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Universal health coverage could save $1T and 114k lives a year: study

ysph.yale.edu

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Re: Universal health coverage could save $1T and 114k lives a year: study

#301

Post by tptacek »

jandrewrogers wrote: post #293
tptacek wrote: post #273

Earlier quoted context omitted.

No it didn't. The ACA slowed cost growth, which was already skyrocketing by the time it passed.

The sharp discontinuity in insurance costs over a single year for many people when ACA went into effect isn't explained by your dismissal.

All the stories I've heard about that came from people with bad insurance (for instance: insurance programs that could rescind coverage if you were diagnosed with something serious, and that functioned mostly as billing processors for routine care, which is where ~none of the expense in the system is). The ACA did effectively regulate those plans out of existence, so if you had one, and relied on it, it raised your cost.

But when we talk about the ACA's impact on cost, we're always talking in a macro sense. Every program has individual winners and losers.

Re: Universal health coverage could save $1T and 114k lives a year: study

#302

Post by pessimizer »

afavour wrote: post #15

In a more sane world the Republican Party would be in favor of universal health coverage. How many potential entrepreneurs stay working at BigCorp because they need the health benefits? How many small businesses are crushed by the cost of providing healthcare to their employees? It would be great for business to remove any involvement they have in personal healthcare. But I suppose they are the party of big business,…

If they published the plan, it was a normal rational one without carveouts for their friends, and they started pushing specific legislation now to implement it, they'd crush the Democrats, and Trump could declare himself God-Emperor.

All they'd have to do is cut a few friends (insurers) loose. They'd still even have the power of the contract to reward theoretically productive elements of the new health system in return for kickbacks, and there'd simply be more money sloshing around within government to take advantage of. They could continue to stomp the planet freely, because Americans don't care about anyone but themselves. The upper-middle class post-Obama "left" would evaporate. Give them free state college and they'd start calling Republicans the real left.

Another reminder that the US government spends more per-capita on health care than every country with universal health care, and then the population pays again.

One of the things usually cited to defend this waste of money is the massive excess army of people working in healthcare administration, half of whom are employed to file paperwork and the other half employed to throw it in the trash. Now that they're all soon to be replaced by AIs which will be able to simultaneously file and delete worthless paperwork at inhuman speeds, we can let go of that garbage excuse.

But in a more sane world the Republican Party would simply acknowledge slavery as being a real debt owed, and stop being racist, without changing anything else. Most black people are socially conservative Christians, and it would instantly become another God-Emperor situation. Democrats haven't won whites since Kennedy; they gave them entirely up for supporting basic civil rights for black people (an own-goal for the Republican Party, started as a single-issue antislavery party) and big business. Without guaranteed black support (the only other choice black people have to Democrats is not to vote, which is quickly increasing its share), the Democrats wouldn't be a viable party at any level. Republicans are not sane, they are short-termists like everyone else.

Picking out the Republicans is unfair, though. Democrats lobbied furiously and entirely dishonestly against single-payer healthcare in 2016 and 2020. They even tried to sell single-payer and its supporters as racist.

Re: Universal health coverage could save $1T and 114k lives a year: study

#303

Post by jonhohle »

epistasis wrote: post #75
jvanderbot wrote: post #21

We've been down this road. ACA was predicated on studies like this, to no avail (it turns out that intense opposition chips away at it over time regardless of these studies). I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I'm not saying that this is what is happening now , but I am saying that…

ACA has saved tons of lives. Due to the intense opposition, it was not structured in a way that could save money, but rather structured in the way that it could get through congress. Additionally, as somebody who was around pre-ACA, I can not tell you how much better, in every single way, the post-ACA healthcare world is. Pre-existing conditions? Access to healthcare as an individual? These are life-changing possibil…

Before I went indie, prior to ACA requirements I researched private insurance and found plans for around $3K. This year I’ll pay over $20K for a bronze plan for my family. 700% increase in less than a decade. Aetna left the marketplace input state and no pediatrician in a 10 mile radius takes the most cost effective ACA plan. The pediatricians we found are actually just GPs who have training in pediatric medicine, but we bring in the only minors they see. This is in a top-5 market based on population.

