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

#281

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

sjg007 wrote: post #249

beat wrote: post #149

Earlier quoted context omitted.

This is where I think political leaders (Democrat or Republican) could do really well. It's not just making sure people are covered. It's the existential dread of dealing with opaque, unpredictable, and incomprehensible bureaucracy that can make life-and-death decisions or drop financially crippling bills in your lap, even if you have good insurance . The American health care system isn't just bad for the poor. It's…

One problem is that a bunch of folks have gold platinum private insurance. Things like $0 copays, no co-insurance etc... A lot of that was union negotiated. Some high end jobs have similar perks. Regular rank and file workers use to have HMOs but those plans have given way to HSAs and PPOs. PPOs were advertised as doctor choice but that's really misleading, all they really do is increase your out of pocket. For a con…

I'm on a PPO right now, new to me this year, and it's great. I have a chronic condition that requires surgery about three times a year, so I'm used to just maxing out my costs. There are two levels of the surgery, and the higher level is full general anesthesia, with all that entails.

In practice, it was less expensive out of pocket for the intensive surgery (a bit over $1000) than it was two months ago for the low-intensity local anesthesia surgery ($1300), even though the initial bill was over twice as high.

At any rate, because of my chronic condition, I'm very sensitive to costs. I'll take the good insurance, thank you!

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

#282

Post by usaar333 » Fri, Feb 21, 2020, 10:54 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…

Are admin issues guaranteed to be better under a single payer system? Don't people run into all sorts of problems with Medicare - what it will pay vs. what it won't?

I give you though that at least it is one set of admin rules than N.. which might be better.

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

#283

Post by BurningFrog » Fri, Feb 21, 2020, 10:54 PM UTC

mochomocha wrote: post #64

bduerst wrote: post #19

Earlier 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…

I once worked at a US biotech startup getting paid by insurers where we would build ML models just to reverse-engineer the inconsistencies of CPT coding & claim reimbursement by insurers & hospitals so we could get paid. Basically trying to automate "learn that Karen at insurer X processing claims wiht code Y from hospital Z usually decides to reimburse $XX". This whole idea of "free market is more efficient for heal…

> * This whole idea of "free market is more efficient for healthcare" has to die*

The current US healthcare system has very little to do with "free markets"!

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

#284

Post by codegeek » Fri, Feb 21, 2020, 10:55 PM UTC

A4ET8a8uTh0 wrote: post #261

codegeek wrote: post #148

Earlier quoted context omitted.

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…

Holy crap. I am in the process of "fighting" with insurance over meds we paid out of pocket even though they were supposed to cover it.. long story. We thought we hit a wall and we contacted one of the enforcement agencies. All of a sudden, we get an individual refund form and a place to mail it to. The amount was not astronomical ($1.5k), but not something I can just ignore. And that happens all over the country. No…

yep. Dont even get me started on how many times I had to fight with the insurance/billing/admin departments to even understand why I received a bill and for what. They must have a team of smart cryptographers to generate those crazy bills and invoices /s

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

#285

Post by codegeek » Fri, Feb 21, 2020, 10:56 PM UTC

usaar333 wrote: post #282

codegeek wrote: post #148

Earlier quoted context omitted.

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…

Are admin issues guaranteed to be better under a single payer system? Don't people run into all sorts of problems with Medicare - what it will pay vs. what it won't? I give you though that at least it is one set of admin rules than N.. which might be better.

definitely not guaranteed. But I am so sick of status quo that I am willing to try ANYTHINg different. It just happens to be Single payer option at the moment.

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

#286

Post by beat » Fri, Feb 21, 2020, 10:56 PM UTC

codegeek wrote: post #220

beat wrote: post #149

Earlier quoted context omitted.

This is where I think political leaders (Democrat or Republican) could do really well. It's not just making sure people are covered. It's the existential dread of dealing with opaque, unpredictable, and incomprehensible bureaucracy that can make life-and-death decisions or drop financially crippling bills in your lap, even if you have good insurance . The American health care system isn't just bad for the poor. It's…

"isn't just bad for the poor. It's bad for everyone" Thank you for saying that. I am amazed at how so many people don't see and understand this. It is not just about Cost which is insane alright. It is about the BS we have to go through after a visit to a doctor or hospital. I am scared about the type of bills and claim fights I have to do if I visit a doc. Not because I cannot afford it necessarily. But because I ha…

I went through a billing/process dispute with a provider last year after a change in their process led to a 30x increase in out-of-pocket costs for necessary treatment. It ended with them flatly lying to me that the changes were for my "safety". When I first dealt with all the new process, I asked my doctor why they were doing it, and he said "I think they just want to charge more money".

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

#287

Post by PaulDavisThe1st » Fri, Feb 21, 2020, 10:56 PM UTC

wahern wrote: post #255

claudeganon wrote: post #206

Earlier quoted context omitted.

> 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…

> 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.

THIS. I don't know why this isn't being said more openly, more often and more widely. It's absolutely the crux of the matter. Yes, it will be great if we get M4A or somethng similar, but it's not going to solve the cost issues, which are bigger (or under any conditions, at least as substantive) than the insurance system itself.

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

#288

Post by aaavl2821 » Fri, Feb 21, 2020, 10:56 PM UTC

wahern wrote: post #160

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…

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…

I agree, so many of these studies are not very high quality, and there is so much money behind the scenes trying to push agendas -- between pharma lobbies, hospital lobbies, payer lobbies, and politicians capitalizing on public anger at pharma and high healthcare costs in general -- that most of what we read seems to reflect political agendas more than facts

Many drug prices are too high but 80% of rx in the US are generic, and US is middle of the pack in terms of drug spend as a percent of HC spend compared to OECD countries

Drug prices "feel" higher bc copays are higher for drugs than office / hospital visits. If the goal is to reduce actual costs rather than perceived costs, we should look at hospital and provider costs, not just drug costs. But hospitals are huge employers with lots of political power, not to mention large lobbying budgets

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

#289

Post by usaar333 » Fri, Feb 21, 2020, 10:56 PM UTC

beat wrote: post #149

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…

This is where I think political leaders (Democrat or Republican) could do really well. It's not just making sure people are covered. It's the existential dread of dealing with opaque, unpredictable, and incomprehensible bureaucracy that can make life-and-death decisions or drop financially crippling bills in your lap, even if you have good insurance . The American health care system isn't just bad for the poor. It's…

> We just can't deal with it, because we are exposed directly to unnecessary complexity.

I'd argue though that those best adept at handling the complexity are actually winning in this model. If you are reasonably healthy already and can navigate HDHP/HSA rules, you can have a much higher take-home income + savings than in other countries with government run healthcare systems.

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

#290

Post by andymockli » Fri, Feb 21, 2020, 10:57 PM UTC

james-mcelwain wrote: post #227

chasd00 wrote: post #118

Earlier 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.

Medicare requires billing, but Medicare 4 All does not require billing?