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Paperwork is strangling U.S. health care

Medical insurance forms and bills have become a torment for middle-class Americans. We have trouble understanding their complexities, and we do not know why the computers keep spewing them out at us. When we telephone for help, we usually end up more frustrated. The paperwork is just one symptom of the extraordinary complications of the American system of health insurance, the most complicated on earth. Another, which can be even more burdensome, is the penalty we pay for mobility.

Every time an American moves or changes jobs, she is likely to find herself with a different health insurance carrier. The new policy may very well not cover "pre-existing conditions" _ pregnancy, for example. In addition, some people get no medical benefits where they work and have to find expensive individual policies.

All of that is from the patients' viewpoint. From the doctors', the situation is no happier.

In the year 1987 the average American doctor spent a little over 134 hours filling out insurance forms. That was 4.4 percent of his or her total professional time. And doctors have hired more and more clerical staff to deal with the forms.

Those figures come from an article last month in The New England Journal of Medicine. It was by Dr. Steffie Woolhandler and Dr. David U. Himmelstein of the Harvard Medical School. What they reported was numbing.

Administering health care in the United States cost between $96.8-billion and $120.4-billion in 1987. The higher figure was nearly a quarter of total spending on health care.

And the burden of administration is growing. Between 1970 and 1987 the number of health administrators in this country rose by nearly 400 percent. At the present rate of growth, the study found, administration will consume a third of all our health spending by the year 2003.

The recent government efforts to contain costs have only made matters worse. They "have required an army of bureaucrats," Drs. Woolhandler and Himmelstein write. "Each piece of medical terrain is meticulously inspected except that beneath the inspectors' feet."

The cost of health paperwork and bureaucracy is especially striking compared with other countries. The New England Journal article makes detailed comparisons with Canada.

Canada devoted at most 11.1 percent of its health spending to administration in 1987, compared with as much as 24.1 in the United States. Administration cost at most $156 for each Canadian, compared with $497 per capita in this country. If health care had been managed as efficiently here as in Canada in 1987, the United States could have saved as much as $83-billion. By now the saving would be on the order of $100-billion a year.

The reason for the difference is no secret. Canada has a genuine national health system, covering everyone. We have a crazy quilt of Medicare for the elderly, Medicaid for some of the poor and 1,500 private health insurers.

Fragmentation is what makes U.S. medical insurance complicated and expensive. Every patient must be individually billed, individually processed for insurance. Policies vary in deductibles, in excluded conditions, in requirements for co-payments. Some people buy secondary insurance _ another layer of bureaucracy.

The article concludes that "universal comprehensive coverage under a single, publicly administered insurance program" is the key to "administrative simplification."

In short, the cost and irritating complexity of health insurance in this country, for patients and doctors, point to the same reform as the system's inadequate coverage. Some 34-million Americans have no health coverage at all. They, and we who are covered, need a universal system.

New York Times News Service

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