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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

#741

Post by runako »

jonhohle wrote: post #378
lotsofpulp wrote: post #318

Earlier quoted context omitted.

ACA premiums are literally taxes, the price you pay has nothing to do with your health risks. You are paying more because a lot more healthcare is being delivered, to people who never used to either due to exceeding maximum benefits (we have the opposite today with out of pocket maximum), or being denied for pre existing health conditions. So to answer: >Who is it better for? My 4 year old, who has received hundreds…

> ACA premiums are literally taxes, the price you pay has nothing to do with your health risks. Then turn it into a tax and be done with it. I don't shop for my tax collector and I don't pay taxes to companies with the biggest buildings in the city. Companies that don't actually provide health care, but just collect their pound of flesh from patients and providers, driving up costs for everyone. I'm glad your child h…

This is effectively Medicare for All.

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

#742

Post by nobody9999 »

nobody9999 wrote: post #512
nradov wrote: post #419

Earlier quoted context omitted.

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 expl…

>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.) Yep. Hospital "bills" are a fiction. On one occasion I was presented with an "Explanation of Benefits"…

Just in case anyone didn't get the reference (I forgot to include the link -- mea culpa).

A Pap smear[0] is a diagnostic test to detect (pre)cancerous cells on one's cervix[1].

[0] https://en.wikipedia.org/wiki/Pap_test

[1] https://en.wikipedia.org/wiki/Cervix

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

#743

Post by lkbm »

tptacek wrote: post #417
ryaniscool wrote: post #383

Earlier quoted context omitted.

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…

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

Somewhat off-topic, but I think this explanation of the car accidents misses the mark. It might be part of the cause, but car accident deaths were dropping in the US and Europe until around 2010 when they kept dropping in Europe, but flatlined and then rose back up in the US.

I don't think we were driving less and less and are now driving more and more. We changed policies. (I think it's mostly bigger cars, plus less focus on traffic infra/systems/rules that prevent fatalities.)

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

#744

Post by brandonb »

TuringNYC wrote: post #706
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…

Those are two real effects, but together they wouldn't compensate for the rate cuts.

About 8% of the population is uninsured. The uninsured population skews younger, with less healthcare utilization (Medicare already covers everyone 65 and older).

Another comment in this thread estimated billing overhead at 8.5%. Medicare for All would eliminate some, but not all of this, since Medicare is still a claims-based system. You would remove a lot of overhead around prior auths, which I agree is a good thing, but could be achieved with more focused legislation.

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

#745

Post by jasonhong »

bentt wrote: post #724

There are a lot of people making a lot of money on the inefficiencies of the US system. They won’t give up their revenue streams without a fight, and they are filthy rich on the backs of sick people. You better believe they will play dirty.

I saw Jim Clark (of SGI and Netscape fame) talk one time about his new healthcare startup (Healtheon). He said something insightful that captures a lot of why it's hard to get things done in general: one person's inefficiency is someone else's bottom line.

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

#746

Post by nobodyandproud »

shdh wrote: post #736

Legislate transparent pricing for all medications and procedures first. Paying 40 dollars for lozenges in the ER is insane. Right now the system has an opaque pricing structure which makes no sense. Force hospitals to expose API's with transparent pricing.

Also legislate transparent negotiated pricing for medications and procedures for each insurance plan, as well as rejection rates for medications and procedures.

Oh yes, and patient/coverage drop rates

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

#747

Post by cwmoore »

cwmoore wrote: post #714
nradov wrote: post #681

Earlier quoted context omitted.

So what's the solution? Some states have already limited malpractice liability but that hasn't done much to hold down costs. When patients are harmed by preventable medical errors they should be compensated.

The solution is NOT to decide on one problem at a time to all agree on solving by incremental compromise, or trust free market competition driving what is in reality a non-free market. Most patients never file a lawsuit, even if things don't go well, and most injuries that aren't deaths or newsworthy are not worth the trouble to an "overburdened" court system itself imposing a lot of burdens. And the quality life yea…

[dead]

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

#748

Post by maxlybbert »

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…

I’m saying the US won’t implement anything like what other countries implement. I honestly think Philip Greenspun’s proposal ( https://philip.greenspun.com/politics/health-care-reform ) makes sense but has no chance of being implemented. Americans asking for some kind of single payer system are expecting something better than basic health care.

I remember when President Obama suggested “maybe you’re better off not getting the surgery but taking the painkiller” ( https://youtu.be/rin4h4cRs6Y ). That seemed to surprise many of the people who wanted a single payer option. He stopped suggesting that kind of cost-cutting that very quickly.

I also remember when a few people received anthrax in the mail. Every news story said that people who had any contact with the letter had received Cipro to avoid developing an infection. After a couple of weeks, the government actually announced that other (cheaper) antibiotics were effective against anthrax, but it was obvious that no company was going to hand their employees something other than Cipro.

Incidentally, my autistic adult son has Medicaid. I don’t think I’ve yet found a doctor who will accept it. Luckily he’s also on my health insurance.

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

#749

Post by brandonb »

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.

Uncompensated care attributable from uninsured patients is ~2–3% of operating revenue/costs. So it's there but not massive.

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

#750

Post by chimeracoder »

shdh wrote: post #736

Legislate transparent pricing for all medications and procedures first. Paying 40 dollars for lozenges in the ER is insane. Right now the system has an opaque pricing structure which makes no sense. Force hospitals to expose API's with transparent pricing.

> Force hospitals to expose API's with transparent pricing.

Unless you're uninsured (which is a whole separate clusterfuck), the hospitals aren't the ones who decide how much you pay for any service - the insurance companies are. The sticker price that hospitals charge is almost meaningless and is intentionally high because it's used as the starting point for negotiations, which always bring the price down (never up). There isn't any expectation that any insurer is actually going to pay the billed amount as-is.

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