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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

#701

Post by mrguyorama »

0xy wrote: post #444
yibg wrote: post #409

Earlier quoted context omitted.

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

Life expectancy is a function of demographics, which averages ignore. Income is also an assertion not supported by data. For simple procedures such as a knee or hip replacement, many people earning under $80K CAD opt for US treatment. Likely because Canada has extremely bad waitlists which are continuing to deteriorate. That coupled with a lack of specialist medical options and lesser quality. In Canada, a woman with…

It's just because America is big and has a lot of hospitals and has changed dramatically many times over the past 100 years.

There's lots of places in America with spare hospital capacity. In those places, locals still cannot get affordable treatment, because our health insurance system is bad.

Meanwhile, plenty of places in the US have the absurdity of our broken healthcare system, and get to wait 4 months to see a doctor after having a stroke, like my mother had.

Or like my ex, who had to wait TWO YEARS for an MRI and neurology appointment, and that took so long that by the time her appointment was coming up, her situation had changed and needed other investigation and that appointment was not really a good fit anymore.

The situation is so mediocre in most of the US, that you have to travel hundreds of miles to see specialists anyway.

Nearly every single person in Maine who needs to see a specialist is waiting months. If you are in northern maine, you will have to wait months and travel to southern maine, or wait a year for a traveling specialist who has to fit a hundred patients into a timetable meant for 20. If you need to see a special specialist, you will be triaged on the same list as the entirety of New England for the one doctor in Boston who can actually do anything for that condition.

The same guild system that keeps US doctor compensation high is also keeping supply low! Someone is going to be waiting to see a doctor! If they weren't, US doctors wouldn't be paid as much!

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

#702

Post by bhelkey »

GratiaTerra wrote: post #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.

There are not enough physicians because we have limited the number of physicians. This was done, in part, by limiting the number of residency positions.

[1] https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...

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

#703

Post by [deleted] »

bigmadshoe wrote: post #689
tptacek wrote: post #620

Earlier quoted context omitted.

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…

Why do doctors need to be paid integer multiples more in the US than every other country on earth? This is not rhetorical, I mean it sincerely. And I’m aware that medical debt is a big issue, but it seems like a chicken-or-the-egg type problem. Of course you can charge $500k for a medical degree when the doctor can make it back and then some in 5-10 years.

[deleted]

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

#704

Post by cogman10 »

qwytw wrote: post #642
mirzap wrote: post #595

Earlier quoted context omitted.

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…

> All insurance should be non-profit. Aren't their profits regulated regardless? If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically? There are many factors, e.g. amongst other things American doctors are better paid than just about anywhere else in the world.

> Aren't their profits regulated regardless?

Yes and no. It's sort of a weird thing where insurance is somewhat regulated nationally but also regulated in a piecemeal fashion state by state.

There's a non-government standards body called the NAIC which provided national guidance for insurers. Most (all?) states basically say that "if you follow NAIC standards, you are good".

> If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically?

It's a huge mess. It's not even really a profit vs non-profit thing but rather "what's the motivation". One major issue is that the ACA put in a loss ratio of 80%. Which isn't a terrible thing in principle, it forces insurance companies to spend money on treatment. The problem is it also means that the profit of insurance companies is tied directly to how much they spend on healthcare. As a result, they are incentivized to spend more, not less, on medical treatments so they can justify higher premiums.

This is a big part of why I think universal public insurance is a must. Basically the only organization that's motivated to keep costs as low as possible is the government.

> American doctors are better paid than just about anywhere else in the world.

This is a problem, but the bigger issue and why doctors are paid so well is because becoming a doctor is one of the more costly and hard to do things in america. There are limited spots, schools, and residency requirements that severely restricts the number of possible doctors we add per year. That drives up the their salaries.

I have a nephew going to medical school in Idaho of all places, and he's looking at $500k in debt by the end of the whole ordeal.

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

#705

Post by bonsai_spool »

tptacek wrote: post #446
toomuchtodo wrote: post #416

Earlier quoted context omitted.

