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

#271

Post by sjg007 » Fri, Feb 21, 2020, 10:44 PM UTC

rayiner wrote: post #210

codegeek wrote: post #178

Earlier quoted context omitted.

Yes but at least, Govt. is not looking to make record profits.

No, but government has strong incentives to deny claims to control costs. At least at the state level, governments have gotten extremely aggressive about money collection. E.g. $50 administrative fee for not paying a $4.00 toll.

This is not a thing and if it ever became a thing it would be challenged in the courts. What is covered is all determined by the CMS and the medical associations. I would imagine some red states would try to do it. But to deny claims for cost control would be akin to the "experimental" treatment BS that insurance companies try to do. Insurers who deny for cost control reasons get hammered in the courts.

In fact medicare/medicaid have an even better mechanism to route out fraud. They can jail the medical provider for doing so.

Your last claim about fees for collecting tolls is unrelated.

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

#272

Post by ianleeclark » Fri, Feb 21, 2020, 10:44 PM UTC

dcolkitt wrote: post #92

> Employer contributions to health insurance currently average $10446 per employee and cover 71% of a household’s premium. These employer premiums are equivalent to a 12.29% tax on payroll exceeding the first $2 million... Therefore, any payroll tax less than 12.29%, our upper bound in the SHIFT interface, would result in savings for employers. This excerpt makes it glaringly obvious that no economists were consulted…

> In response that means those employers will lower their demand for labor, which results in either both economy-wide reductions in employment, wages and ultimately investment and GDP.

Unless there's another equilibrium at the new demand which neither you nor I can state that there is or isn't.

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

#273

Post by TurkishPoptart » Fri, Feb 21, 2020, 10:44 PM UTC

paulirwin wrote: post #245

apta wrote: post #161

Earlier quoted context omitted.

> And on top of it I get a better deal if I use no insurance at all for prescriptions. Interesting. So is it also the case that you can "negotiate" medicine prices? Is the actual price then different from what is on the tag?

I'm sure I'm not 100% accurate on the numbers here because I don't feel like finding the receipts, but close enough. Here's another anecdote from the US. My dog has a pulmonary condition that requires him to take Sildenafil daily (yes, generic Viagra). We got the prescription filled at a local pharmacy for a 90 count, they charged us something around $280 for. We were not expecting that high of a prescription, for a…

Yes, IIRC there was a thread talking about this GoodRX thing. When I was uninsured, it brought the price for a month's supply of generic Singulair from ~$60 to ~$9. Very convenient for me, but where does that money come from? Does GoodRX get paid for that data, that I'm a 30-yo man in x-state who needs x-medicine? Very sketchy.

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

#274

Post by throwawayhhakdl » Fri, Feb 21, 2020, 10:47 PM UTC

mullingitover wrote: post #21

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.

New Jersey gas pumpers seem like a close approximation here. They provide a legally mandated service which I find makes my day worse.

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

#275

Post by tialaramex » Fri, Feb 21, 2020, 10:50 PM UTC

cotillion wrote: post #44

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…

I live in a universal health care country. I also had a private health insurance thru my employer which guaranteed specialist care within a certain time. The universal health care means that the extra insurance was not very expensive at all since it only covered the speedy access part. If you have money capitalism will always ensure you have speedy access to healthcare.

In Britain part of the reason it's cheaper is that the public system handles everything that goes wrong. So private healthcare is only doing routine stuff even though that's the cheap bit.

When a patient in the operating theatre at the boutique private hospital collapses or stops breathing or whatever, they don't have an in-house team to fix that, they'll deliver first aid (admittedly they'll be better at it than a lay person who took a two day course months ago) until the public system's ambulance takes the (likely unconscious) patient to a public hospital's emergency reception which can take proper care of them. Many of the doctors are the same people but even if the private hospital had the right people, and the right equipment it doesn't want the liability.

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

#276

Post by meheleventyone » Fri, Feb 21, 2020, 10:51 PM UTC

codegeek wrote: post #148

onemoresoop wrote: post #79

I'm paying nearly 20k (parents+child) on insurance I don't have time to use (and luckily no serious need) and once my son went to see his pediatrician and our 'private' insurance company (that i'm not going to name) sent us bill of $500, for a check-up. We disputed the charge with the insurance and they agreed to wave the payment next month. Next month comes and guess what? The same letter comes in mail. We disputed…

For a family of 4, I pay total of about 20K per year as well (employer + employee cost) and even after that, we have a $5000 deductible AND on top, we have to be concerned about in-network/out of network bullshit. So for me, unless $25,000 has been spent, insurance company would not even come in the picture AND I am always scared if I wil get a bill that was out of network. This madness has to end and I don't give a…

The seemingly (to me) crazy thing is that private insurance in places with single payer healthcare aren’t like this at all. Our entire insurance bill for everything from healthcare to house insurance for a family of four is less than a quarter of that. There’s even pretty affordable private GP clinics where I’d never even think about using my insurance.

