Single-payer healthcare would save $450B and 68k lives a year: study • Hacker News Board

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#21

Post by mullingitover » Fri, Feb 21, 2020, 9:17 PM UTC

jays wrote: post #5

It’s hard not to appreciate the cost savings, saved lives, and benefits employees and employers would see from universal healthcare. Has anyone seen any studies on the potential impact it would have on insurance and medical administration industries? i.e. lost revenue, jobs, etc.?

> Has anyone seen any studies on the potential impact it would have on insurance and medical administration industries? i.e. lost revenue, jobs, etc.?

I wonder about this in the same way I wonder about a world where we have professional window breakers, and what effects it would have on the window repair industry if we stopped having people go around breaking windows.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#22

Post by Olscore » Fri, Feb 21, 2020, 9:18 PM UTC

Fundamentally, it is disgusting we are forced by government to buy insurance products (e.g., car, health) provided by for-profit companies; however, I do not support universal healthcare either. The government has zero ability to control its expenditure, because the electorate vote themselves benefits.

The long-term financial incentives to maintain a functioning society are all broken because of the misaligned short-term (vote for me, get free stuff) and long-term incentives (debt reduction, financial management, business planning and other investments.) Voters are simply looting the treasury at this point. It is a shame. I cannot believe anyone actually buys into the notion that government will fix problems, or somehow do a better job than what already exists.

The candidates are just handing you money from your own pockets, and skimming off the top.

It's so damn dumb.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#23

Post by markroseman » Fri, Feb 21, 2020, 9:18 PM UTC

mgraczyk wrote: post #7

In the study, nearly all the computed savings comes from two sources. 1. Decrease in pharmaceutical costs as a result of better bargaining power. 2. Decrease in administrative overhead, calculated by extrapolating the overhead in medicare to the entire US healthcare economy. I don't have an informed opinion on either of these estimates, but my intuition is that #1 seems reasonable while #2 seems unlikely. The justifi…

Lower administrative costs? In the US, doctors need at least one or two full-time admin staff to negotiate with a variety of insurance providers, argue for approval of every line item, etc. Here in Canada, I spend about 5-10 minutes per week dealing with all aspects of billing for my wife's medical practice.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#24

Post by deugtniet » Fri, Feb 21, 2020, 9:18 PM UTC

mgraczyk wrote: post #7

In the study, nearly all the computed savings comes from two sources. 1. Decrease in pharmaceutical costs as a result of better bargaining power. 2. Decrease in administrative overhead, calculated by extrapolating the overhead in medicare to the entire US healthcare economy. I don't have an informed opinion on either of these estimates, but my intuition is that #1 seems reasonable while #2 seems unlikely. The justifi…

All you need to do is look at the health care costs per citizen of other developed countries to understand that the US is paying way too much in their current healthcare system. I'm aware that the US's healthcare system is unique in many ways, but so are all the other countries on that list and they made it work.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#25

Post by anonsivalley652 » Fri, Feb 21, 2020, 9:18 PM UTC

mgraczyk wrote: post #7

In the study, nearly all the computed savings comes from two sources. 1. Decrease in pharmaceutical costs as a result of better bargaining power. 2. Decrease in administrative overhead, calculated by extrapolating the overhead in medicare to the entire US healthcare economy. I don't have an informed opinion on either of these estimates, but my intuition is that #1 seems reasonable while #2 seems unlikely. The justifi…

I watched a long-form interview with one of the PI's. They used very conservative estimates and didn't estimate additional savings and benefits from uncountable knock-on side-effects that would increase lives saved. M4A would save additional lives per year over double that of the ACA. That's a minimum additional twenty-three (23) 9/11's of people saved every year like clockwork while saving money on a net basis.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#26

Post by fjp » Fri, Feb 21, 2020, 9:19 PM UTC

three_seagrass wrote: post #13

threeseed wrote: post #8

Pretty disingenuous study. If you move to a Medicare for All policy it would shift employer health care costs to the government. Which they would never be able to financially support especially with the challenges of an ageing population and excessive debt. And so when they say it saves $450b it's not taxpayers. It's mostly employers. There is a reason that countries that started with M4A e.g. Australia, UK have all…

That's why the Medicare for all will still be funded, in part, through a business tax. The difference being you've removed the for-profit middlemen, so the healthcare costs are less for businesses than the privatized hybrid version we have now.

