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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

#591

Post by jpalawaga »

tylervigen wrote: post #572
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…

I think for the math to work you have to consider the bigger bulk of work that could be eliminated by universal healthcare: the payer industry. Insurers, PBMs, and all the smaller sectors that support them. The utility provided to society is fairly low — basically, just selective claims denial. Any model that gets rid of these frees up a huge swath of capital and work from society, and can use that work elsewhere. Of…

Truly. Aetna, United Healthcare, Anthem, etc are examples of industry that does not need to exist, and exist only to serve the status quo.

Each of those are companies worth billions of dollars that could be instead used to lower the individual cost of providing health insurance.

As you say, this would of course be unsavory in some respects as those companies employ a lot of people. It's not a very economically productive industry though, the main output seems to be consuming patients' and doctors' time, causing financial anguish, and causing stress among people as to whether or not if their condition will be covered.

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

#592

Post by MSFT_Edging »

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…

We're quick to want to automate trucking, manufacturing, even knowledge jobs and say "ooh but the horse shoe maker became the tire installer" but the pointless middleman jobs making everyone's health worse seems to be the line in the sand for job automation.

You can't touch the legions of people who exist to make things more expensive.

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

#593

Post by orangecat »

robot_jesus wrote: post #469
EA-3167 wrote: post #369

Earlier quoted context omitted.

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...

Exactly this. They need to offset the areas where they lose money. And we have federal laws (justifiably so, IMHO) that ERs must provide stabilizing services regardless of insurance and ability to pay. And while that law is obviously humane and reasonable, my only gripe is that the rest of our system is so backwards that it increasingly forces people to leverage that. There was a story about a woman who needed dialys…

There was a story about a woman who needed dialysis but had no insurance.

And who was in the country illegally so she couldn't use Medicare or Medicaid. Still a terrible situation, but not representative of the typical American.

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

#594

Post by outside1234 »

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.

This is because a whole swath of people are getting the aspirin for free (uninsured) so they need to gouge the payers for the aspirin.

Also, then, of course, we need to cover the United Healthcare guy's salary, which decreases margins.

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

#595

Post by mirzap »

adgjlsfhk1 wrote: post #590
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…

A lot of the reason hospitals have to charge so much is that they take massive losses on uninsured people in emergency rooms. Medicare for all means they don't have to treat anyone for free.

They are not taking any losses; they just charge the regular price with a very tiny profit margin. US healthcare costs are heavily inflated. Insurance is a scam that lets the rich get richer. All insurance should be non-profit.

We all contribute to the pool at a time when we don't need it so we can use the money when we do, not to make CEOs or stockholders rich. That is how an insurance pool should work. Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary.

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

#596

Post by Xirdus »

Aurornis wrote: post #580
chermi wrote: post #447

Earlier quoted context omitted.

It almost seems like obscurity is the goal with the current system. Basically, job security (for admin, insurance) via obfuscation.

All healthcare systems have administrative overhead, including completely nationalized systems. The US discourse on health care overestimates the administrative overhead by a large amount. We could remove all insurance company profits and adjust our administrative overhead to be in line with countries with nationalized systems and it wouldn't change health care costs by an appreciable amount. The discourse also under…

> The discourse also underestimates how much of our health care costs go to our significantly higher salaries throughout the medical system.

Well, the salaries of medical personnel only account for about 20% of total healthcare spending. So even cutting those by half wouldn't change much.

> One of the reasons hospitals operate in this convoluted way and still barely clear a profit is that we require them to treat everyone and attempt to collect payment later. A lot of what you and I pay for health care goes to cover people who can't or won't pay.

If that was a major reason, then those who don't pay would balance out those who pay and the grand total of all healthcare spending in the US would be pretty average despite individual premiums and out of pocket costs being sky high. But in reality, the total healthcare spending is just as sky high (several times more per capita then median OECD country).

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

#597

Post by ohlookman »

DataDive wrote: post #588

[flagged]

> The first issue with this is that the gap between the uninsured and insured is not necessarily due to the lack of insurance. It could be due to factors associated with not having insurance, like living on the streets, being schizophrenic, being poor, and so on.

Made up perspective to justify his angle.

Not having healthcare access for a lot of people is 100% a policy choice. Waved off here by a list that really says why we should have universal healthcare; some people are mental and not aware they could have access without the stupid policy decision.

Just strings together sentences to ultimately make a reductive point about arithmetic and their own literacy.

Despite Yale's issues they're still a better source than random blogger with high school math literacy.

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

#598

Post by Pragmata »

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 understand that hospitals have more costs than just aspirin, right? Depreciation, amortization, utilities, rent, taxes, maintenance, salaries, etc...

Its all coming out of revenue.

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

#599

Post by SpicyLemonZest »

no-name-here wrote: post #557
maxlybbert wrote: post #292

Earlier quoted context omitted.

> 1. A number of other developed countries have UHC while also allowing a private system as well - what is unique about the US that other countries' existing approach couldn't work here? Mainly, expectations. I understand that UHC in European countries doesn’t cover all the things Americans assume it does. Japan apparently keeps costs down by not using cutting-edge drugs. That’s not going to happen in the US. The US…

The US is dead last in terms of health outcomes among every developed country (despite spending far more), but you believe expectations will cause every other developed country's system to fail here? I guess your argument is that the propaganda machine pushing the idea that America's healthcare is not the worst in terms of outcomes (while also being about the most expensive), would prevent Americans from accepting no…

> The US is dead last in terms of health outcomes among every developed country (despite spending far more), but you believe expectations will cause every other developed country's system to fail here? I guess your argument is that the propaganda machine pushing the idea that America's healthcare is not the worst in terms of outcomes (while also being about the most expensive), would prevent Americans from accepting no longer having the worst results and the highest costs?

The argument is that the US system has a much lower floor, which leads to the bad health outcomes, but also generates a lot of people who expect and demand more than most universal healthcare systems would give them. An Uber driver with the cheapest marketplace plan he could find would benefit greatly from any universal healthcare system; a guy with really bad ulcerative colitis (https://www.propublica.org/article/unitedhealth-healthcare-i...) would likely not be able to get a prescription for a cocktail of drugs at non-FDA-approved doses costing $2M/year.

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

#600

Post by [deleted] »

jpalawaga wrote: post #591
tylervigen wrote: post #572

Earlier quoted context omitted.

I think for the math to work you have to consider the bigger bulk of work that could be eliminated by universal healthcare: the payer industry. Insurers, PBMs, and all the smaller sectors that support them. The utility provided to society is fairly low — basically, just selective claims denial. Any model that gets rid of these frees up a huge swath of capital and work from society, and can use that work elsewhere. Of…

Truly. Aetna, United Healthcare, Anthem, etc are examples of industry that does not need to exist, and exist only to serve the status quo. Each of those are companies worth billions of dollars that could be instead used to lower the individual cost of providing health insurance. As you say, this would of course be unsavory in some respects as those companies employ a lot of people. It's not a very economically produc…

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