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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

#351

Post by nradov »

sys32768 wrote: post #194
epistasis wrote: post #75

Earlier quoted context omitted.

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…

Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened. My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib. Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough. We had an insurance rep come to my work last year who said after AC…

Your blame is misplaced. Costs are increasing in spite of the ACA, not because of it. Pre-ACA your family insurance policy was likely worse in some key ways: it probably excluded coverage pre-existing conditions and had a lifetime maximum coverage limit.

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

#352

Post by missedthecue »

onlypassingthru wrote: post #316
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…

> Hospitals have an operating margin of 2-5% There's no way a Chairman/CEO would ever reduce the operating margin by just giving themselves and their buddies a raise is there?

Are you saying that most hospitals have 50% profit margins, of which 90% are paid to the chairman leaving only a thin margin? That seems difficult to believe.

They may have 4.2% margins knocked down to 4% by exec comp but I don't see that how that fact would change OPs point.

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

#354

Post by onraglanroad »

sys32768 wrote: post #194
epistasis wrote: post #75

Earlier quoted context omitted.

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…

Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened. My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib. Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough. We had an insurance rep come to my work last year who said after AC…

So you support single payer where none of that exists?

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

#355

Post by tptacek »

detourdog wrote: post #348
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…

If universal healthcare just made access simpler with less paperwork it would be a major improvement. The flipside to fraudulent billing is that people that need care are denied. The fraudulent billing was perpetrated by the insurer.

No, fraudulent billing is the natural predator of insurance companies. You have this backwards.

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

#356

Post by autoexec »

GuB-42 wrote: post #337
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…

Yes, I consider big numbers like this to be red flags. The GDP of the US is $32T. Saving $1T will essentially make 3% of the US economy vanish. You don't vanish 3% of an economy without wide ranging repercussion, it would be a crisis similar in scale to that of 2008. With such numbers we are not "saving money", these are about rebuilding an entire economy, a painful process. So either the effect will be much smaller…

The money doesn't vanish. It stays in the hands of people. People who would spend it on other things, feeding it into the wider economy instead of the pockets of a small number of corporations. There's zero reason to think this would result in anyone rioting except maybe insurance company CEOs.

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

#357

Post by _heimdall »

dmschulman wrote: post #300
_heimdall wrote: post #245

Earlier quoted context omitted.

(1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything. Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.

There's a multitude of evidence that points to the success of the ACA from a cost perspective (among other things). Cost of healthcare for individuals is not a good metric to judge by. The ecosystem of hospitals, patients, doctors, insurers, health systems, and the federal government is complex and you're not going to get a clear picture of the overall impact of the ACA by looking as something as simple as cost savin…

If the ACA was so successful at reducing coats we wouldn't still be having discussions like this about the excessive costs of both care and insurance in the US.

We will never know how costs would have changed if we didn't implement the ACA, and cost is not the only metric of success. But it clearly hasn't led us to a place where people feel okay with what the industry costs.

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

#358

Post by Certhas »

GuB-42 wrote: post #337
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…

Yes, I consider big numbers like this to be red flags. The GDP of the US is $32T. Saving $1T will essentially make 3% of the US economy vanish. You don't vanish 3% of an economy without wide ranging repercussion, it would be a crisis similar in scale to that of 2008. With such numbers we are not "saving money", these are about rebuilding an entire economy, a painful process. So either the effect will be much smaller…

The US spends more than 16% of GDP on health. The UK around 11%.

Shrinking US health expenditure by 3% of GDP while roughly maintaining health outcomes is eminently, obviously doable.

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

#359

Post by _heimdall »

hx8 wrote: post #274
_heimdall wrote: post #245

Earlier quoted context omitted.

(1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything. Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.

1. Do any of the cost savings recommendations you address come close to $1T/yr impact? This is the scale we should be aiming for. 2. If you think this modeling is inaccurate or incomplete you can directly discuss that. That would be a much more interesting discussion than "it might be incorrect."

That's a great question, and one that should receive similar funding and attention to properly compare.

My hunch is that (a) this study over estimates on the cost reduction side and would not pan out, and (b) improving health should always be a better cost savings than reducing corporate overhead (especially given how piss poor our average health is today).

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

#360

Post by bell-cot »

nullocator wrote: post #345
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…

> Hospitals have an operating margin of 2-5% Very curious where this comes from and how accurate it is. For example the $37 a provider charges for an Aspirin seems like more than 2-5% margin.

Hand-waving numerous details, but - That $37 isn't the price in the hospital's gift shop. It's n=1 pricing, hand delivered to your bedside by a nurse with a whole hierarchy of higher-level medical & admin staff behind her, and documented out the wazoo. Aspirin could be free & unlimited at the hospital pharmacy's receiving dock, and it wouldn't affect the @bedside price.
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