I have wondered if an option would be to have a state make it law that every 4 or 5 years they open the bidding for a health care insurance provider for the entire state. A state committee then takes the bid with best premiums to services ratio and they do the job for the contract term. There would still be the option of people and businesses to buy 3rd party "extras" like private hospital rooms, vision care etc. on…
You’re proposing a rational option on an issue where irrational dogma has taken hold
the "irrational dogma" you speak of is simply the status quo in all other civilized countries.
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.
Right.... but it is also an industry that provides an insane amount of (often well paying) jobs to a large amount of people to do "make work", admin tasks. Reliable details are hard to come by, but some estimations are that more people in the industry are doing admin tasks than instead of providing care, admin tasks that will be reduced drastically once the industry is streamlined. Once we get affordable care there w…
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…
> Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
Would this go away, though? Instead of fighting with insurers they would be fighting with the government insurer?
I am very pro universal healthcare, I just don’t want to pretend there aren’t still going to be fights over what should be paid for.
No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
Universal Health Coverage has a lot of other benefits: 1. It detaches health insurance from the employment market. This means those minimum wage walmart jobs just became more feasible, or any low end job really, since their is no pressure to provide "benefits" anymore. This would seriously lubricate the labor market, because the friction to providing, taking, and changing a job is reduced. 2. It ends a bias for group…
As a Canadian, I would caution against the kind of universal health plan we have. But yes I agree there should be some kind of public healthcare. Perhaps more as a government owned hospitals and clinics alongside the private ones rather than the fully public system we have here which comes with its own host of problems. I think it's easy to shout free healthcare as a slogan but I think the important bit is how it's i…
I don't think anyone really envies the American system. We have all the capacity problems that you guys do up north, and we pay a lot more out of our own pockets for the pleasure. Our results are also worse.
I don't think anyone from any country thinks their healthcare system is perfect or even sufficient. It all kind of stinks although some countries it is easier to solve problems with above average money (but not if you are average). We need to fundamentally figure out how to do more with less, automation (AI) could help out a lot here and I don't care about purists who want hand crafted artisanal advice about how they need to lose weight or they will die of a heart attack. But otherwise, a lot of problems exist just due to bad incentives.
It’s more like a politically palatable Rube Goldberg machine for transferring costs to those (well-insured through their jobs, the Federal government, rich supporting institutions and donors) able to pay.
Nice comment, and true enough, but $37 aspirin and similar is a criminal fraud, and so are the laws not treating it for the coercive robbery it is.
The laws that define criminal fraud are themselves fraudulent?
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.
The flip side of Bezos' "your margin is my opportunity". But that's for competitive markets, not for heavily regulated multi-party setups with minimal competition. That's the real wonder of American healthcare, as it manages to neither be a good market, nor to have regulator mercilessly going after the largest profit centers. Near the worst of both worlds.
This is a top-level example but you do not have to look at the top, really. The whole private insurance system is a scam at every level. I mean: I immigrated to US couple years ago, and I can tell you that any hospital visit, or a diagnostics, such as CT scan or ultrasound are 15-20x more expensive here than in my home country (which is in the EU). Funny thing is: if you tell the hospital that you do not have an insu…
>The whole private insurance system is a scam at every level. All for profit insurance must by definition bring in more than it pays out. From cars to homes to health to pets. If instead of paying all your premiums, you'd be far more likely to be able to afford the services that the insurers are supposedly paying for. Like, yeah, there's a chance you need a new engine, and a small chance that all of your monthly car…
On car insurance, you have a competitive market with actuaries trying to identify actual risks, and that, with their prices, modify bad behavior and purchases of cars that are expensive to repair. So all in all, you can end up with very narrow margins, and end up ahead only on the float between receiving premiums and paying out. Health insurance, especially how it works in the US, with no public system williyto cover all the expensive stuff for catastrophic situations and chronic conditions, would compete by trying to fail to insure risky people. But since most insurance is handled by employers, all the levers for that fail too, so it's an especially bad insurance system. Home insurance, car insurance, normal life insurance... all more competitive and more beneficial economically, as their efforts lower costs overall.
Nobody, including congress, gives a rat's ass about insurance companies and their profits. The truth is that someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision. After the CEO of United Healthcare was gunned down in the streets for doing that thankless job do you think congress is saying to themselves "hey, maybe we should get into that…
> someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision That's another lie you've been told and believed. With Universal Healthcare the government just provides the funding. Medical decisions are made by Doctors.
>With Universal Healthcare the government just provides the funding.
And what makes you think that they fund everything? I support universal healthcare as well (I'm literally Canadian), but I can accept that there are tradeoffs associated with it.
I'm sure there are qualifiers and rationalizations when comparing cancer survival statistics as well. As someone already pointed out, uninsured Americans aren't necessarily included. They cited sources, you rebutted without sources. I believe a single payer system is a matter of when not if . It works just fine in other countries. In our country, the healthcare industry has evolved into extracting as many dollars as…
Uninsured Americans are in fact universally included in death statistics and in cancer survival outcomes; we have top-tier cancer outcomes. Europe has several universal coverage systems without single payer. The original sin of the US system isn't private insurance, it's employment-based coverage; that's the thing nobody else has.
Again, you cite zero sources. Survival rates for lung cancer in the USA, the most common cancer in the world, are much lower than Japan and South Korea. South Korea is single payer and Japan has strict government regulation of healthcare costs.
The second most common cancer is Breast Cancer. The USA is "top-tier" but so is pretty much every other Western Country. Australia, also famously single-payer is a mere 0.4% behind the USA.
This is the only source of modern survival statistics by country:
Take note of two things: First, some states weren't even included in the study and second, there is no mention of insurance. The statistics are only tracking people who were diagnosed with cancer. It's reasonable to assume that some people who had cancer symptoms did not seek treatment because they didn't have insurance and died without being diagnosed.