Live data from Hacker News

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

ysph.yale.edu

621–630 of 1001 posts

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

#621
post #551

Earlier quoted context omitted.

It is a system where all prices and costs are so far detached from reality for multiple reasons, that looking at any current profit margins is not going to be very realistic either. Really need to step back and start from first principles. When I go to urgent care I get 15 minutes with a doctor who on average makes about $300K and maybe another 15 minutes with a nurse assistant who might be making $100K (or less). So…

How much does insurance, legal representation, a department to argue with insurers, etc cost the hospital?

About 8.5% of revenue. This is not a poorly-studied number.

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

#622
post #544

Earlier quoted context omitted.

> In general the countries with the highest levels of nationalization also have the most problems with shortages. Do you have any citations for this? I've heard this rhetoric before, but every time I look into it, searching around for studies on google scholar or the web, I can only find studies and reports indicating that health outcomes trend better in countries with more universal coverage. There are think pieces…

One way to begin is look for studies on wait times or procedures of a given type per capita.

Those studies have all, to my knowledge of them, shown no system mode that is better or worse than any other. The USA for many categories of care has often in those studies had worse wait times compared to nations with fully nationalized healthcare.

Heck when I went to college in Ohio's capital, the recommendation on how to get psychiatry or therapy as a new patient was to call the suicide helpline and claim that you were suicidal. That would get you a new patient appointment within 72 hours versus over 3 months on average for patients looking to get into care through normal channels.

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

#623

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.

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 u…

The fun part is when you break those numbers down between government and non-government expenditure. You’ll find that US governmental spending on health care per capita is higher than every other country’s entire (gov and non-gov) spending per capita.

https://www.oecd.org/en/publications/health-at-a-glance-2025...

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

#624
post #596

Earlier quoted context omitted.

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 eve…

That number might be true across all health spending, which includes hospital plant, home health care, all public health work (including animal control), and medical equipment. But if you zoom in on clinical and specialist practice, the parts of the health care equation where payer-structure actually enters the picture, compensation for practitioner shoots up; it's the dominant cost of running a health provider.

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

#625

Earlier quoted context omitted.

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 indu…

Funny how one of the arguments against Medicare in the 60s was that providers wouldn’t accept it.

Turns out when you have the choice of accepting lower payment per patient for Medicare or having a lot fewer patients, you choose the lower payment per patient.

I would expect the same situation here. Doctors would grumble, but no one would force them to accept patients on whatever “Medicare for all” would be called. Nothing other than market forces.

A number of things would probably have to change, including the cost of medical school. But the system right now is expensive and essentially unsustainable. So change is inevitable.

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

#626

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…

You can quibble with the specific projected savings, or the projected lives saved. But it kinda doesn't matter? If we can have net savings of half what this paper said, or a quarter, and still have more lives saved, that would still be a strong argument to do it.

Somewhere there's a pareto-optimal frontier where one can't possibly save more lives without spending more, or spend less without more people having negative health outcomes ... and the question is whether universal health coverage would be a step towards that frontier (b/c we're all pretty sure we're far from the frontier today). And the fact that plenty of countries have both lower costs and better outcomes through such a system is highly suggestive that it is a more efficient policy regime.

Maybe the big quibble is whether the American penchant for creating corporate givewaways to powerful organizations that lobby politicians would create an especially toxic public-private-partnership monopoly in which the biggest existing private healthcare networks are granted regional monopolies and set crazy prices (or some other dystopian warping of an initially reasonable idea) so costs actually balloon. I do think that would be a risk and so we need to be careful about the specifics of how we implement this.

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

#627

We've been down this road. ACA was predicated on studies like this, to no avail (it turns out that intense opposition chips away at it over time regardless of these studies). I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I'm not saying that this is what is happening now , but I am saying that…

> …if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I suspect Social Security would have met that definition at one point in time. Perhaps even paid overtime, the 40-hour work-week, etc.

Sort of. They were not campaign slogans though. They were battle cries, by militant labor, insisting on what they deserved.

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

#628

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.

It also means that emergency rooms can be used just for emergencies and ongoing and preventative care can happen in clinics. Cheaper to operate and preventing preventable emergencies lowers the load.

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

#629
There aren't enough Physicians, they don't make much and they all seem to be working 12 hour days but being paid a salary that would equate to an 8 hour day.

Doctors see downsides of a universal coverage are mostly about loss of autonomy and increased demand because when care becomes free demand rises along with pressure to expand access without extra staff.

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

#630

Earlier quoted context omitted.

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.

If that’s the only benefit couldn’t that have just been made a law and left out all the rest? Healthcare system is worse than ever, I don’t know the cause but with its current prices I can’t imagine subsidizing it further being the answer
Post reply on HN