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

#341

Post by DanBC » Sat, Feb 22, 2020, 12:06 AM UTC

dx87 wrote: post #101

Loughla wrote: post #45

Earlier quoted context omitted.

That's what I've never understood about the arguments against single payer: >You can't pick your own doctor I already can't. If they're in network, I'm good, but if they're out of network - like my doctor was - then I have to find a new one. >You can't pick your treatments My spouse was denied medication by an insurance company because it was too new. So. >You don't get to have all the healthcare you want I already h…

I know it's an edge case, but there was that kid in the UK with an easily fixable, but fatal, heart condition. Their health association refused to pay for it because no doctors in the UK knew how to perform the surgery, and they weren't willing to pay for them fly to the USA where there were specialists who could do the surgery. After they started a GoFundMe to pay for the surgery themselves, and there was a lot of p…

There can be long waits for GP appointments. This is because the government has chosen to underfund the NHS.

But in England if you need same day medical care you call 111 to talk to a healthcare professional, or you walk into your nearest pharmacy to talk to the pharmacist, or you visit your local walk-in medical centre to see a GP, or if it's something a GP can see as an emergency you call your GP and make an emergency appointment.

If it's more serious you visit your local MIIU (minor injuries and illness unit), or UTC (urgent treatment centre) or A&E, or you call 999 or 112 for an ambo.

> but there was that kid in the UK with an easily fixable, but fatal, heart condition

Do you know the name of the child? Because every single time someone mentions one of these cases they're going by information they've read in US media, and the details are always wrong.

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

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Post by fzeroracer » Sat, Feb 22, 2020, 12:07 AM UTC

dx87 wrote: post #123

elicash wrote: post #81

Earlier quoted context omitted.

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 bri…

Speaking as someone who has parents whom smoke a lot, I think you don't understand the mentality of smokers or the addictive behavior of smoking.

Nothing is going to stop her from quitting smoking, even if she was denied pain medication or surgery. They'd find other ways to numb the pain and just walk straight into an early grave.

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

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Post by Gibbon1 » Sat, Feb 22, 2020, 12:22 AM UTC

codegeek wrote: post #327

pw wrote: post #250

Earlier quoted context omitted.

What problems have you had with the current system?

Many problems. - Every visit to a doctor is a game of cat and mouse. I am never sure what bill to expect and how many bills to expect. - Price is always inflated due to the fact that insurance company has to make money on every visit to the doctor. - Every visit requires a Claim. Claims get filed incorrectly. Fun and games trying to call a bunch of different "departments" trying to understand the claim and why am I b…

Two other problematic things.

- Doctors have no idea how much anything costs.

- Pricing has nothing/little to do with the actual cost of providing a service.

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

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Post by maxerickson » Sat, Feb 22, 2020, 12:32 AM UTC

joe_the_user wrote: post #318

BurningFrog wrote: post #283

Earlier quoted context omitted.

> * 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"!

"The current US healthcare system has very little to do with 'free markets'!" Sure, the US health care system is certainly not governed by wide open competition, transparent pricing or similar things. But it certainly has something to do with the "free markets". The system is basically "what you get when you realize you have to insure and regulate but you never, ever do it in a centralized rational way, 'cause that w…

Medicine changed so much after ~1880 (or maybe ~1900) that there's little to learn from the prior era.

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

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Post by chrisdhoover » Sat, Feb 22, 2020, 12:34 AM 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…

You realize the market is highly regulated and fully captured by the insurance companies? Not to mention the doctors guild that limits practitioners. The current system is not a free market. It is highly distorted and gamed.

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

#346

Post by sjg007 » Sat, Feb 22, 2020, 12:41 AM UTC

beat wrote: post #281

sjg007 wrote: post #249

Earlier quoted context omitted.

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-i…

I am curious, why does the PPO make a difference here? Is it vs the HSA or vs HMO or in network? Is your provider in network?

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

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Post by TuringNYC » Sat, Feb 22, 2020, 12:45 AM 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…

My friends hired a consultant to reconcile pregnancy related bills coming from all angles from a half dozen entities. The consultant corrected things from over $17,000 to “only” four figures of copays and balance billing.

That is nuts. The fact that a consultant with expertise in this “skill” exists and is required is also a sign of a supremely broken system.

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

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Post by tzs » Sat, Feb 22, 2020, 12:50 AM UTC

BurningFrog wrote: post #277

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.

You could put on a blindfold and then throw a dart at a map of the of first world countries, and if we just adopted whatever system is used where that dart lands it almost certainly would be a big improvement.

If making a better health care system was a problem that everyone else sucked at also then I'd be more inclined to worry that trying to improve ours could make it worse, but with so many good examples--using a variety of different approaches--of how to do it better I'm not worried that trying to fix ours would make it suck even more.

Even if, somehow, we actually do manage to make it suck more we can just try again. Eventually we'll have run out of new ways to suck and will have to stumble onto one of those good approaches that the other first world countries use.

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

#349

Post by TheAlpacalypse » Sat, Feb 22, 2020, 12:54 AM UTC

codegeek wrote: post #243

cmollis wrote: post #180

It’s a complete scam run by insurance companies who operate with ostensibly a government mandate (although with seemingly zero oversight). I work for myself and and have historically been paying about 20k per year in premiums for my family with a family deductible which I’ve never gotten remotely close to hitting. I have an hsa which I use to pay for out of pocket expenses pre tax and there is a tax deduction for hea…

I wish i could upvote you 1000 times. Why is it so hard for many people to understand all of this ?

Because it takes advantage of risk. OP's gamble pays off if he never has an emergency, but if he ever pays more than 20k on doctors visits he's fucked.

Granted, that doesn't often happen. But it's a risk that most people can't afford.

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

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Post by leetcrew » Sat, Feb 22, 2020, 12:57 AM UTC

mrep wrote: post #336

codegeek wrote: post #301

Earlier quoted context omitted.

You are missing the point. It is not about being healthy. You are always worried about the "what if I have to go see a doctor" situation in America because you don't know what it will cost and you definitely don't know what kind of issues you will have to fight through with incorrect claims, incorrect bills and what not. If someone can address that here in US, I am willing to keep the current system as is.

My max out of pocket spending is $2,600 a year and I can put $3,500 pretax money into my HSA every year which I do. What I am supposed to worried about?

I have a similar plan and a good income. I am in good health and I make my yearly budget assuming I might have to pay the out of pocket max if I have a health problem.

the usual "gotcha" that people mention is going in for a planned procedure and accidentally receiving care from an out-of-network physician. this makes your out of pocket max irrelevant. I've never had this happen to me and I have no idea how often it actually occurs (outliers are always the loudest on the internet), but it still worries me.