Single-payer healthcare would save $450B and 68k lives a year: study • Hacker News Board

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#381

Post by burnte » Sat, Feb 22, 2020, 5:08 AM UTC

tptacek wrote: post #295

bduerst wrote: post #19

Earlier quoted context omitted.

I worked in the EMR software industry and have certifications that involve hospital & lab billing, among others. I've been on site with healthcare providers, and there are entire buildings full of people whose job it is just to code and scrub claims, and cover disputes/negotiations with private insurance providers. Consumers do not see it because it's typically off-site from the main hospital care facilities, but bel…

Nobody is saying there aren't real administrative savings to be had, but the amount we spend on administrative costs is something close to an empirically observable fact, and you can do the mental exercise of taking any credible number and zeroing it out to see how big an impact it would have on overall health spending. It's not huge. Which is to say that even in the most optimistic case, where single-payer forces ev…

> It's not huge.

It's massive. Healthcare is byzantine on purpose. It's opaque to patients so that providers can prevent shopping around and adjust charges per patient, and it's opaque to providers from insurers to help prevent having to pay claims.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#382

Post by tptacek » Sat, Feb 22, 2020, 5:10 AM UTC

burnte wrote: post #381

tptacek wrote: post #295

Earlier quoted context omitted.

Nobody is saying there aren't real administrative savings to be had, but the amount we spend on administrative costs is something close to an empirically observable fact, and you can do the mental exercise of taking any credible number and zeroing it out to see how big an impact it would have on overall health spending. It's not huge. Which is to say that even in the most optimistic case, where single-payer forces ev…

> It's not huge. It's massive. Healthcare is byzantine on purpose. It's opaque to patients so that providers can prevent shopping around and adjust charges per patient, and it's opaque to providers from insurers to help prevent having to pay claims.

You're saying "it's massive" and, in, like absolute terms, sure, it is; everything we do is massive, we're a huge country. But in relative terms? No. It's not massive. It's a small fraction of our total costs. The total benefits we can reap from minimizing it? Not that great. Ambitious plans based on minimizing those costs? You should be skeptical. You should be asking: how are we going to solve this huge problem by zeroing in on such a small fraction of the total problem? Maybe the answer will surprise you, but you should start by needing to be surprised by the answer.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#383

Post by ykevinator » Sat, Feb 22, 2020, 5:12 AM UTC

beat wrote: post #149

onemoresoop wrote: post #79

I'm paying nearly 20k (parents+child) on insurance I don't have time to use (and luckily no serious need) and once my son went to see his pediatrician and our 'private' insurance company (that i'm not going to name) sent us bill of $500, for a check-up. We disputed the charge with the insurance and they agreed to wave the payment next month. Next month comes and guess what? The same letter comes in mail. We disputed…

This is where I think political leaders (Democrat or Republican) could do really well. It's not just making sure people are covered. It's the existential dread of dealing with opaque, unpredictable, and incomprehensible bureaucracy that can make life-and-death decisions or drop financially crippling bills in your lap, even if you have good insurance . The American health care system isn't just bad for the poor. It's…

I'm not sure that's fair. There is only one party that has ever put forth serious health care legislation in this country. I wish we had two parties policies to debate but we don't.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#384

Post by retreatguru » Sat, Feb 22, 2020, 11:48 AM UTC

bureaucrat wrote: post #352

grecy wrote: post #296

Earlier quoted context omitted.

I live in Canada, and haven't even earned $20k of income in a few years, but I still have excellent cover. I broke my nose, was seen within 5 minutes and it was straightened (after anaesthetic). I got hit by a car on my bike, was seen in 5 minutes, no worries. Needed and x-ray for my lugs to get residency. Took 10 minutes. Free. My brother broke his leg horribly. Multiple surgeries, a month in hospital, etc. etc. The…

Don't forget 6 months waiting time for breast cancer diagnoses. Don't forget over a months waiting time for a simple antibiotic shot, which my friend died while waiting. Don't forget, can't see a doctor for two freaking weeks for a simple stomatitis. Don't forget 3+ months and waiting for a freaking endoscope procedure. For everyone not in critical situation, your country's health care is shit. Don't even deny that i…

Another Canadian here - this is not my experience at all. I have lived both in the east and west of Canada. Health services are excellent. Any issues and I just visit the hospital and they take care of it promptly and walk out not having paid a cent. Oh I think I do have a monthly charge for our entire family - something like $75 per month.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#385

Post by narag » Sat, Feb 22, 2020, 3:17 PM UTC

ve55 wrote: post #304

narag wrote: post #187

Earlier quoted context omitted.

Actually it happens. You go to the doctor with some side effect, like headaches or high blood pressure and they nudge you to go to the dietist. Of course you can refuse, but there are a lot of kind and caring professionals and you know it won't cost you money, so it works sometimes.

Right, but the keyword there is 'nudge'. If you are already having headaches and high blood pressure due to your diet, your diet should have been modified long ago. Similarly when people have cardiovascular issues and atherosclerosis, the time to change things was likely decades ago, not after they've already damaged their body so much. Sometimes these 'nudges' help patients, but getting someone to significantly alte…

Still there are much less obesity over here.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#386

Post by pnutjam » Sat, Feb 22, 2020, 3:38 PM UTC

beat wrote: post #291

pnutjam wrote: post #204

Earlier quoted context omitted.

This is literally the argument that Liz Warren and Bernie have been making, not to mention other Democrats.

