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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

#851

Post by ahartmetz »

ThunderSizzle wrote: post #831
jasonfarnon wrote: post #796

Earlier quoted context omitted.

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 deni…

>typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay

Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.

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

#852

Post by Barrin92 »

ThrowawayTestr wrote: post #518
xhkkffbf wrote: post #171

Earlier quoted context omitted.

If spending drops by $1t, it will come out of someone's paycheck. Yes, some are greedy folks who will be just fine making 20% less a year. But many will be nurses or hospitals or some combination of providers.

That you actually believe that is so sad. No, the money would come out of the pockets of insurance CEOs.

it would not because the margins in the insurance industry aren't high. The OP is entirely correct, insurers are a source of payment, not a driver of cost. Insurers don't benefit from hospitals charging them high prices, they try to negotiate cost down, that is their service. They don't enjoy paying hospitals more money.

What is driving the actual cost is the high expenses hospitals have, and the biggest source of that is labour cost, as in any other industry. American healthcare workers, doctors and nurses, earn about 2-3x as much as their peers in the developed world.

One of the biggest benefits of a national healthcare system for consumers is that the government becomes a monopsony buyer of healthcare workers. The British system is half as expensive because the government gets to set the prices for its healthcare workforce and that gets passed on to the patients.

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

#853

Post by anonymars »

ajross wrote: post #806
ziofill wrote: post #798

Earlier quoted context omitted.

No, overwhelmingly more people support a single payer healthcare system. The issue is that the people in Washington won’t make it a “votable” decision.

> The issue is that the people in Washington won’t make it a “votable” decision. Sorry, that's ridiculous. Universal Health Care policies are an almost 100% partisan issue. I can literally count on one hand the number of federal lawmakers who cross party lines here. The real problem is people like you refusing to vote for the people with the policy you want, as often as not as part of a bothsidesist stance designed t…

> The real problem is people like you refusing to vote for the people with the policy you want, as often as not as part of a bothsidesist stance designed to get more upvote in peer forums like HN

That's a lot of words they didn't say. It is a true statement that Congress did not give the USA single-payer healthcare nor even a public option.

Nothing about that says anything about who voted for whom, where anyone even lives for that matter, or anything about political parties.

To say this is the fault of "people like you" is out of line.

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

#854

Post by Jimega36 »

Switzerland has the system closest to the US in my experience, but with universal coverage.

As individual, you buy basic insurance costing roughly $500/month with a $2500 yearly deductible (LAMal/KVG). Applicants must be accepted even with pre-existing conditions. Post-deductible, you pay 10% co-insurance capped at roughly $800/year (no medical bankruptcy). Insurers operate basic plans as non-profit. They make their profit on optional supplemental insurance (private hospital rooms, extra benefits...) The state subsidizes basic premiums for low-income individuals. A doctor's visit is a $150 minimum, similar to the US.

What was most surprising compared to here in the US is employers pay $0 toward premiums. Funding is entirely decoupled from employment. You don't lose coverage or change plans when changing jobs.

On the negative, basic insurance does not have dental, so dental stuff is out-of-pocket and expensive.

In terms of stats, the US spends 18% of GDP on healthcare vs. 12% for Switzerland and the gain is lower stress too. Not perfect but maybe the best of both worlds.

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

#855

Post by ThunderSizzle »

ahartmetz wrote: post #851
ThunderSizzle wrote: post #831

Earlier quoted context omitted.

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 deni…

>typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.

It's even worse when they claim to be "in-network" and they make you sign that. To me, the entire point of being in network is I shouldn't have to worry about the provider filing claims correctly on my behalf, and if there is an issue, it should be on the "network" side, not my side.

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

#856

Post by Hobadee »

reverius42 wrote: post #758
chimeracoder wrote: post #750

Earlier quoted context omitted.

> 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)…

It should be illegal to charge different prices for the same thing to different customers.

That's how virtually all industries work though. The computer you are typing on right now probably costs a different amount depending on which retailer you bought it from, even though it's the same manufacturer.

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

#857

Post by doodlebugging »

That $1T that it might save is currently hitting lots of quarterly or annual reports as profits. With that much on the table I think the chances of seeing Universal Health Care here in the US are not great. The ones banking that money now will fight hard to keep it flowing into their pockets.

Real lives don't factor into their decisions, even if there are more than enough to fill a large city in this country - every year.

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

#858

Post by root_axis »

bentt wrote: post #771
frmersdog wrote: post #754

Earlier quoted context omitted.

If someone shoots some more CEOs, they'll have a change of heart. (A lot of people are going to be very mad at me about this comment, without having the awareness to understand that this is the inevitable conclusion to, "You wanna play rough, ah?!"ing people's access to life-saving treatment. Please grok that we can preclude any more assassinations by cutting profits and letting people get the care they need.)

If it were only the CEOs that were at fault you might have a point. Hundreds of thousands if not millions of Americans benefit from this system and the leaders are accountable to them - the shareholders, employees, and on down the chain. Congress is our only hope, along with a president who signs reform.

The people are in charge of congress, and they consistently show they do not support socialized healthcare systems. It will never be a politically viable path for the u.s, regardless of the economics. Even if it somehow passed, opposition would quickly sabotage and dismantle it.

Obama had a generational mandate and couldn't even pass a public option which, is far more moderate than a single payer approach. Even the abomination of the ACA that actually got signed into law was subsequently gutted to the bone in the following years.

There is room for more tweaking, but the system we're living with now is pretty close to what most voters prefer.

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

#859

Post by annzabelle »

cortesoft wrote: post #823
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…

> 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 med…

The way a lot of other countries deal with this is that the government calculates out a benefit vs cost assessment for every new treatment and only covers ones that come out ahead. But, that ends up with things like new targeted chemotherapies being unavailable for years after their initial release, vs in the US where they are available to much of the population once the right prior auth is filed. There is also more top down management of costs, such as long term life support for people in vegetative states.

All of this was branded as "death boards" in the American healthcare debate.

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

#860

Post by HDBaseT »

DrScientist wrote: post #230

As I understand it - ~30% of US federal spending is on health care. In the UK it's about 20%. Yet apparently the UK is mostly nationalised under the NHS, while in the US there is huge additional spending on private insurance. Can somebody from the US explain to me how that's the case and why American's still put up with it?

Because the US buys medicine at absurd pricing. Something that should cost dollars, costs hundreds. [0]

[0] https://aspe.hhs.gov/reports/comparing-prescription-drugs

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