insurance. As the Vermont Strategic Plan notes, "Interacting with insurers costs an estimated $83,000 per year per physician in the U.S. — four times as much as in Canada" — without four times better health care. By the way, the Vermont model includes global budgeting for all hospitals — another important evidence-based practice mentioned by Dr. Sharfstein and his colleagues.
We will only solve our health care cost problem by directing our health care dollars toward actual health care. Let's look to the north for a truly effective solution.
Jeff Singer, Baltimore