Eh. I'm watching it pretty closely, and I don't hear them talking in detail about how difficult it is.

https://elizabethwarren.com/plans/health-care

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#387

Post by shoo » Sat, Feb 22, 2020, 4:21 PM UTC

TheAlpacalypse wrote: post #349

codegeek wrote: post #243

Earlier quoted context omitted.

I wish i could upvote you 1000 times. Why is it so hard for many people to understand all of this ?

Because it takes advantage of risk. OP's gamble pays off if he never has an emergency, but if he ever pays more than 20k on doctors visits he's fucked. Granted, that doesn't often happen. But it's a risk that most people can't afford.

> but if he ever pays more than 20k on doctors visits he's fucked.

I agree with the general point that there's more risk, but it doesn't logically follow that if you pay more than 20k in a given year you are ruined, compared to if you'd taken the insurance policy. Suppose you were paying 20k / year minimum for "insurance", needed some healthcare, and ended up paying 25k = 20k for the cost of the "insurance" and another 5k out of pocket that wasn't covered. Does that mean you're ruined even if you do take insurance?

To make a better argument we'd need to understand how much wealth & income & expenses someone has, and if they're able to set aside spare cash (perhaps in an investment account) that's saved in the good years by not paying for insurance, that can be used to cover or partially cover expenses in the years where healthcare expenses are high.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#388

Post by jrs235 » Sat, Feb 22, 2020, 4:31 PM UTC

leetcrew wrote: post #353

jrs235 wrote: post #331

Earlier quoted context omitted.

And the really crazy and stupid thing is why are we burdening our doctors with knowing whether someone's insurance plan covers their services? Doctors ought to focus their time and talent on treating people and illnesses, not trying to calculate bills for patients.

on its face, I don't think this is as crazy as you make it seem. it's just that the complexities of medical billing has become too much for the doctor to understand and convey to the patient. can you think of any other role where a professional interfacing directly with customers wouldn't be expected to at least estimate how much the service will cost them?

I think I understand your point.

However, a car body shop can estimate how much it will cost to fix up my vehicle after a collision with a deer. Those professionals can provide an estimate based on the amount of effort and materials they believe are required. But they don't sit there and try and tell me how much my insurance will pay and how much I will have to pay out of pocket or if my insurance will cover any of the bill.

Obviously in the situation above, time isn't of the essence as much as it might potentially be for a medical issue.

Knowing the "hourly" rates and what treatments may be needed can allow a doctor to estimate the total cost range from a low end to the high end (might be $200 for simple diagnostic and we find nothing more to treat to $2,000,000 if as we progress done the rabbit trail we find evidence that leads up to more tests and it turns out to be cancer). Medical issues are like software development. You don't know what you don't know so God only knows how much effort (cost) will be involved. We can give estimates but the doctor and the software developer shouldn't be trying to figure out if the work involved is covered by external requirements (what and how much will medical insurance cover or does this development qualify for some tax credit or is considered sufficient to fall under some contractual constraint/requirement higher up). Should we expect software developers to know and understand tax laws? Should we expect doctors to know everyone's insurance plans and coverages?

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#389

Post by gremlinsinc » Sat, Feb 22, 2020, 5:01 PM UTC

meheleventyone wrote: post #276

codegeek wrote: post #148

Earlier quoted context omitted.

For a family of 4, I pay total of about 20K per year as well (employer + employee cost) and even after that, we have a $5000 deductible AND on top, we have to be concerned about in-network/out of network bullshit. So for me, unless $25,000 has been spent, insurance company would not even come in the picture AND I am always scared if I wil get a bill that was out of network. This madness has to end and I don't give a…

The seemingly (to me) crazy thing is that private insurance in places with single payer healthcare aren’t like this at all. Our entire insurance bill for everything from healthcare to house insurance for a family of four is less than a quarter of that. There’s even pretty affordable private GP clinics where I’d never even think about using my insurance. It’s reasonably common to have private healthcare insurance for…

Part of the administrative savings though is the fact that $0 dollars is spent to essentially what amounts to 'billing' agencies. Every $ spent on medical billers in hospitals, lawyers contesting claims, etc... can better be spent inside hospitals and research labs, etc.. John Oliver said basically our plan does go above and beyond all other plans, covers more, etc... so it's basically the utopia of plans.

Of course it's probably better to start at utopia and get semi-utopia than start at the public option and only get the public option.

I can see maybe something bigger to cover things like maybe subsidies for fertility which my wife's really concerned about - because there's a LOT of emotional depression related to that, and maybe even adoption which sort of ties into fertility.

Though, I'd definitely be happy w/ lesser I mean what we have now is murderous.

Re: Single-payer healthcare would save $450B and 68k lives a year: study

#390

Post by Can_Not » Sat, Feb 22, 2020, 5:41 PM UTC

leetcrew wrote: post #350

mrep wrote: post #336

Earlier quoted context omitted.

My max out of pocket spending is $2,600 a year and I can put $3,500 pretax money into my HSA every year which I do. What I am supposed to worried about?

I have a similar plan and a good income. I am in good health and I make my yearly budget assuming I might have to pay the out of pocket max if I have a health problem. the usual "gotcha" that people mention is going in for a planned procedure and accidentally receiving care from an out-of-network physician. this makes your out of pocket max irrelevant. I've never had this happen to me and I have no idea how often it…

> I've never had this happen to me and I have no idea how often it actually occurs (outliers are always the loudest on the internet),

I've never been to a doctor without a ridiculous "outlier" scenario following the visit for months.