All of the providers have consolidated. I don’t know if ACA affected that or not, but wait times for checkups went from later this afternoon to sometime 6 months from now.

Part of my experience is going from corporate health insurance to marketplace, but in the past 5 years, ACA plans have consistently gotten worse and more expensive while service for those plans has gotten significantly worse in almost every way.

Who is it better for?

Re: Universal health coverage could save $1T and 114k lives a year: study

#304

Post by [deleted] »

consensus1 wrote: post #119
greenpizza13 wrote: post #53

The US is far too broken for such a thing to ever come to be. Politicians are bought and paid for, and the impact on the insurance companies and their profits make this impossible. US legislators will never, ever, ever put the needs of the people above the needs of corporations, not as long as corporations can wield their massive wealth as "free speech" in the form of lobbying and political donations. Sounds nice, th…

Nobody, including congress, gives a rat's ass about insurance companies and their profits. The truth is that someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision. After the CEO of United Healthcare was gunned down in the streets for doing that thankless job do you think congress is saying to themselves "hey, maybe we should get into that…

[deleted]

Re: Universal health coverage could save $1T and 114k lives a year: study

#305

Post by RunSet »

brandonb wrote: post #113

I'd like to believe this, but the study makes a bunch of really hasty assumptions. The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewe…

Even if universal health coverage lost money it would be better than the current system that is based on a "causing cancer is better for the GDP than curing it" mentality.

Re: Universal health coverage could save $1T and 114k lives a year: study

#307

Post by somenameforme »

hx8 wrote: post #125
_heimdall wrote: post #64

Earlier quoted context omitted.

These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause. The problem with US healthcare isn't who pays for it, its how damn expensive it is. As always there are multiple factors at play, my list would include corruption, lack of legal accountability/responsibility, and a population that is much less healthy than reasonable. Go after any…

> The problem with US healthcare isn't who pays for it, its how damn expensive it is Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.

The problem with models is that depending on your assumptions you can show just about anything. In general I think the foundation of a good argument, and good science, is assuming the minimum and seeing if your idea still works. They assume:

- hospital reimbursement drops to medicare rates ($296 billion)

- pharma prices decline 51% ($378 billion)

- administrative overhead way down ($286 billion)

- fraudulent billing way down ($286 billion)

- people stop going to the ER and stop being hospitalized as frequently, so the expanded use of services only costs $198 billion

Those seem like extremely optimistic assumptions, and the paper gives 0 consideration to most knock-on effects. For instance I don't think it's reasonable to cut hospital funding by $296 billion, increase the access to these hospitals, and assume everything will work out just fine. They at least acknowledge not acknowledging this, but that one factor alone already is likely to dramatically reshape things. And there are many others.

Re: Universal health coverage could save $1T and 114k lives a year: study

#309

Post by tptacek »

RunSet wrote: post #305
brandonb wrote: post #113

I'd like to believe this, but the study makes a bunch of really hasty assumptions. The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewe…

Even if universal health coverage lost money it would be better than the current system that is based on a "causing cancer is better for the GDP than curing it" mentality.

The US has top-tier cancer survival-after-diagnosis outcomes. We spend too much to get there, and other countries in our cohort would "argue" that we get those numbers in part by diagnosing earlier and that our outcomes are broadly similar, but if you're going into these debates with "the US private health care system causes cancer deaths", that's a pretty rebuttable argument.

Re: Universal health coverage could save $1T and 114k lives a year: study

#310

Post by nemomarx »

Schnitz wrote: post #298
nemomarx wrote: post #17

Earlier quoted context omitted.

You can easily drop those from a universal healthcare system - look at the NHS and gender affirming care across the pond. So it can't only be that part - I think it's wanting the undeserving to not have healthcare.

It’s not that easy. You have to make it through the primaries to stand for election. Both parties are increasingly dominated by their outside wings. If you said “I’ll try to get universal healthcare done and I’ll build the coalition needed for it, even if it means accepting painful compromises like not covering gender affirming care” you won’t make it out of the democratic primaries. That’s why there’s so many common…

What I mean is that if the conservatives only objection to universal healthcare was these things, they could just leave them out. There's no requirement that a single payer system cover all procedures.

Ergo the reason they didn't support the ACA and won't do this is something other than it covering hormones and abortion.

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