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Why Single-Payer Health Care Saves Money

nytimes.com

31–40 of 206 posts

Re: Why Single-Payer Health Care Saves Money

#31
I personally think Medicare for all could potentially be a good system. But this article doesn't make a good argument at all.

> Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States.

Not a valid comparison. They literally give examples of three liberal states where there were cost concerns. And the response? It is not to compare to states where single payer actually worked, bit compare it to different countries with widely different budgets and levels of centralization from medical research, medical school to employment of doctors. Just not a valid comparison at all.

> It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.

Useless fluff statement

> By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement

How is this an "obvious " point? Need some justification for this very important point !

Hence this statement doesn't follow as the premise is not established

> Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue.

.

> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single-payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.

Finally, some relevant fact and justified points. These are good points in favor of single payer.

> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers

Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers? That would be such a strong point in favor of Medicare. I just don't think you can compare the entirety of the American healthcare system to other countries without controlling for the wide disparity in the systems as mentioned above.

> In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France

Sad reality but again this comparison is meaningless without controlling. Why not compare states with single payer with states that don't have it? Or why not compare Medicare bypass surgeries with those of private? If none of those support the argument for single payer, then at least control for the variables when comparing countries... Otherwise the comparison is just lazy (or worse, just narrative building ).

> In short, the evidence is clear that single-payer delivers quality care at significantly lower cost than the current American hybrid system. It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.

I agree with this point, I am willing to take a higher tax hit to support single payer but the tax question is not an irrelevant object at all!

Anyway, sorry if I sound bitter. I really want to see the US have a robust single payer system that respects it's ability to innovate with drugs and provide great healthcare to everyone. I just hope defenders of single payer (especially economics professors like the author ) can build a better case for it. I hope.

Re: Why Single-Payer Health Care Saves Money

#33

> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. That story needs to come with a caveat that Medicare's anti-fraud efforts are covered by law enforcement budgets, namely FBI https://news.google.com/news/search/section/q/medicare%20fra...

Anti-fraud enforcement is a tiny nit compared to the overall poor performance of US healthcare compared to other single payer nations. We pay roughly double per capita, cover fewer people (which means the people who do pay in our system are paying more than double), and have lagging health measures such as life expectancy and infant mortality rates (2-3x higher in the US!).

https://ourworldindata.org/the-link-between-life-expectancy-...

Anti-fraud measures can be evaluated for cost-benefit in isolation, but when the fundamental cost structures are so completely out of whack then we should prioritize discussion of the fundamental problems - which is lack of single payer universal healthcare in America.

Re: Why Single-Payer Health Care Saves Money

#34
post #6

A big part of this to is drs in places like Canada get training on how to save costs which generally means not providing service. I had to switch to a private system in Canada to get drs who would take a proactive approach.

It's also worth noting that more than a few Canadians come to the United States for treatment because they can either get treatment faster, or they can get treatments that aren't available in Canada.

I should point out here that this applies to serious illnesses. If you have a cold, the flu, or a broken bone, you're fine in Canada.

Re: Why Single-Payer Health Care Saves Money

#35
> "Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with."

Some taxes maybe? The whole "mandate vs. tax" argument was at the core of the opposition to the Affordable Care Act. I would argue that this issue is not decided by a long shot and a great deal of people are still upset by this.

Further, this article addresses aggregate costs but doesn't acknowledge that costs of the change to single payer will impact people in much different ways. Some folks will be asked to pay a lot MORE, and some will be asked to pay LESS, and it may settle out to be cheaper in aggregate, but cheaper to whom? These impacts (especially felt in the short term) need to be considered and mitigated.

Re: Why Single-Payer Health Care Saves Money

#36

> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. That story needs to come with a caveat that Medicare's anti-fraud efforts are covered by law enforcement budgets, namely FBI https://news.google.com/news/search/section/q/medicare%20fra...

Here's the other thing about administrative costs: Medicare's patients cost a lot more per person than private insurance.

In other words, if it costs you $500 in administration costs and one patient has care that totals $5,000 and another has care that totals $10,000, then their administrative costs are 10% and 20%.

And yet we think that if we shifted more people onto a Medicare-like system, we'd save money.

Re: Why Single-Payer Health Care Saves Money

#37

How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the bang for buck . In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer. http://www.who.int/healthinfo/paper30.pdf But there are single payer healthcare systems with bad heal…

This is a really good point. One problem I think though is that not everyone will come out ahead in a single payer system. Our system is explicitly organized around the fact that you must pay for care and we have the best and most expensive care in the world. Our system is setup so that those at the top of the economic ladder can buy a level of care they could not get anywhere else. They will undoubtedly receive worse care were the US to switch to a system which diminished the effect of personal wealth.

Re: Why Single-Payer Health Care Saves Money

#38

Earlier quoted context omitted.

> Americans will die needless deaths First off everyone dies. Who's not receiving healthcare right now that would be ultimately saved by the government? Secondly let's cut the hyperbole and have a rational conversation about this.

But not everyone dies a needless death, which was his point. It is not irrational to point out the cost of ongoing debate.

> In the meantime, Americans will die needless deaths from not receiving basic healthcare

No, it's the typical appeal to emotion nonsense that got the ACA passed to begin with. Now that's going to fail before it's even completely applied.

Re: Why Single-Payer Health Care Saves Money

#39

How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the bang for buck . In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer. http://www.who.int/healthinfo/paper30.pdf But there are single payer healthcare systems with bad heal…

This simplification seems disingenuous. Would switching to single payer solve your last sentence / quote from the article? Aka, would putting the US government in the middle make things simpler and more efficient (and cheaper) for the end user (health care patients)? I can't say I'm convinced.

Compare with the current system, where any given user is still effectively dealing with a single payer -- their insurance provider. Their insurance provider is one level of removal from the health system that has to be paid.

Now, the idea of transparency? That's lovely, and would force accountability and that sort of thing which could potentially have impact. I can't disagree with that. I'm not sure that just putting the government in the middle fixes that either, though.

As /u/frgtpsswrdlame points out, we have the most expensive health care, which seems like the bigger issue that isn't addressed. If we lessened the cost of health care in the US, that would probably be a better start, imo. Does single payer fix that? I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate, but perhaps I've got that backwards.

I'm not disagreeing with the thought on the whole, I just don't see how single payer fixes these problems.

Re: Why Single-Payer Health Care Saves Money

#40
post #9

I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach. With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see i…

> a truly free market health care system would be substantially cheaper Why would you imagine that? Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical.

It's a fun thought experiment, but we'd never do it.

A free market would look something like this:

1) everybody buys their own insurance in a genuinely free marketplace (this is ENTIRELY not the case now and would probably require significant gov intervention to defeat cartel-seeking behavior from insurance co's. There are good reasons insurance is so highly regulated, only the first of which is that insurance companies are highly incentivized to not pay out since they already have your money, and you can't go elsewhere with your claim.)

2) if you can't pay, you die in the gutter.

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