The important issue with Warren's "plan" is that it's essentially a $8,000 per year per employee head tax, so it's a regressive tax. An afterthought in the expense of hiring a very highly-paid employee, but a not-insignificant expense of hiring a lower-paid employee.

Not to mention that her plan exempts contractors and business under 50 employees, so it incentivizes businesses to to lean on contract labor or reorganize themselves into smaller sub-companies - a small paperwork expense in the scheme of things.

The business tax should be universal to stamp out avoidance and scaled to all payroll spend so it's at least not regressive, even if it's not a progressive tax.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#27

Post by fmakunbound » Fri, Feb 21, 2020, 9:19 PM UTC

Well there you have it, I guess. Thinking in the small, I wonder how it would have affected that Rabies shot treatment I had to get that ended up costing me $25,000 and the fucking thing wasn't even infected.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#28

Post by burkaman » Fri, Feb 21, 2020, 9:19 PM UTC

mgraczyk wrote: post #7

In the study, nearly all the computed savings comes from two sources. 1. Decrease in pharmaceutical costs as a result of better bargaining power. 2. Decrease in administrative overhead, calculated by extrapolating the overhead in medicare to the entire US healthcare economy. I don't have an informed opinion on either of these estimates, but my intuition is that #1 seems reasonable while #2 seems unlikely. The justifi…

> less incentive to investigate fraud

From the paper: "In addition to savings on overheads, a comprehensive database of health-care charges would facilitate detection of fraud, which extracts $85·7 billion every year. Following the transition to a single-payer system in Taiwan, an 8% reduction in overall national expenditure was attributed to the reduction in fraud. By moving from a fragmented health-care payment system to a unified system, irregularities in provider claims can be more easily detected. For example, under the fragmented system excessive claims for physician time can be spread across patients with several different insurance providers. However, acknowledging that improvements have been made in fraud detection since Taiwan's transition, we conservatively assume that the improved fraud detection would garner savings amounting to half that observed in Taiwan, corresponding to 4% of total health-care expenditure."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Aside from decreased executive pay and decreased fraud, many jobs will be eliminated.

From the paper: "Improvements in system efficiency, such as reductions in billing tasks, will involve a contraction of the workforce. Although the country will benefit from lower costs, 936 000 administrative positions and 746 600 positions in the health-care insurance industry are estimated to become redundant. However, detailed transition plans have suggested either funding for early retirement options, extensive severance, retraining programmes, and relocation expenses for all workers in these sectors. Implementation of such a plan is estimated to cost $61·5 billion annually over 2 years, a sum which would be recouped within the first year by the health-care savings estimated here."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#29

Post by ar-nelson » Fri, Feb 21, 2020, 9:19 PM UTC

newguy1234 wrote: post #15

What I don't get is how do 37 million Americans not have health insurance when the ACA was suppose to fix that issue? All of the plans are adjusted based on your income level and you get a tax credit if you are low income. If you are very poor then you get free healthcare....

When I was working as a software development contractor, I went without health insurance for a year. I'm young and I don't have any medical problems, so I could get away with this.

Because I'm a software developer and I make decent money, I didn't qualify for any tax credits or discounts. The cheapest health insurance plan that I could find cost twice as much as just paying both the ACA penalty and the Massachusetts state penalty. It made more financial sense to just go without insurance.

I can imagine that a lot of young software developers and other people who do contract work find themselves in similar situations.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#30

Post by macinjosh » Fri, Feb 21, 2020, 9:20 PM UTC

I am sure, on paper, it is a brilliant plan. Unfortunately, reality and human behavior almost never follow the plan.

Is waste, fraud, and abuse taken into account at all in this study? What about the inevitable changes to consumers' motivation, behavior, and decision making around healthcare? It will change drastically as the cost of their care is even further removed from them than it is now.

People who have a proclivity to go to the doctor too much will go even more when its 'free'. Younger people who eschew doctors because it interferes with their current lifestyle will feel even safer continuing bad health habits because free care will be there for them later in life.

Why should I subsidize other people's bad decision making?

EDIT: All healthcare is really too broad of category for government funding. Obvious things like cosmetic surgery and others are already excluded from consideration because they are not necessary. But IMO even when medical care is necessary I don't think it always falls into the category of something society should pay for. How many ER visits, ambulance rides, and surgeries a year can be attributed to purposeful recklessness by an individual? If someone decides it is a good idea to stand on a motorcycle's seat on the freeway and then crashes, why should the public pay for that? On the other hand people who have medical issues that are no fault of their own do deserve care.