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

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

#411

Post by caseysoftware »

ryaniscool wrote: post #383
tptacek wrote: post #309

Earlier quoted context omitted.

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.

This is a cherry picked statistic. We still have lower life expectancy, high infant mortality rates, and one of the highest rate of preventable and treatable deaths among developed countries

The unfortunate truth is that if you break life expectancy out by ethnicity, it tells a different story. Generally Asians, Latinos, and Whites are above while Blacks and Native Americans are below and pull down the average: https://pmc.ncbi.nlm.nih.gov/articles/PMC9256789/#S12 If you break the groups out and individually compare against countries of similiar ethnicity, the US is often ahead.

For infant mortality specifically, in the US we count every baby with a sign of life, regardless of the age. In many developed countries, they simply don't count too premature (under 22 weeks or 500 grams, iirc) and therefore don't consider them in the metrics. It makes for an apples to oranges comparison.

You're right on "preventable and treatable deaths" with heart disease and diabetes being the biggest contributors. The question for that comes down to "is that a result of systemic issues or individual choices?" because we can do lots about one of those.

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

#412

Post by nradov »

missedthecue wrote: post #373
nradov wrote: post #351

Earlier quoted context omitted.

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.

But then the blame might be correctly placed? If he had no pre-existing conditions and was on a no-existing conditions plan, that plan might have saved him a lot of money. Imagine car insurance regulations changing in such a way to force underwriters to blanket-assume everyone has had a couple speeding tickets this year. I understand why we do it. We are ok with speeders paying more for insurance, and not ok with som…

Pretty much everyone who lives long enough will end up with some sort of pre-existing condition.

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

#414

Post by tptacek »

toomuchtodo wrote: post #396
tptacek wrote: post #390

Earlier quoted context omitted.

That's not how this system came into being. It's a path-dependent quirk of the tax codes of the 1940s. We got into this predicament because of WW2-era wage controls (a dollar spent on health care by your employer was literally worth more than a dollar in wages). This is one major reason why most of the world's universal systems make private insurance work, and it doesn't blow up the way ours does. But I don't think e…

You are of course correct on how we got here, I argue we are still here for many reasons, one of which is what I stated. I mean, there is no will to fix healthcare, but lots of will to spend $100B+ to go to war with Iran, right? I simply do not see anyone who cares enough to fix this exceptional mess, even taking into account the coordination problem of doing so. We could treat this as an emergency requiring a fix, b…

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

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

#415

Post by [deleted] »

ryaniscool wrote: post #383
tptacek wrote: post #309

Earlier quoted context omitted.

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.

This is a cherry picked statistic. We still have lower life expectancy, high infant mortality rates, and one of the highest rate of preventable and treatable deaths among developed countries

[deleted]

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

#416

Post by toomuchtodo »

tptacek wrote: post #414
toomuchtodo wrote: post #396

Earlier quoted context omitted.

You are of course correct on how we got here, I argue we are still here for many reasons, one of which is what I stated. I mean, there is no will to fix healthcare, but lots of will to spend $100B+ to go to war with Iran, right? I simply do not see anyone who cares enough to fix this exceptional mess, even taking into account the coordination problem of doing so. We could treat this as an emergency requiring a fix, b…

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

The evidence shows we could spend less and deliver more within the scope of healthcare delivery (this piece). We actively choose not to. The Pentagon hasn't passed an audit eight years in a row, I hear little that "we cannot afford to keep funding the military at these levels and with such inefficiency."

https://usafacts.org/government-spending/

https://usafacts.org/articles/how-much-of-the-federal-budget...

https://www.militarytimes.com/news/pentagon-congress/2025/12...

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

#417

Post by tptacek »

ryaniscool wrote: post #383
tptacek wrote: post #309

Earlier quoted context omitted.

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.

This is a cherry picked statistic. We still have lower life expectancy, high infant mortality rates, and one of the highest rate of preventable and treatable deaths among developed countries

Life expectancy differences between the US and other countries are dominated by just a few factors:

* Car accidents, because we drive much more and are much more spread out than other countries.

* Drug overdoses, though other countries are starting to catch up to us there.

* Homicide, because of our gun policy and the universality of firearms (which also bears on our suicide stats).

* CVD.

That last item sounds like an indictment of the US health care system, but it isn't. If you break CVD out by state, northeastern states like Massachusetts have outcomes resembling the Nordics, and Mississippi has outcomes like a developing country. But the structure of the health care system is the same in both places.

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

#418

Post by jasonlotito »

HEmanZ wrote: post #406
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.

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 mon…

fyi: Your link returns a 404 for me.

Oops! We can't find the page you're looking for

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

#419

Post by nradov »

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.

Hospital billing practices are often terrible or even fraudulent, but stories about the $37 aspirin are generally misleading. Most hospital claims and bills are actually coded around day rates and DRGs, so even if the aspirin shows up as a line item it doesn't actually impact the patient's financial responsibility or the amount allowed by their health plan. (I'm not trying to defend such a confusing system, just explaining how it works.)

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

#420

Post by [deleted] »

strictnein wrote: post #268
dylan604 wrote: post #258

Earlier quoted context omitted.

Paid for how? The expansion of people not on medicaid to be paying in was supposed to be how expanding medicaid could be achieved.

The Feds pay ~$150 billion a year and the states pay ~$20 billion a year for that Medicaid expansion. Those are increases on top of previous spending. How are we paying for that? Debt. On top of that, the ACA provides $100 billion a year to subsidize the healthcare markets.

[deleted]
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