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Hi Merrill:

Do you remember Donald Berwick? I believe his position was the head of CMS. A departing (?) comment of his was "30% of healthcare is waste." IOM: "IOM report identified six major areas of waste: unnecessary services, inefficient delivery of care, excess administrative costs, inflated prices, prevention failures, and fraud." Donald was talking about such since 2012 (JAMA) and probably longer.

As you have pointed out the costs of healthcare have hovered around 17% of GDP for a good time now except with the recent pandemic when the economy decreased. A growing economy pays for the increase in prices and vice versa. Not that we should ignore the growing prices, much of which could be avoided. EpiPens come to mind. My scrapping out of millions of old pills comes to mind, The cost of doing so being a few $thousand as compared to a much higher sales price.

Single payer experience Kip Sullivan and I talk about the costs of going to Single Payer to which Bernie misses two of the four elements necessary. One the saves is in the an actual single payer system which reduces administrative costs of about 15-20% due to the many insurance plans and the inputs needed.

McKinsey is a big fan of whacking Labor when the real direct labor cost in manufacturing is the smallest component. Overhead and materials have a greater cost and in that order. Gonna stop here as the topic is far bigger than my comment. I mostly agree with you. One quick comment and then I am out of here. I had four doses of Rituxan a couple of years ago. List was ~$28,000. Medicare paid in the single digits of $thousands. Find a new use for it and the ICER will justify its pricing and patents are forthcoming.

Nice read.

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