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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

#401

Post by mindslight »

nradov wrote: post #362
mindslight wrote: post #311

Earlier quoted context omitted.

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…

One can always craft some excuse, which is how the terrible system continues to perpetuate itself. Doctors cannot even tell you how much they themselves will charge for anything. The problem I'm describing originates completely with them - no escaping blame here.

(And "might take years" lol. How about eliminate whatever flagrant regulatory capture is allowing providers to create and enforce post-facto and downright fraudulent bills in the first place, and watch the system reform itself overnight)

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

#402

Post by happyPersonR »

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.

Hospitals, now that private equity is involved, do this weird cost shifting accounting BS with shell companies etc, as such their books aren’t straight forward and the 2-5% thing is likely greatly underestimated given the amount of understaffing PE has driven in that space and how much gouging there is from PBM etc.

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

#403

Post by cyberax »

jonhohle wrote: post #303
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…

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, bu…

> Who is it better for?

People with pre-existing conditions. They were literally uninsurable before the ACA.

The insurance costs are also skyrocketing in the employer-sponsored insurance.

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

#404

Post by onraglanroad »

_heimdall wrote: post #259
larkost wrote: post #203

Earlier quoted context omitted.

I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered p…

I understand that theres an argument for removing private insurance companies in favor of thr government can cut costs. It can also increase them. I'd argue that the primary issue with insurance costs today is the lack of market competition, obscurity of what costs and prices are, and government protections that prevent insurance companies from being legally liable for many of the problems they cause. Corruption and…

>theres an argument for removing private insurance companies in favor of thr government

I don't see why you'd need to do that. Just expand medicare to everyone and if people want to also buy private insurance they can.

They'd just need to be more competitive and add significant value, which they don't currently do.

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

#405

Post by logravia »

davidfekke wrote: post #306

"You can have state of art Healthcare, or you can have Universal healthcare, you can't have both." -- Malcolm Gladwell The way that universal health coverage saves money is by rationing care. You do not save lives when you ration care.

That's a very weird framework and dichotomy you have there. Try untangling yourself out of it by considering some empirical facts, for example, hospitals acquired by private equity often have worse outcomes.

> private equity acquisition was associated with a 25.4% increase in hospital-acquired conditions, which was driven by falls and central line–associated bloodstream infections

https://pmc.ncbi.nlm.nih.gov/articles/PMC10751598/

> Medicare beneficiaries in the emergency departments of private equity hospitals experienced seven additional deaths per 10,000 visits after acquisition relative to hospitals that were not acquired by private equity, the team found. This rise represented a 13 percent increase from a baseline of 52 deaths per 10,000 visits

https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft...

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

#406

Post by HEmanZ »

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.

You can search for more reports, because they do vary based on methodology. But the median hospital in the US makes between -1% (yes, negative, they lose money, because a huge percentage are non profits) and 4% depending on the source.

When the hospital charges you $37 for an aspirin, that singular pill might have a crazy profit margin in isolation. But your entire treatment could very well be losing the hospital money.

In my own anecdotal experience, the one hospital I know enough details about to comment on specifically, had something like 85% of patients costing the hospital more money than the hospital made. It was entirely funded by the relatively small number of people who had the “right” insurance and had the “right” procedures done.

Eg Kaufman: https://www.vizient.com/insights/reports/national-hospital-f...

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

#407

Post by wmorgan »

missedthecue wrote: post #352
onlypassingthru wrote: post #316

Earlier quoted context omitted.

> 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.

Yeah, if the hospital is part of an HMO, it wouldn't even be legal. The ACA sets a floor on medical loss ratio.

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

#408

Post by Retric »

_heimdall wrote: post #269
Retric wrote: post #150

Earlier quoted context omitted.

No, it’s not a question of who pays for it but who benefits. You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.

No one benefits when there's a single player in an industry. When that single player also owns your taxes and military, its a risk we should at least avoid if at all possible.

Let’s try and deal with actual facts here. If you disagree then you should be able to post some actual data in terms of lifespans or costs that says otherwise.

There’s multiple healthcare systems around the world, single payer results in vastly less administrative and thus overall spending and equal or better outcomes overall. So by objective criteria the average person massively benefits from single payer healthcare.

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

#409

Post by yibg »

0xy wrote: post #376
poncho_romero wrote: post #30

Earlier quoted context omitted.

What about them? The Canadian healthcare system has better outcomes than the American healthcare system in several areas. Most simply, Canadians live longer.

Can you reconcile this with skyrocketing Canada to US medical tourism?

Those with money and those without.

Gap between Canada and US life expectancy overall: ~3 years in favor of Canada

Gap between Canada and US life expectancy for top 10% economically: ~0

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

#410

Post by sahila »

Aurornis wrote: post #380
nullocator wrote: post #345

Earlier quoted context omitted.

> 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.

Insurance pays the higher of their negotiated rate or the billed charge. Medical facilities set their billed rates so high that they’re guaranteed to be higher than all negotiated rates, ensuring that they get paid. When you see $37 aspirin on the line, nobody actually pays $37 for it. The billed amount is replaced with whatever insurance rate is allowed for that. If someone is cash paying they get a large discount.…

> The billed items also have to cover everything. It’s not directly $37 for the aspirin, or the $5 or whatever allowed coverage it ultimately gets billed it. That had to cover the facilities, the salaries of the pharmacy staff who reviewed the request and dispensed it, the staff who inventory and order the medications, and the cost of billing insurance.

That's the same as any? CVS charging $5 for aspirin has to cover their staff who stocked and checked out the item, the shelf space, the marketing, and the looting.

The comparison you make between a bottle of wine vs a glass is not the right one. It's two different stores selling the same product. What's different about hospitals?

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