I'm sure it depends on how you calculate the numbers. It has been awhile since I've read a study or analysis of government administrative costs, but previous numbers that I've seen run in the 1-2% range. I've read that Canada's system runs around the 3% range.

I briefly skimmed this position paper from CAHI (the association of health insurers), which obviously argues that Medicare admin costs are underreported. I take some issues with their methodology for "adjusting" the true administration costs of Medicare (e.g. they include portions of congressional salaries spent working on Medicare policy, and judicial costs of dealing with Medicare fraud). Still, even by their numbers the "adjusted" rate for Medicare administration runs at 5.2%. By comparison, the non-profit related admistrative costs for private health insurance runs at 8.9%, with profit it runs 16.7%.

http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

That is indeed curious accounting. The USACE charges other fed agencies 47% overhead. Some DoI agencies charge each other 41%. USDA is about 40% interagency overhead.

I wonder if we're talking about the same thing?

For example, a work order from USACE will have the full cost accounting of the project and at the bottom line you'll see an additional 47% charge for administrative costs and then the final cost to the customer.

Maybe what you're reporting is that the final (cost + overhead) = 1% less than equivalent private sector bid for work with the gov.

I can believe that. If I were a civilian entity I'd sure as hell bid high for a gov contract. Not just because they have deep pockets but because of all of the crap the gov makes contractors tack-on to meet some feel-good gov committee standard.

But I guess I'm cynical due to experience on both sides of that fence. It's a sausage factory.

I don't know much about how federal agencies bill for work with each other. I think the main difference between what you're talking about and how health insurance works is that, by and large, Medicare and private health insurance basically just shift huge piles of money from payers to payees. Obviously there is more to it than just that, but there is so much money that the total expenditures completely dwarf the administrative costs.

Most fed agencies are forbidden to compete with private industry and so, regularly seek money from each other when there is a disparity in capability and there is no private company that can do the work. There are legions of bean counters who gaze into boiling kettles of bat wings, lizard lips and owl guts to come-up with the overhead charges.

Pay for performance seems like a good idea but adds complexity to an already complex system. Hard to make rules for healthcare since it changes so fast "standard of care"

Basing Pay-for-Performance on Outcomes - NYTimes.com

Milwaukee Journal Sentinel, Oct. 16: "End-of-life care initiative prompts worries about abuse"

Couple of points:

- If it were easy we would be doing it already. (Obviously.) We still are not at a point where the industry and the profession have a good understanding, let alone agreement, on how best to measure performance and quality, and then to provide incentives to reward improving quality.

- Regardless of how the industry and providers feel about it, Medicare is already moving towards performance measures as well as financial disincentives for undesirable outcomes (e.g. hospital readmission within 30 days).

- Although the research is conflicting, there is some evidence that outcome monitoring may have some beneficial impact on utilization and results. A California evaluation of CABG reporting rates noted a decrease in both CABG rates as well as risk-adjusted operative mortality rates after requiring hospitals to report CABG mortality rates. Similarly, a JAMA article earlier this month evaluated the impact of cardiac cath reporting rates in New England. It found a decrease in the rates of cardiac cath for acute heart attacks but no change in 30 day mortality, which suggests but does not prove that cath outcome reporting decreased the rate of low-benefit procedures. (This is because it was an observational study. You can only prove causation with a randomized controlled trial.)

Wow. That is one of the most reprehensible things I have read this week. I cannot imagine how anyone who has actually seen a POLST would say that it promotes euthanasia or expedites death. One of the VERY CLEAR options on the POLST form is "I WANT ALL LIFE SUSTAINING MEASURES," and "FULL RESUSCITATION."

These people are doing a huge disservice to the end-of-life care discussion in Wisconsin. And they are not even doing it with an informed point of view. Sorry, that should read, "they are doing it with an intentionally distorted and disingenuous view of the facts."

Also, shame on the Wisconsin Medical Society for not standing up to these hacks.

First, define life. Then at least we'll know what we're all talking about.

(Hahahaha!!!)

FWIW, if we do go down the path of publicly financed healthcare then you bet your bippy I want death panels. I sure as heck don't want to pay for your granny's last few weeks. Pull her plug!

Well maybe a little to far for my tastes. But it is good to setup a DNR and a power of attttorney with whom you can trust.

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Darryl, Hill
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DNR is for relatives. I'm talking a Star Chamber that deals death on the just and the unjust, rich and poor. Their only regard is "quality of life" whatever that is.

Since we're not talking about me or my family I'm all for snuffing granny if she sneezes.

Your granny. Not mine.