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Single-payer healthcare would save $450B and 68k lives a year: study
251–260 of 407 posts
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#252Earlier quoted context omitted.
"any affects of changed consumer preferences if you eliminate copays and deductibles" I am curious on what you think are the effects.
More people will get the care they need than currently. Right now, there's a real dis-incentive to going to the doctor or to hospital for non-critical care/injuries.
And that's a good thing I would say.
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#253Earlier quoted context omitted.
Do you think they'll give me free health insurance as a 23 year old who lives with a parent? I don't have any interest paying a dime for health insurance because I could use that money to eat healthily instead and try to stay out of trouble. Otherwise, I'd starve or sacrifice my diet in order to afford the health insurance. It has never made sense to me.
You are risking bankrupting you and your parents for a single hospital visit. Friend had a heart arrhythmia scare at 28 years old. Lost consciousness, ambulance to ER, admitted and then stayed in hospital for three days. $67k in Billings that they negotiated down to about $50k. That’s why.
That's one of my fears indeed. But what if I have no job? Leaving my parent aside because there's no reason they should be legally liable to their adult child who lives their own life...they are going to have to enslave me or help me find a job if they ever want to see any of that bill paid. Otherwise, they could just kill me too, to repay my debt to the hospital with my life if that makes them happy.
Probably a very immature view on this, but still, I see no reason to sacrifice my health in terms of food and quality of life for health insurance. Won't that just increase the likelihood of me becoming sick and needing healthcare to begin with?
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#254Earlier quoted context omitted.
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…
Medicare billing isn’t any different, it’s just a different payer.
Medicare and Medicaid are different though.
The fee schedule and structure is much more defined, simpler, and easier to abide by. So much so that software can calculate it out of the box at the time of ordering. There isn't the negotiation and level of dispute handling that private insurance companies create in their profit-maximizing behavior.
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#255Earlier quoted context omitted.
In 2017 retail prescription drug expenditures were $333 billion, accounting for just 10% of total healthcare expenditures.[1] I realize prescription drug prices are insane, the patent regime is broken, and the industry is generally messed up. But at 10%, relying on lower cost prescription drugs to save the day isn't going to help. People feel it's a bigger issue than it is (relative to the overall problem), because i…
> those who want a public option or single-payer--willfully ignore the evidence. What you say is true about the public option, because it incentivizes insurance companies to dump expensive patients onto the public dole, while charging ever increasing premiums for those who either don’t need healthcare or are self-rationing because of things like co-pays or high-deductibles. Obamacare and Medicaid in tandem also don’t…
> It’s not true for single payer systems, who across the world pay less than what we pay in the US.
It's also not true for systems with public options, like Germany. You're making a hypothetical claim about the abstract economic incentives of a public option. But like many such economic arguments, without accounting for the technical realities these arguments have exceptionally poor predictive power.
The cost problem isn't about public or private. That much should be clear. Even domestically, if you look at the best run and widely loudly HMOs (e.g. Kaiser, Mayo), which also are more heavily burdened by low-income and sicker patients, their costs are still much greater than what optimists claim can be achieved.
Prescription drugs and administrative fees account for at worst 25% of expenditures. The real costs are in the practice of medicine in America: compensation, structure of surgical units, organization of hospitals, treatment recommendations, manufacturing industry, FDA regulations, etc. Single-payer doesn't address any of this directly--at best indirectly, and only if you're really optimistic. Obamacare reforms did try to address some of this (it's why it's gargantuan), but with mixed and often poor success. If you want to fix healthcare, it's these unsexy, complex, and hidden things that need to be addressed.
The debate over single-payer is a debate among armchair pundits, which often includes healthcare professionals. (Just like software programmers cargo cult poorly supported ideas about improving the software industry.) Maybe, after accounting for technical realities, an all-private, public option, or single-payer system may be marginally more efficient in the United States. But nobody is making such arguments. The debate is far too abstract, with unsupported, sweeping claims about comparative efficacy.
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#256In 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.
Back when I was a teenager my doctor was part of a four doctor practice. They had a nurse and one of the doctors wives handled everything else.
Compare with a doctors office today.
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#257Earlier quoted context omitted.
> Not sure what other arguments there are. The one I've heard the most lately is that "people like their existing insurance companies", which I think is an almost absurd thing to say on its face. But its probably just a way to say "people don't like change" that doesn't get insurance companies or "people" salty about it.
I've never heard that - I don't know anyone who likes their insurance company. I have heard some people say that in the current system that there might in theory be some competition, although in practice government rules mean that there isn't really much competition. Most people I've heard want to go the other way from single payer, and increase competition for insurers.
> I've never heard that - I don't know anyone who likes their insurance company.
I've never heard any normal citizen say that. I was mostly commenting on current politicians saying that to justify their stances. For example:
"One hundred sixty million people like their private insurance" - Joe Biden, Nov 21 2019
"You don't start out by saying I've got 160 million people I'm going to take away the insurance plan that they love." - Michael Bloomberg, Feb 19 2020
etc
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#258Earlier quoted context omitted.
>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.
There undoubtedly will be trade-offs. For example it'll be harder to exploit the working poor which is a very important benefit rich Americans rely on today. One side effect that might be popular on HN is entrepreneurship is less scary if the society you live in has promised it won't just let you die because you dared to strike out on your own rather than sticking close to the big corporation that provides affordable healthcare to its employees.
But your "bandwidth" analogy seems confused. What is "bandwidth" here? Because lots of American medical professionals seem to insist they spend a lot of effort on things that aren't healthcare - things which are unnecessary in single payer systems. If the US redirects all this healthcare "bandwidth" to actually delivering healthcare, that's a bunch of extra healthcare delivered, not just re-organizing who gets access.
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#259Earlier quoted context omitted.
i've done medical billing systems too and it is, indeed, crazy but what's make you think the gov. would be any better? I wrote a specialized service dealing with Medicaid in a handful of states and it was even worse than normal. The incompetence at Medicaid is dangerous. Formularies, eligibility, reimbursements changed randomly with reimbursement changes retroactive to some random date. I have zero faith in any part…
> i've done medical billing systems too and it is, indeed, crazy but what's make you think the gov. would be any better? Well, first of all, because there's no medical billing in M4A. It's free at point of service, so I'd hope they do better at billing considering they don't need to bill at all.
Billing is how the doctors and hospitals get paid.
If there is no billing, do they work for free?
Re: Single-payer healthcare would save $450B and 68k lives a year: study
#260What 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....
Do you think they'll give me free health insurance as a 23 year old who lives with a parent? I don't have any interest paying a dime for health insurance because I could use that money to eat healthily instead and try to stay out of trouble. Otherwise, I'd starve or sacrifice my diet in order to afford the health insurance. It has never made sense to me.
What happens whenyou get run over by a drunk driver? You don't get to choose when that happens, and there's little you can do to prevent it.