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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

#611

Post by amluto »

mvdtnz wrote: post #606
amluto wrote: post #589

Earlier quoted context omitted.

On the occasions that I’ve watched a hospital go through the actual process of selling a small amount of inexpensive medication for a large amount of money, there is a ridiculous amount of ceremony involved. I can easily imagine that it costs that hospital 2 cents for the pill, $5 in amortized capital plus operating expense for the facility that stores that pill, plus $25 in labor and IT expenses to get that pill to…

I, too, can invent numbers from nothing.

Yes, but can you personally allocate four people, two computers, a wristband, a HIPAA-compliant database, a HIPAA-compliant data entry system, and at least two barcode scanners to get an aspirin out of the bottle?

I’m making a serious point here: medical overspending is not just gobs of money ending up in a single pocket. The US medical system really is incredibly complex, and the money is moving all over the place and being spent on many things. Most of those cost centers may all zero or even negative value to the patient, but that doesn’t mean they don’t exist.

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

#612

Post by kentm »

johndevor wrote: post #254
jkestner wrote: post #236

Earlier quoted context omitted.

The government is more directly accountable to me. The only way I have to influence what insurance companies do is through the government.

You can switch insurance companies, no?

In many cases, no.

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

#613

Post by gizmo686 »

mirzap wrote: post #595
adgjlsfhk1 wrote: post #590

Earlier quoted context omitted.

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 m…

It doesn't matter what they charge if the patient doesn't pay it; which is what often happens with uninsured people showing up at the ER.

> 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

Under the ACA, excess money in the pool must be rebated to policy holders. In practice, this worked for a few years, but eventually insurance companies ended up increasing cost in order to increase the absolute amount they were allowed to keep. Maybe this is still good (more claims approved), but it is counter productive to the goal of reducing healthcare costs.

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

#614

Post by zdragnar »

AuthAuth wrote: post #541
scoofy wrote: post #534

Earlier quoted context omitted.

Did I mention the 100° summers or the fact that people usually live 20+ miles from where they work? I agree with you generally on the incentives, but it took us 70 years to paint ourselves into this corner, and we’re not going to get out of it because of a third-order incentive.

Thats not every where nor is it everyone. Im not saying it will specifically be bikes but the government will be incentivized to have a healthier population. It could be higher tax on cigs, or sugars, it could be more annual leave it could be any number of wellbeing policies.

But it is many places. You can't just magically hand-wave away the fact that the demographics between these places are wildly different, and that changes the burdens on the systems in place.

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

#615

Post by petilon »

0xy wrote: post #382
dbbk wrote: post #270

Earlier quoted context omitted.

The government provides your police force and fire department. Why not?

Look no further than the UK, with 24 month waiting lists, the shunning of experimental treatments (many high profile kill decision cases) and skyrocketing costs. In the UK, a brain surgeon is paid less than the General Manager of a single Buc-ees Gas Station location in the United States. Absolutely diabolical.

Why not take a look at Medicare in the US instead? The US healthcare system has way more money than the UK, so comparing to UK is not meaningful.

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

#616

Post by ohlookman »

martythemaniak wrote: post #605
ohlookman wrote: post #597

Earlier quoted context omitted.

> 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 say…

> random blogger with high school math literacy He's actually a well-known and widely promoted political activist on X. His niche is using technocratic language and a whiff of 'analysis' to advance MAGA policies.

[dead]

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

#617

Post by smallmancontrov »

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.

No, this absolutely does not explain the US's wildly off-base per-capita expenditure because uninsured people still go in the denominator of the per-capita figure! I'm sure the per-insured-capita figure is worse but that's not what we are comparing!

Americans are constantly trying to exclude uninsured people from their statistics (and, worse, from the care itself) but the comparable countries don't do this so it is utterly ridiculous to propose that the correct statistical comparison is one in which the US excludes the undesirables while other countries don't.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

    Total health spending per capita in PPP$
    
                    2024    2023    2022
    United States   14,885  13,818  12,898
    Switzerland      9,963   9,301   9,089
    Norway           9,393   8,909   8,533
    Germany          9,365   8,503   8,652
    Netherlands      8,436   7,615   7,517
    Austria          8,401   7,697   7,700
    Luxembourg       8,087   7,173   6,854
    Sweden           7,871   7,364   6,977
    Ireland          7,813   7,027   6,748
    Belgium          7,750   7,178   6,906
    Australia        7,469   7,015   6,907

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

#618

Post by tptacek »

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.

That claim is at odds with the working paper's methodology, which gets a good chunk of the $1T in savings it discussed by assuming very sharp cuts to practitioner compensation.

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

#619

Post by marysminefnuf »

amluto wrote: post #589
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.

On the occasions that I’ve watched a hospital go through the actual process of selling a small amount of inexpensive medication for a large amount of money, there is a ridiculous amount of ceremony involved. I can easily imagine that it costs that hospital 2 cents for the pill, $5 in amortized capital plus operating expense for the facility that stores that pill, plus $25 in labor and IT expenses to get that pill to…

My wifes a doctor and i can assure you they are gouging you. What it is is that the insurance companys are really in the purchase processing business. So what they do is institute fees on every possible charge and the hospitals in our area mark everything up as a result. Thats part of the problem.

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

#620

Post by tptacek »

MrSkelter wrote: post #565
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…

Healthcare reform isn’t actually hard. Every advanced country has done it bar the United States. In every case costs have gone down and outcomes have improved. You always build on what you have because you can’t pause healthcare for very obvious reasons. Hence a lot of different systems all with the same aim. Controlled costs and universal coverage. The idea the US is somehow different and cannot make the change is t…

Yeah, and they all generally get there by paying practitioners much less than the US does (by integer multiples). Single-payer, which this working paper equates with "universal coverage", is in fact not the norm among universal systems; besides using Medicare to ration the supply of practitioners, the original sin of our system is employer-based coverage, not payer structure.

Health care is an absolutely massive industry (everywhere, not just in the United States), and slashing compensation in a massive industry by top-down fiat is in fact not an especially easy thing to do.

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