It’s reasonably common to have private healthcare insurance for unexpected events even in places with national health services. I’ve had it variously through work, unions and now as a private individual. Typically you want it to make up the difference between the level of provided state support and what you’d lose by not working.

Personally I’d rather than private insurance and healthcare industry wasn’t necessary but the American debate seems polarised into either/or rather than realising that it’s very common for private healthcare to coexist and be part of nationalised healthcare systems.

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

#277

Post by BurningFrog » Fri, Feb 21, 2020, 10:51 PM UTC

onemoresoop wrote: post #79

I'm paying nearly 20k (parents+child) on insurance I don't have time to use (and luckily no serious need) and once my son went to see his pediatrician and our 'private' insurance company (that i'm not going to name) sent us bill of $500, for a check-up. We disputed the charge with the insurance and they agreed to wave the payment next month. Next month comes and guess what? The same letter comes in mail. We disputed…

The trap to be aware of here is that the fact that the current system sucks is no guarantee that any proposed alternative will be better.

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

#278

Post by aaavl2821 » Fri, Feb 21, 2020, 10:51 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…

Does the study also look at lower provider and hospital costs? Spending on hospital and providers makes up ~50% of US healthcare spend according to CDC. Rx spend is between 10-20% and admin overhead is 30% or so

I wonder why this paper didn't contemplate effect of Medicare for all on hospital and provider spend?

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

#279

Post by noodle » Fri, Feb 21, 2020, 10:52 PM UTC

AcerbicZero wrote: post #202

noodle wrote: post #94

Earlier 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 don't know if I could say I "liked" my insurance company, but I can say with a great deal of certainty that my interactions with my insurance company are orders of magnitude more frustration free (enjoyable seemed like too much of a stretch) than any of my mandatory interactions with State/Federal government. My worst interaction with an insurance company in my entire adult life was being billed in an annoying fash…

> I don't know if I could say I "liked" my insurance company, but I can say with a great deal of certainty that my interactions with my insurance company are orders of magnitude more frustration free (enjoyable seemed like too much of a stretch) than any of my mandatory interactions with State/Federal government.

I think I'd suggest that you ask around your social circle to see if you're the outlier or the standard with your experience. Particularly if you've never had a major unplanned life event that resulted in a large medical bill.

I feel like, at least for me, I'd rather have a system that has a constant amount of low grade frustration in it; instead of a system that is smooth sailing while you're healthy and paying, but will throw you under the bus when you actually need them.

> My worst interaction with an insurance company in my entire adult life was being billed in an annoying fashion and having to sit on hold for half an hour to get it fixed. Compared to just my last trip to the DMV the insurance company is already pretty far ahead.

My worst interaction was watching a family member of mine begin to actively die and then pass away a few months after insurance decided to stop covering their primary medication - which was literally keeping their disease at bay, keeping them alive. It was too expensive to cover without the insurance.

> While I lean strongly libertarian, I'm pragmatic enough to understand the current half commie, half free market health care system is entirely untenable, and I seriously doubt it will be acceptable to move in the free market direction anytime soon.

I'm actually shocked that more libertarians don't take this view. Healthcare is almost by definition not a free market and never will be. You can't make a rational purchasing decision when both parties know the possible outcome of not buying is your literal death (amongst other similar reasons). It's an outlier in the business space that needs special considerations (IMO).

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

#280

Post by herbstein » Fri, Feb 21, 2020, 10:53 PM UTC

koolba wrote: post #173

Loughla wrote: post #61

Earlier quoted context omitted.

Real question, not snarky: Why is this sort of downsizing always wrong for white-collar workers when blue-collar workers have been dealing with it for decades?

There’s a huge difference between downsizing caused by economic forces of the private sector and downsizing caused by outright elimination of an industry by elected officials.

But that line is massively blurred when said downsizing of blue collar workers is a direct (and known) result of free trade agreements made by elected officials. You're adding one step to the chain, but the chain is still there.