A Priceless Answer

To justify sounding a false alarm that doctors’ opposition will torpedo single-payer health-care reform, Mike Konczal turns to a Koch-brothers-funded analysis that claims Medicare for All would either slash doctors’ income and hospital funding or break the bank [“The Score: $5 Trillion Questions,” May 13].

Konczal credulously adopts the Koch study’s underestimate of single-payer savings on insurance overhead. But more important, he (like that study) ignores overwhelming evidence that single-payer would save doctors and hospitals vast amounts on billing, insurance paperwork, and other wasteful tasks that are required by the current byzantine payment system but would be eliminated under single-payer. For instance, a recent Harvard Business School and Duke University study published in the Journal of the American Medical Association found that the average primary-care doctor at an efficient group practice spent $99,581 (and 243 hours) annually on billing. That’s four times what Canadian doctors spend interacting with insurers.

The $75,000 savings in per-doctor billing costs means doctors’ take-home pay could be stable even if their per-patient revenue goes down. It also means they could use the time they currently spend jousting with insurers to deliver (and bill for) more care.

A similar calculus applies to hospitals. At a six-hospital system in Toronto, the equivalent of just 5.5 full-time employees handle all insurance billing and patient collections. A comparable hospital system in the US employs more than 200 people for those tasks. US hospitals spend one-quarter of their budgets on administration, versus 12 percent in Canada. Streamlining hospital administration by paying hospitals global budgets (the way we currently pay fire departments and Canada pays hospitals) would produce major savings, freeing up vast resources for care. Indiscriminately slashing hospital budgets, by contrast, would be neither necessary nor desirable under Medicare for All reform—and the House and Senate bills propose no such thing.

All told, single-payer could save doctors and hospitals about $225 billion annually on billing and bureaucratic costs (in addition to about $220 billion saved on insurance overhead and tens of billions more from streamlining the billing for nursing homes, home-care agencies, etc., and by lowering drug prices), offsetting the costs of providing first-dollar comprehensive coverage to everyone in the nation. Even though Konczal doesn’t understand that, most doctors do. That (and altruism) explains why single-payer is now doctors’ favorite health-care-reform option and 23,000 have joined Physicians for a National Health Program.

David U. Himmelstein, MD
Physicians for a National Health Program

new york city

Steffie Woolhandler, MD, MPH
Physicians for a National Health Program

new york city

Adam Gaffney, MD, MPH
Physicians for a National Health Program



On the Record

Kudos to The Nation for publishing Mark Hertsgaard and Kyle Pope’s article about the failure of the media to report on the threats of climate change [“Fixing the Media’s Climate Failure,” May 6]. They do a masterly job of reviewing the problems with reporting, the history of nonreporting, and how the media can overcome the resistance to sharing with the public that most important information that will affect all of us. Well done.

Len Frenkel
south portland, me.


I fully agree with the analysis of “Fixing the Media’s Climate Failure,” but I have a different take on fixing priorities, which involves changes in the message, messenger, target audience, and context.

Changing the message: The climate threat is more serious than widely portrayed, even by the Intergovernmental Panel on Climate Change, if we consider thawing Arctic ice and tundra that will increasingly release huge amounts of methane and CO2. We should not abandon hope, but this broader message increases the urgency to abandon fossil fuels.

Changing the messenger: It’s time to give more attention to the many collective statements by scientists, which could be publicized by an annual top-10 list of climate-related reports. Books by single authors are useful, but authoritative online reports with readable summaries pack more punch.

Expanding the target audience: Beyond urging journalists to learn the science, key publications should expand their coverage. For instance, The New York Times should begin a weekly sustainability section; Time magazine could include at least one or two green leaders in its annual roundup of the 100 most influential leaders.

Regarding context: Climate change should be seen as part of a larger global environmental emergency caused by pollution and human populations displacing and despoiling flora and fauna. Climate warming aggravates negative trends in the oceans, our landscapes, and biodiversity, but it is not the only cause of these trends. Even if warming is halted, which is very unlikely, these other damaging forces will continue. Thus, more attention needs to be given by the media to the United Nation’s 17 Sustainable Development Goals. Climate change must also be seen as an increasingly essential part of thinking about national and global security.

Today’s wicked problems will not be solved but can be alleviated. Similarly, the media’s climate failure will not be fixed but requires constant pressures on many fronts.

Michael Marien
lafayette, n.y.


Corrections and Clarifications

In “A Republic of Readers” [April 29], Marc Cooper writes that Mexicans spend about five hours a day reading, just a few minutes per day less than readers in the United States. However, both figures, according to a 2005 study, should refer to the number of hours people in each country spend reading per week. We regret the error.

Also in “A Republic of Readers,” Cooper writes that the Mexican government reportedly shot 26 student activists in the Tlatelolco massacre of 1968. This figure, which is the official government tally, should have been framed as a minimum; the actual death toll is believed to have been significantly higher.

Due to an editing error, the penultimate sentence of Katha Pollitt’s column “Harvard’s Strike at 50” [May 20/27] says that Harvard “hasn’t been reluctant to meet student demands about fossil-fuel divestment.” The university has been reluctant to meet student demands. We regret the error.