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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

#831

Post by ThunderSizzle »

jasonfarnon wrote: post #796
Detrytus wrote: post #732

Earlier quoted context omitted.

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…

I'm clueless about healthcare economics, but this sounds fishy to me. Why would insurers go along with that? In fact I would expect insurers to be in a much better position to bargain with a hospital than a private party. Actually it's if the hospital were billing the govt (not as motivated as a private party) where I would expect that overcharging to creep up and up.

Insurers can only spend 15% of premiums on admin spend (e.g. salaries, etc). That means if the CEO (and everyone else) wants more money, they need to pay more money to the hospitals, so their 15% cut grows.

Also, for beyond that, unspend premiums have to be refunded, which also cuts into the potential admin spend bucket, so it's best to always ensure your paying as much as possible in claims.

Plus, patients hate denied claims, because typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay.

And with most health insurance spending being locked to employer benefits, the big market is the group market, which means your stuck with either getting your job's option(s), finding a new job, or not getting insurance basically.

In other words, you don't have a price choice as an individual in a group.

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

#832

Post by BirAdam »

karim79 wrote: post #799

As a person living in Germany I find it insane that this hasn't been solved by the US of A. What the actual hell is going on?

Regulatory capture of our legislature and regulatory bodies, intense bribery, proof of need legislation, and people consistently providing an obviously corrupt system with more money and power thinking that somehow, magically, the people who’ve obviously been corrupt and dishonest will be made angels when given more money and power.

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

#833

Post by cwmoore »

tptacek wrote: post #780
cwmoore wrote: post #740

Earlier quoted context omitted.

“We have numbers” is always refreshing, especially in a shell game. Cost of all licensed medical practitioners? Or overweighting incomes of outlier CEO physicians? 25% is a steep tax on health in any case.

At the point where you're just dismissing the CMS NHE, you're well into the terrain of unfalsifiability.

Fair enough, but it is a political topic, and there are different and more confusing slices of the healthcare system exposed to patients than org spending breakdowns. Not sure how many of this thread's comments could hold water if falsification were universally applied.

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

#834

Post by hawaiianbrah »

refurb wrote: post #773
TuringNYC wrote: post #706

Earlier quoted context omitted.

>> 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…

What hospitals makes has nothing to do with physician pay - those are separate categories. Hospitals aren’t going to magically start giving some of their profit to doctors to help cover their lower fees. OP makes a good point. The studies assumes two diametrically opposed things will happen - doctors will take a 50% pay cut but access to primary care physicians will increase. Why would we solve the primary care physi…

Allow/force medical schools to grow, increasing the provider pool, thereby reducing their pay?

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

#835

Post by [deleted] »

brandonb wrote: post #749
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.

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

[deleted]

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

#836

Post by demibabs »

goodmythical wrote: post #811
Detrytus wrote: post #732

Earlier quoted context omitted.

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…

> All for profit insurance must by definition bring in more than it pays out. From cars to homes to health to pets.

Well yes, but you are paying for reduced variance, which itself has a value.

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

#837

Post by oliyoung »

karakoram wrote: post #791
oliyoung wrote: post #783

It's crazy that universal health is the political third rail in most modern countries but for the opposite reasons In most of the world it's the policy that cannot be touched, just in Europe, Canada and Australia its _existance_ is invoilable, in the US the _introduction_ seems to be the unwinnable war

Very good point. In the UK, the NHS is on the same level as a religion. The NHS can NOT be meddled with whatsoever. Complete political suicide.

Medicare is the first scare campaign bought up in any Australian election

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

#838

Post by InTheArena »

nradov wrote: post #351
sys32768 wrote: post #194

Earlier quoted context omitted.

Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened. My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib. Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough. We had an insurance rep come to my work last year who said after AC…

Your blame is misplaced. Costs are increasing in spite of the ACA, not because of it. Pre-ACA your family insurance policy was likely worse in some key ways: it probably excluded coverage pre-existing conditions and had a lifetime maximum coverage limit.

It's almost like the real problem is hospital and medical costs versus cost of living.

)which is why as a percentage of GDP, Americans, European costs are remarkably similar, just distributed differently).

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

#839

Post by beloch »

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.

"Healthcare costs have been rising faster than inflation, and a staggering share of that spending is consumed by administrative middlemen, soaring drug prices, and emergency care for conditions that should have been treated earlier and for less"

-----

It's a n-tuple-whammy. Co-pays and deductibles discourage early diagnoses by preventing most people from visiting doctors for issues that aren't serious. The painful process of claiming the small amounts that would cover preventive care discourage people from getting it even if they've seen a doctor and been told to. Preventable conditions balloon into things that are very expensive and unpleasant. This process takes years though, and there are many, many insurance companies, plus people change jobs and coverage frequently. Odds are, the company denying preventive care won't be on the hook for the heavy costs down the road. If they are, they have ways to wriggle out of it. Also, with more people waiting until conditions get bad before seeking treatment, the whole system consumes more resources to keep people less healthy, on average, than if the system pushed preventive care effectively.

When governments assume responsibility for medical coverage, incentives start to be much less perverse. You pay taxes while you work. You work while you're healthy. So, the government wants you healthy. The government wants to do that as cheaply as possible, so they're incentivized, not just to provide preventive care, but to make sure you take advantage of it. I live in Canada. I have a genetic condition that could cause me problems if I don't get preventive care. One of my relations had those problems, so they tested her and found the problem gene. The government then tasked a genetic counsellor to seek out everyone related to her. I had the gene, so they now book me for the care I need to manage it. I don't have to pay for this. I don't have to fight insurance companies to prove I need preventive care. I just do what they ask me to do and I get to live longer. This is the kind of stuff that happens when the incentives are right.

Insurance companies need to be cut out of the loop entirely. They know they're what's wrong, so they employ expensive lobbyists. Americans need to realize this and start making it an election issue.

_______

EDIT: TIL that preventative and preventive are used interchangeably in the context of medicine, so I changed my very inconsistent use of them to just one.

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

#840

Post by purplepatrick »

This would be much easier to sell if everyone stopped referring to it in the context of “healthcare” and instead used “universal health insurance” or “universal health insurance rates”.

The number of politicians that conflate healthcare and health insurance (notwithstanding the actual convergence of the two through payers’ purchasing provider entities) is mind boggling.

Striking the word “healthcare” from the conversation would make this much more digestible for folks afraid of the “socialism boogeyman”…

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