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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

#361

Post by rayiner »

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.

Audited financial statements of all kinds of hospitals, both non-profit and for-profit. Here’s data from Moodey’s a credit rating agency: https://www.chartis.com/insights/hospital-margins-trend-high... (“This month, Moody’s credit rating agency released its annual not-for-profit and public healthcare median financial report for 2024, showing that overall hospital performance continues to improve. The median operating margin increased from 0.5% in 2023 to 1.5% in 2024.”).

The $37 for an aspirin offsets huge costs elsewhere for (non-NP) nurses, receptionists, janitors, orderlies, etc., who can’t bill directly to medicare.

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

#362

Post by nradov »

mindslight wrote: post #311
_heimdall wrote: post #262

Earlier quoted context omitted.

I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.

It's also caused by absurd nonsense like how doctors can't tell you how much anything they're proposing to do actually will cost (a necessary condition for entering into a contract !), but then the system makes up arbitrary bills after the fact - with fraudulent amounts that nobody actually pays! No other industry works like that, as it's not the foundation of a market in the first place. Imagine if going to the groc…

That's all true, but from a practical standpoint providers really have no way to accurately estimate a patient's out-of-pocket financial responsibility in advance. The current HIPAA adopted standard transactions don't allow for sending a prospective claim. So all they can realistically do is perform the procedure, submit a claim to the patient's health plan, wait for it to (maybe) be paid, and then send a bill to the patient for the balance.

https://www.cms.gov/priorities/key-initiatives/burden-reduct...

The good news is that CMS is working on an update to those standards which will at least make prospective claims technically possible. Although it may take years until that functionality is widely implemented.

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

#363

Post by tptacek »

thatfrenchguy wrote: post #341
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…

> Take "Medicare-level payments to providers". Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch. I mean, admin costs at hospitals are ~25%, around half of that…

Billing and insurance ("BIR") is reported at around 8.5% of revenue --- admin isn't just BIR, as you note. But replacing private insurance with Medicare doesn't drive BIR to zero; Medicare is also a claims-based system. Estimates are that you'd cut BIR by somewhere around 30-40% (of 8.5%).

Most of the savings in these kinds of reports simply comes from paying doctors less (or delivering fewer procedures, which is also a problem we have.)

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

#364

Post by ck2 »

let's imagine an impossible country where somehow Democrats pull this off in 2029 and the 2030s start with actual healthcare for all and not just "insurance"

DOGE 2.0 will destroy it overnight

because somehow funding is not exempt from executive manipulation

look at what they did to ACA (and everything else)

all it takes another apathetic Congress and poof it will be gone so billionaires can get a few million off their taxes

there's absolutely no way to harden it against that

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

#365

Post by hnlmorg »

_heimdall wrote: post #262
hnlmorg wrote: post #155

Earlier quoted context omitted.

The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems. The problem is you either need to regular or nationalise. And neither of those are particularly “American”.

I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.

I think the high upfront capital required to start out in the industry is a much much bigger hurdle than the regulation.

You see the same problem in IT with hardware startups vs purely software ones. The moment you need to own something more than 1s and 0s, the risk grows exponentially.

Reducing regulation doesn’t solve that problem.

And that’s without even considering all the shady tactics that the incumbents can do to drive new ventures out of business.

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

#366

Post by AngryData »

gryfft wrote: post #170

I wonder how many people would be on board for a program to make Medicare available for free for households making over $100,000 annually with 1-3 children. We're talking about families that are provably not lazy or sucking up handouts: taxpaying citizens with beautiful, healthy children. The job creators and professionals driving America, securing their future and their children's future. If the government were to f…

First class citizens? Wow, that is both disgusting and sad. What do you do that you think is so important and irreplacable that sets you above the average person?

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

#367

Post by _heimdall »

mindslight wrote: post #311
_heimdall wrote: post #262

Earlier quoted context omitted.

I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.

It's also caused by absurd nonsense like how doctors can't tell you how much anything they're proposing to do actually will cost (a necessary condition for entering into a contract !), but then the system makes up arbitrary bills after the fact - with fraudulent amounts that nobody actually pays! No other industry works like that, as it's not the foundation of a market in the first place. Imagine if going to the groc…

Sure, I'd be all for such reform. Those are the kinda of changes we can and should make before even considering nationalizing an entire industry. If nothing else we'd want that setup anyway under a centralized system, and we could change pricing regulations now with much less controversy unless you ask the lobbyists who would fight it tooth and nail).

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

#368

Post by rlewkov »

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…

As the article said - it has not been peer reviewed

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

#369

Post by EA-3167 »

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.

Ever hear of loss leaders? Some parts of a typical hospital make money while others lose it hand over fist. The overall margin isn’t across the board, it’s after everything hopefully balances out.

ER’s for example are money pits, but society really needs them.

https://www.definitivehc.com/resources/healthcare-insights/h...

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