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://…

I don't want to sound like I'm fundamentally arguing with you, because if I could swap our system with Germany's I'd do so in a heartbeat. But (a) the "money that should be going into health care and education is going to military" argument is highly rebuttable, so I'd be careful hanging my hat on it, and (b) everybody, literally everybody (except the AMA) agrees we're spending too much on health care --- the problem…

> except the AMA

What an idle comment - where is the AMA on record saying that we should spend more on healthcare? Here's all the work they do to describe our increasing costs:

https://www.ama-assn.org/about/ama-research/policy-research-...

Also, when people invoke the bogeyman of 'AMA' they treat it like the lobbies that tech companies belong to. The AMA is not enriching physicians or hospitals (which have their own lobby!) but generally espouses consensus perspectives among doctors while making money from administering things like a residency program application system.

It's frustrating for someone like you to make this statement which feels quite divorced from any fact when you would not do the same about a security topic.

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

#706

Post by TuringNYC »

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…

>> Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch.

You arent considering

1. Hospitals eating the cost of the uninsured, which this would solve

2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce

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

#707

Post by nradov »

chaps wrote: post #498
gadflyinyoureye wrote: post #491

Earlier quoted context omitted.

The average Georgian plumber has higher purchasing power than the average German doctor. In order for the United States to balance its medical books, doctors will have to be paid dramatically less than they are at present. Perhaps there’s a deal to be made where doctors take the hit, but all of their debt is paid off by the state. Going forward medical school is free, but like in Germany you have to qualify, I mean r…

Yeah, a lot of these issues are felt in other fields too so it feels like there's a need for a larger, wider schism. Like I would love to go to law school but I can't afford it. So many possible but inherently unattainable futures. We'll get there.

You can afford to go to law school if you're willing to prioritize it and make some sacrifices. There are plenty of law schools that have part time night or online options. Take one class at a time and you'll eventually get through.

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

#708

Post by bonsai_spool »

jtbayly wrote: post #566
QuercusMax wrote: post #284

Earlier quoted context omitted.

Which requirements made them cancel it? Was it a high deductible scam plan?

It was a high deductible insurance plan, not a monthly subscription to all your healthcare needs. Why would you call that a “scam”? And for the record, it was not as high a deductible as most “silver” plans on the exchange currently.

> It was a high deductible insurance plan

Why do you believe that the ACA would have wanted such plans cancelled? There's a very straightforward public health reason that's reminiscent of why states require drivers to have car insurance.

> And for the record, it was not as high a deductible as most “silver” plans on the exchange currently.

The plan would have been in effective over 18 years ago. Does your internet plan look the same now as it did 18 years ago? Your cell phone plan?

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

#709

Post by nradov »

dbbk wrote: post #267
dbspin wrote: post #50

Earlier quoted context omitted.

Interesting. In every European country I know of, the private option is still available. Just vastly cheaper and more beneficial due to having to compete with a public option which covers basic necessities, surgery etc.

Yes, this is what I find a little odd about the US proposals. I've lived in UK and Spain and in both they have great free public healthcare for everyone, and if you (or your employer) want to layer private insurance on top you can. Wouldn't that be a much more appealing proposal to Americans?

Perhaps, but given the current shortage of healthcare providers we would probably see many doctors drop out of the public healthcare system and only accept private insurance or cash payments.

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

#710

Post by bayarearefugee »

loeg wrote: post #479
TimorousBestie wrote: post #197

Earlier quoted context omitted.

Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency > The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost. > In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.

We want consumers to consider cost when evaluating what services to buy, though. That's a feature. The medical emergency debt statistic is just the usual thing of people not really understanding how medical insurance works.

> We want consumers to consider cost when evaluating what services to buy, though.

A lot of medical care involves inelastic demand because your options are 1) pay this or 2) suffer and/or die.

"The market" does not function correctly with inelastic demand curves.

Yet another reason to socialize healthcare.

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