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

#401

Post by pnutjam » Mon, Feb 24, 2020, 1:57 PM UTC

michaelbuckbee wrote: post #159

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…

There's a third major cost-saving which is preventative care. I have a family friend who lost his job, lost his insurance and couldn't afford to take his meds which would have prevented the massive stroke that paralyzed him 3 weeks later. This was 10 years ago and his rehabilitation is still ongoing. His wife can't work and is his full-time caretaker. Multiple lives destroyed because we as a society can't get a syste…

Just look what a lack of mental healthcare has done to the country...

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

#402

Post by pnutjam » Mon, Feb 24, 2020, 2:33 PM UTC

genomer wrote: post #207

briandear wrote: post #126

Earlier quoted context omitted.

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.

That's an interesting point and I completely agree, but wouldn't America's already real lack of "supply" buffer this a bit? I have to wait several weeks to get into my personal family doctor, and it took over 4 hours to be admitted during our last visit to the ER (we went in because of a suspected ectopic pregnancy, which it turned out to be). It seems like the physician shortage will only continue to worsen. https:/…

Most of these shortages are regional. That will probably continue, but at least it would be possible for people to get reimbursed for travel expenses, etc. At least that's what other countries do.

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

#403

Post by pnutjam » Mon, Feb 24, 2020, 2:42 PM UTC

redler wrote: post #263

leetcrew wrote: post #196

Earlier quoted context omitted.

it's not really like a deductible. it's a small fixed cost you pay every time you see a doctor or fill a prescription. it creates a small amount of friction, presumably to prevent frivolous use of resources.

There is also "co-insurance", which can be in the range of 20 to 50 percent of the billed amount, depending on one's plan. It should go without saying that 20 to 50 percent of the bill on almost any substantive medical problem can be a financial extinction-level event for many American families.

Let me give an example of the billing issues American's face.

Last employer I paid around $9,100 annual ($350 every 2 weeks). This plan had a $6k deductible with no coverage until that was met, then a $6500 OOP (out-of-pocket) max. So the insurance company was guaranteed to get $15,600 before they paid anything outside of "preventative care".

Now, unfortunately, the insurance company had me under a totally different plan, with a 7300 OOP max. Since I don't pay them, I pay my employer, I have to deal with my incompetent HR dept to get this fixed. They not only don't fix it, they somehow split my family so the member with the majority of expenditures is now on the correct plan, but everyone else is on a different plan. This causes the insurance company to claw back payments to doctors and bill me for old services, around $400.

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

#404

Post by beat » Mon, Feb 24, 2020, 5:47 PM UTC

sjg007 wrote: post #346

beat wrote: post #281

Earlier quoted context omitted.

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?

Basically, I have one provider, except for emergency care - a large local network. It's fine for me, because my family doctor and both the specialists I need regularly for chronic conditions are in that network.

For my condition that requires regular surgeries (like 3x/year), there are two levels of surgery - one local anesthetic, one general anesthetic. The first time I got the general one done, the bill to my insurance was $35k. This time, with the new insurance, the bill was $19k. So I think the PPO relationship is making a huge difference in how the internal billing works.

At a higher level, the full hospital general anesthetic surgery in January on new insurance cost me less out of pocket than the much less complex local anesthetic surgery cost me in December, on previous insurance.

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

#405

Post by burnte » Mon, Feb 24, 2020, 10:25 PM UTC

tptacek wrote: post #382

burnte wrote: post #381

Earlier quoted context omitted.

> It's not huge. It's massive. Healthcare is byzantine on purpose. It's opaque to patients so that providers can prevent shopping around and adjust charges per patient, and it's opaque to providers from insurers to help prevent having to pay claims.

You're saying "it's massive" and, in, like absolute terms, sure, it is; everything we do is massive, we're a huge country. But in relative terms? No. It's not massive. It's a small fraction of our total costs. The total benefits we can reap from minimizing it? Not that great. Ambitious plans based on minimizing those costs? You should be skeptical. You should be asking: how are we going to solve this huge problem by…

Yes, in relative terms it's a large percentage. I work in this business, I see it every day. It's a HUGE chunk. Nationwide out of the 3.5 trillion we spend on healthcare, it's about 800 million.

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

#406

Post by harambaebae69 » Tue, Feb 25, 2020, 3:09 PM UTC

bduerst wrote: post #59

markroseman wrote: post #48

That also doesn't factor in the indirect benefits to the economy, like all the people who can't start a new business (etc.), being stuck in jobs they don't want because if they left they'd lose their benefits.

Or the boon from not having one of the highest infant mortality rates in the developed world.

I'm not defending the US healthcare system, which is deeply broken, but the particular statistic on infant morality rate can be deceiving. For example:

"...very low-birth-weight infants who are at high risk of dying within the first day tend to be counted as live births. In countries where the health care system does not place the same emphasis on neonatal intensive care, the outcomes of such pregnancies are not likely to be recorded as live births. Hence, it appears that the more resources a country's health care system places on saving high-risk newborns, the more likely its registration will report a higher IMR" [0]

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193257/

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

#407

Post by GFischer » Tue, Feb 25, 2020, 4:52 PM UTC

bureaucrat wrote: post #359

grecy wrote: post #354

Earlier quoted context omitted.

It depends entirely on where you live. Out West there is no waiting and I've never experienced any of what you're talking about. I've only heard stories about how it is in the East, I've never met anyone first hand that has experienced it, or really hates it.

Because you haven't experienced a problem in your body that is rotten deep inside but shows little to no symptoms. My friend died in Alberta. It took two weeks to even see a doctor and more to wait for antibiotic shots. Doctors try hard to not make problem a problem because the system is fucked in a way that doctors benefit from less patients. They don't try to cure. They wrap up the symptom and makes patients think…

I live in Uruguay, and my mother in Canada.

I agree that for those fringe cases, healthcare in the U.S. might be better (Uruguay is also bad with tough to diagnose diseases).

But for 99.99% of the remaining cases, Canadian or Uruguayan health system is way better.

And I think there has to be a way to reconciliate the very good U.S. top of the line healthcare with the way better general healthcare most of the rest of the world has.

My sister lives in San Francisco and there are several benefits I regularly use which you basically can't access in the U.S. except if you're a millionaire - like doctor visiting your house when you're sick, and I mean things like a fever or a flu, and ambulance coverage included in basic healthcare.