Who's to blame for high healthcare costs?

In the section "The single payer advantage".  I'd like to correct a few things. We do not have thousands of insurance plans each with their own regulations.  States, the Federal government, and recently local governments (i.e. San Francisco's Healthcare Ordinance) set regulations, not carriers.  I would like more detail on HOW a non single payer system CAUSES waste.  Not presume that it does by data comparison between apples & oranges (i.e. U.S. & Canada) and go on hypothesizing the ramifications assuming that premise in true.  That's no more valid than writing an argument about physics & biology assuming the premise that we're all made of cheese.  There are not 755 different health plans in Seattle.  For administrative purposes, there is no difference between the Washington State Blue Cross HMO plan 1 and the Washington State Blue Cross HMO plan 2.  They are in fact the same health plan with differing copays.  The insurer to provider relationship is the same.  The insurer to insured relationship is different in that copays will be different.  Calling both of these a different health plan is misleading and dishonest.  Most areas of the U.S. only have about 4 or 5 health insurance companies who have established networks in the area.  If you have more in your area, I'd look at HOW some of the smaller market share insurers actually provide insurance.  Its often via renting the network of a larger more entrenched insurer.  Thus, the insurer to provider relationship remains the same.  There really isn't that much admin work directly involved with REMEMBERING WHO TO SEND THE BILL TO. People really aren't that stupid.  For most areas, there are about 10 different insurer options, usually 4 or 5 of which are government.  How this breaks down is that you have private insurer A.  Private insurer A has either a capitated fee structure, or a fee for service structure.  Same with private insurer B, C, & D.  Thats about 8 differnet paper forms you may have to keep on hand.  Then you have Medicare, Medicaid, USERRA, etc...The thing is that a lot of this is done electronically.  If your smart enough to work at McDonalds, your probably smart enough to handle the task of "who do I send the bill to" at a doctors office.

I honestly believe that most of the admin people at doctors offices and hospital who collect your insurance information are smart enough to keep track of this.  I'd like to know where this army of admin staff that tackles this mountain of payment options is.  Usually you'll see one person at a doctors office, or a few people at the hospital. 

Most admin staff are actually tied up with Hippa, Medicare, ERISA, etc...Ask a home health care service or hospital how much work they have to do with Hippa vs. having to keep track of who to send the bill to.

This is a link to a handbook for providers on how to bill Medicare:

I think it helps show why admin staff are tied up with the above government programs I mentioned.  That handbook is monstrous. 

A single payer system may alleviate the costs with multiple payers, which is not a large cost in comparison to other influencing factors (such as poor health by U.S. citizens in general), but ironically, the government is what causes much of this increased cost.  I'd like to go back to the statement that asserts "We must jump into the waters with a single payer system because incremental changes preserve the problem".  No, incremental changes was a main engine that CREATED the problem of more administrative costs. 

Another main engine was litigation.  About 10% of your healthcare dollar goes towards malpractice insurance, litigation, and defensive medicine as a safe-guard against litigation.  An example of defensive medicine is your doctor prescribing you 12 MRI's when 3 would more than suffice...but "going the extra mile" is cheaper than potentially getting sued.  Hence, electronic medical records to make all this a bit easier for providers to comply with government regulations and also have records of due dilligence to reduce the practice of defensive medicine may be helpful...as Obama is banking on.

Nonetheless, more admin costs pale in comparison to what our culture of being a "fast food nation" does to the healthcare budget.

But either way, I still don't see how a single payer system actually REDUCES costs.  The assertion that multiple payers adds layers of complexity that creates 30% administrative waste is quite an unsupported argument that I believe most professionals in the field do not wholly accept.  There may be waste, but not 30%.  Either way, I hope people do due dilligence on identifying the problem.  Some articles here do in fact do that, some do not. 

Personally, I want a single payer system for the data.  That data will serve a greater good.  I also place much blame on the AMA more than health insurance companies.  The AMA is THE MOST POWERFUL lobby in the United States.  There's no organization that has more effectively kept it's enrollment low and compensation high.  They profit off of sickness, not wellness.  Even if doctors want to promote wellness, their numbers are too low to effectively do so.  Efforts to block nurse practitioners and so forth are also not a welcome activity in my book and demonstrate one or more of the following:

1. Arrogance- "Only I'm smart enough to treat you", even if it is only a general checkup

2. - The desire to keep sickness so profit can be made

3. - The desire to maintain a quasi-monopoly by keeping the number of treatment options low to drive up costs...and make profit..

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