Review Article| Volume 45, ISSUE 1, P177-185, September 2011

The Impact of Health Care Reform on Surgery

      I recently had the opportunity to critique the 2010 Affordable Care Act (ACA) [
      • Trunkey D.
      Health care reform: what went wrong.
      ]. I documented that the 3 pillars of health care delivery—quality, cost, and access—were flawed in the old health care model. Unfortunately, the ACA does not adequately address these 3 issues. I also pointed out that cost is the number one problem, not quality. Cost is negatively affected by the bureaucracy of our health care system because of waste, fraud, and loss of value. The cost of the medical bureaucracy is staggering. In the United States, it is $1059 per capita per year. In contrast, in Canada it is $307. In the US health care system, administrative workers account for 27.3% of total health care costs. In Canada this figure is 3.1%. If the United States had a single-payer system, this would save $375 billion a year in health care costs according to a 2003 article in the New England Journal of Medicine [
      • Woolhandler S.
      • Campbell T.
      • Hummelstein D.H.
      Costs of health care administration in the United States.
      ]. The authors of this study estimated there are 1 million workers (specifically middlemen) who are doing unneeded work.
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