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

#121

Post by codegeek » Fri, Feb 21, 2020, 9:46 PM UTC

macinjosh wrote: post #30

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 procl…

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

You already are through record high premiums, deductibles and what not to private insurance companies. The problem is that those companies are in it to make money which means everything is inflated and not to mention the bullshit of in-network/out of network and fighting with billing/administration to get bills corrected. No. I am sick of that and I would gladly pay to subsidize other people's decision making because we all already are.

If you really don't want to pay for other people, then no insurance should exist and everything should be out of pocket straight. Free market baby. But not gonna happen in the US when it comes to healthcare.

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

#122

Post by pfarnsworth » Fri, Feb 21, 2020, 9:46 PM UTC

bduerst wrote: post #51

markroseman wrote: post #38

Earlier quoted context omitted.

Yes, in a properly functioning universal healthcare system, wait times for specialists can be longer for things that are less urgent. First priority is those with the most medical need, not whoever steps up to pay to play.

It's still comparable with the hybrid system in the U.S. too - i.e. outpatient surgery procedures can take months no matter which system.

I got an MRI within a day and CT scan within a day as well. I got an endoscopy within 5 days. My friend waited 4 months for her MRI to diagnose gallbladder stones. The same friend has to wait 2 years for autism therapy for their children. The waiting times for specialists in Canada are in the months. When I lived in Canada, it was practically impossible to find a GP in downtown Toronto that was taking new patients.

Yes, I didn't have to pay much for health care (I remember having a health care tax in Ontario) but it wasn't a bed of roses either. I'm a lot happier with Kaiser in California than any treatment I received in Canada.

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

#123

Post by dx87 » Fri, Feb 21, 2020, 9:46 PM UTC

elicash wrote: post #81

dx87 wrote: post #73

Earlier quoted context omitted.

My wife's aunt has been on disability for years because she hurt her back and refuses to quit smoking. The doctors said the smoking is preventing her back from healing correctly, and 3 back surgeries later, she still hasn't quit. Because she's poor and on disability, she doesn't have to pay for any of it, and is pefectly content sitting in her trailer watching TV and taking pain killers as her health deteriorates.

And you think if she wasn't allowed to either have private health insurance (which is subsidized by others with health insurance) or have government-paid insurance, that she would suddenly stop smoking?

I think she'll keep smoking as long as she doesn't face any repercussions for it. Right now, she keeps getting free medical care to fix anything wrong with her, so she has no incentive to get better. If she didn't have that, then she'd have to make the choice between continuing to smoke, or having to be immobile and in pain because she couldn't keep getting medication and surgery to mask the health problems she's bringing on herself.

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

#124

Post by refurb » Fri, Feb 21, 2020, 9:46 PM UTC

fernandotakai wrote: post #66

ameister14 wrote: post #36

Earlier quoted context omitted.

I don't believe he'd ban supplemental insurance, just insurance that covers the same services the State option covers.

but... why? i mean, if i can afford it, i would want private health care because it's usually less crowded and you can have stuff done a lot faster. for example: a friend of mine had to wait 6mo to do a vasectomy through our public health care system. another friend waited 2w to do his (through private health care) if you could afford it, wouldn't it be better to pay for it? for me (and maybe i'm completely in the wr…

Wow, someone with actual experience in a single payer system getting down voted for raising a concern.

Well done HN.

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

#125

Post by nthj » Fri, Feb 21, 2020, 9:46 PM UTC

onemoresoop wrote: post #108

pfarnsworth wrote: post #98

Earlier quoted context omitted.

I was in the hospital over Christmas because of a very severe infection. I was there for 2 weeks, and am lucky to be alive. The costs were over $150k, but I ended up paying $1500 in various deductibles to Kaiser, etc. I was happy to pay $1500 and am alive because of the care that I got. I pay about $6000 a year in medical insurance per year through my employer and it ended up being totally worth it. Not a few weeks p…

Yes, I know and that's why I am still paying. But seriously, we are paying for emergencies, this should be stated when paying for the insurance. Second, why were the costs $150000?

It’s right in the name. It’s called Insurance, not Healthcare as a Service.

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

#126

Post by briandear » Fri, Feb 21, 2020, 9:46 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…

This study however, doesn't seem to account for the dramatically increased usage of the system. If medical care were "free" -- the demand would quickly outstrip supply -- there's a real cost to that.

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

#127

Post by jkingsbery » Fri, Feb 21, 2020, 9:46 PM UTC

notatoad wrote: post #18

jkingsbery wrote: post #11

> "Furthermore, we estimate that ensuring health-care access for all Americans" From many anecdotes I've read about medicine in socialized countries, it's unwise to assume that having insurance is the same as access. Many procedures are made unavailable due to being considered cost effective by The Single Payer, and the wait time for specialists can often be long. Further, what counts as "costs" in US health industry…

>Many procedures are made unavailable due to being considered cost effective by The Single Payer whether the insurance is coming from a single payer or a private company, access to health care does not mean unrestricted access to any medical procedure you want. Private insurers also deny treatments that aren't considered to be cost effective.

I don't disagree with that. But if the medical industry has a certain amount of bandwidth, moving to a different organization for compensation won't increase access as the paper suggested, it will just re-organize who gets access. Maybe that is a good thing on the balance, but it seems like it will come without trade-offs.

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

#128

Post by aqme28 » Fri, Feb 21, 2020, 9:46 PM UTC

burkaman wrote: post #28

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 sys…

Is that saying that we could give 2 years of severance to all displaced insurance workers for less than what we would save in the first year? That's incredible, and a great argument against the cries for lost administrative jobs.

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

#129

Post by adamch » Fri, Feb 21, 2020, 9:47 PM UTC

ameister14 wrote: post #57

bduerst wrote: post #51

Earlier quoted context omitted.

It's still comparable with the hybrid system in the U.S. too - i.e. outpatient surgery procedures can take months no matter which system.

Perhaps, but I believe the averages are significantly lower in the US - Canada publishes theirs, you can check it.

Is this confounded by the number of Americans would _want_ treatment, but can't afford it or can't access it via their health insurance?

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

#130

Post by PeteLee-Us » Fri, Feb 21, 2020, 9:47 PM UTC

bduerst wrote: post #19

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 worked in the EMR software industry and have certifications that involve hospital & lab billing, among others. I've been on site with healthcare providers, and there are entire buildings full of people whose job it is just to code and scrub claims, and cover disputes/negotiations with private insurance providers. Consumers do not see it because it's typically off-site from the main hospital care facilities, but bel…

About 10 years ago, I was a freelance consultant for clinics, hospitals and insurance companies (EMR, billing, claims, practice management, etc.). I've also been a volunteer EMT for about 20 years and have many friends who are clinicians.

The amount of administrative overhead is just absurd: a common and believable number is about 15%. This does NOT include the "shadow labor" that everyday people have to deal with, like being on hold with a billing department or insurance company, the merry-go-round of "prior authorization hell" for procedures or prescriptions, etc.

It's TERRIBLE that someone like me--conversant in business practices, ICD/CPT codes, and clinical practice in general--struggles to interpret a bill. It's literally worse than buying a car.

I can make lots of choices in life, but one of them isn't health care: if I need it--especially urgently--I'm not in a position to game out every scenario possible to minimize costs because the ecosystem is non-transparent and labyrinthine.