In the dispute over the future of medical insurance in the United States, one fact is repeatedly observed: the administrative and marketing costs of the current American health insurance system are higher than in some other countries.
In the scheme of health care costs, quality of care and universal coverage are more important considerations. But even so, administrative and marketing costs will be crucial factors if the U.S. system is revamped.
A study released yesterday by Citizen Action, an advocacy group for national health insurance, attempts to estimate how much it costs for private health insurance firms to deliver a dollar's worth of benefits to an individual.
The study concluded that it cost commercial insurance firms 33.5 cents in administrative and marketing costs to deliver $1 in insurance benefits in 1988.
"Not including profits, commercial insurance companies spent $14.9 billion to provide $44.5 billion in health benefits," said Citizen Action.
This 33.5 cents cost for every dollar of benefits, Citizen Action said, was 14 times more than the 2.3 cents it cost Medicare, the government program for the elderly, and 11 times more than Canada's 3 cents per dollar.
The study said that if these costs had been as low per dollar as in Canada or this nation's Medicare system, about $13 billion a year could have been saved -- enough to pay for health insurance policies for a third of the 31 million Americans who lack any government or non-government insurance.
Citizen Action in its comparison measured "the least efficient" segment of the private insurance industry by looking only at commercial insurance firms, which in many cases sell to individuals rather than to large groups, and by leaving out Blue Cross/Blue Shield policies, government programs and employers who self-insure.
If these had been included, the overall average administrative cost ratio would have been lower than for commercial policies alone.
Administrative and marketing costs for Blue Cross/Blue Shield and for self-insured firms historically have been lower because they focus on large groups and do not have to pay for salesmen to sell policies to individuals or for advertising.
Michael Podhorzer, who directed the study for Citizen Action, said Blue Cross/Blue Shield administrative and marketing rates "fall between commercial policies and Medicare. Self-insurance by a firm is also more efficient."
He said these two types of insurance were left out because of a lack of certain types of information needed for the study.
According to Citizen Action, of the $14.9 billion that commercial insurance companies spent in administrative expenses, almost $7 billion went to salesmen's commissions, another $4.5 billion to employee salaries and benefits, almost $300 million to advertising, and more than $2 billion to general overhead.
In addition, Citizen Action said, the cost of identifying the low-risk groups to whom they want to sell and the enormous paperwork of servicing multiple policies with different types of benefits (instead of a government policy with the same benefits for all, for example) require large numbers of employees. All this could be saved, Citizen Action contends, if the nation moved to a national health insurance system.
The Health Insurance Association of America, representing private health insurance firms, criticized the study as a "misleading . . . siren song for national health insurance" because it did not average in the lower administrative-marketing costs of Blue Cross and self-insured firms.
"When these plans are factored in, 1988 administrative costs in the private sector drop to approximately 13 cents for each dollar in benefits paid," said spokesman Don White.
In addition, he said part of private insurance firms' administrative costs go to monitoring waste and averting unnecessary surgery and treatments by physicians, thus saving billions yearly.
Podhorzer noted, however, that the 13-cent cost is still about five times as high as Medicare administrative costs.
As for national health insurance, the Health Insurance Association said the "inability of both the administration and Congress to agree on a budget for the coming year" does not "inspire confidence" in the "efficiency of government-run programs."