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Why Single-Payer Health Care Saves Money

nytimes.com

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Re: Why Single-Payer Health Care Saves Money

#41

Post by prostoalex »

dv_dt wrote: post #33
prostoalex wrote: post #2

> 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…

> infant mortality rates (2-3x higher in the US!).

https://www.theatlantic.com/health/archive/2014/10/why-ameri...

"The researchers compared data on infant health and mortality in the U.S.; Austria, whose rate of 3.8 is roughly average among European nations; and Finland, whose rate of 2.3 is one of the lowest in the world. One of the biggest differences, they found, was in the definition of what could be considered a live birth. “Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries,” they wrote. Although the chance of survival for babies born before 23 weeks is low (the American Academy of Pediatrics recommends that doctors don’t resuscitate babies born before that point), they’re recorded as live births in the U.S."

Re: Why Single-Payer Health Care Saves Money

#42

Post by hirsin »

tvchurch wrote: post #36
prostoalex wrote: post #2

> 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.

I've always read that the problem with Medicare is that it's unfair to hospitals because they pay lower than the average rate (but can't negotiate on medicine). Do the savings from lower care costs not balance out the higher drug costs? (From a steady state of 1 surgery can lead to a lifetime of drugs, I'd guess the balance isn't great)

Re: Why Single-Payer Health Care Saves Money

#43

Post by davidw »

shortstuffsushi wrote: post #39
galeaspablo wrote: post #20

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 pro…

I lived in Italy for a number of years, and the Italian government is no nordic model of efficiency and propriety. And the health care system is still mostly better than in the US :-/

You're right that costs need containing though, and it's not quite as simply as "just" switching to a singly payer system.

Re: Why Single-Payer Health Care Saves Money

#44

Post by warcher »

warcher wrote: post #40
ravitation wrote: post #13

Earlier quoted context omitted.

> 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 compan…

Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"

Re: Why Single-Payer Health Care Saves Money

#45

Post by learc83 »

frgtpsswrdlame wrote: post #37
galeaspablo wrote: post #20

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 wors…

>They will undoubtably receive worse care were the US to switch healthcare systems.

If the US switches to mostly single payer, but still allows for private insurance and private doctors to exist, the wealthy will probably have to pay more to access them, but they'll still be able to access them.

Re: Why Single-Payer Health Care Saves Money

#46

Post by galeaspablo »

frgtpsswrdlame wrote: post #37
galeaspablo wrote: post #20

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 wors…

That is conjecture. I could similarly hypothesize that things would improve under a single payer system, even for the rich... because of the compounding scientific advances of government backed healthcare.

BUT we could go back and forth all day with conjecture... Give me some apples to apples numbers; that's what I joined HN for.

Re: Why Single-Payer Health Care Saves Money

#47

Post by wolco »

fleitz wrote: 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.

Not sure why the downvote there is a lot of truth in his statement. Everyone gets access to healthcare on one end which is good but on the other end newer meds are denied because of costs. On average doctors are trying to reduce the number of patients they serve so there is always a feeling like they are doing you a favor by even seeing you. Other little things you don't expect like it's very hard to get a second opinion.

I have no idea how life is when you rely on an insurance company to approve of your level of care. That sounds like a nightmare.

Wish there was something in the middle where you paid a little bit but had choice.

Re: Why Single-Payer Health Care Saves Money

#48

Post by asah »

frgtpsswrdlame wrote: post #37
galeaspablo wrote: post #20

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 wors…

Actually, the 1% would have private healthcare, i.e. pay twice.

This is directly analogous to private primary education: the wealthy still pay taxes to fund public schools, while paying addition for private schools as well.

Re: Why Single-Payer Health Care Saves Money

#49

Post by jefurii »

tvchurch wrote: post #36
prostoalex wrote: post #2

> 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.

Medicare patients are more expensive because of who it currently covers: elderly and disabled people, two groups that use more services than the general population. The whole point of a single payer AKA Medicare for all system is to cover the entire population, which would (because math) bring down the average cost per person.

Re: Why Single-Payer Health Care Saves Money

#50

Post by hirsin »

larrywright wrote: post #34
larrywright wrote: post #29

Earlier quoted context omitted.

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.

What are the odds they're traveling to the same hospitals that Americans travel to when they're seriously ill? I doubt that Canadians are hopping the border to go to Montana's hospital system - they're more likely going to the Cleveland Clinic just like someone from Texas would.
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