6 ms·

Magical thinking right here. The savings by merely switching to simplified billing are miniscule. It's also a bit magical to think that switching to single paye

• xenihn 9y ago
  > It's also a bit magical to think that switching to single payer in the USA would result in savings >There is no reason to believe that costs would go down without massive price controls (and thus, shortages/rationing) He didn't say either of those things. We can't just switch. It's not a realistic option. He's pointing something out, not saying "hey we should switch now and x would happen".
  • jquery 9y ago
    I didn't say he said them. He strongly implied them. You're being uncharitable with this reply.
• fleitz 9y ago
  Exactly. Just repeat 'free healthcare', never mind that many people in Canada can't even find a family Dr, let alone get things like MRIs. Michael Moore said we have wonderful healthcare just like Cuba, so it must be true. Oh it appears that now ERs are shutting down, but hey, free healthcare. Did I mention that you won't get a bill for dying on a waiting list if you use free healthcare in Canada? It's amazing and you can pay for it easily. Don't even have to leave your house to get free treatments. http://www.cbc.ca/news/canada/british-columbia/doctor-shortage-puts-pressure-on-small-town-ers-1.4249835 http://www.cbc.ca/news/canada/british-columbia/doctor-shorta...
  • JshWright 9y ago
    Canada beats the US in just about every metric you can imagine... From infant mortality to overall patient (and doctor) satisfaction.
    • fleitz 9y ago
      The US is dead last in the G20, Canada is 2nd last. Our system still sucks.
    • jedberg 9y ago
      That's true on average. But if you split the US into wealthy and non-wealthy, the wealthy get excellent care and have better outcomes than almost any other country, whereas the poor fare significantly worse than even many 3rd world countries. That's why people get upset when we talk about this. Some wealthy people point out that their care is far better than Canada's (which is true) while other wealthy people who care about other humans point out that while their care is better than Canada, not everyone's is. And then of course the poor in America just want to not die of totally treatable diseases.
      • fleitz 9y ago
        Exactly, so if you are a median Canadian you're getting very shitty healthcare compared to the median American. In Canada you still get really shitty outcomes for any chronic illness. Basically if any idiot can identify what problem you have heart failure, broken arm, profuse bleeding you get treated for free, and in a reasonably efficient manner. If you have anything that requires tests, scans, diagnostics, a specialist, or isn't going to kill you in the next week plan on spending 5 to 10 years on a waiting list / various waiting lists. My friend has been waiting 4 years for knee surgery that prevents her from working. One of the best things about having a private Dr in Canada is that they know how to work the system and will basically harass the list keepers to bump you up so that the keepers of the lists can go back to doing nothing. Also, most clinics have some sort of consult that you can opt for which makes the waiting list magically disappear. Get a out of pocket brain scan? Voila, brain specialist is available in 2 weeks instead of 2 years.
• whiskers08xmt 9y ago
  The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. With that being said, I agree that if every US citizen should enjoy the quality of service, that people with premium health care coverage has, it would probably be more expensive than most European single-payer systems.
  • pfisch 9y ago
    So we are about to have net neutrality repealed over the objection of everyone except ISPs basically. Medicare isn't even allowed to negotiate drug prices, but our govt run single payer system will definitely be immune from regulatory capture. Right?
    • maxerickson 9y ago
      The drug price thing is overblown. The private companies that administer Medicare Part D are free to negotiate prices and do so. http://www.kff.org/medicare/issue-brief/searching-for-savings-in-medicare-drug-price-negotiations/ http://www.kff.org/medicare/issue-brief/searching-for-saving... At the bottom it mentions saving billions of dollars by extending a Medicaid program to some Medicare drugs, but that is not negotiated, those discounts are required by law.
  • adventured 9y ago
    > The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. You're agreeing with the parent's original point. Salaries in healthcare are far higher in the US than they are in eg the UK or Germany. The US median income is significantly higher than all but a few nations. In the US we don't ration care nearly to the extent that they do in eg Canada, wait times are lower and Americans over-use (abuse) their healthcare and always have. In France a radiologist will make $150,000. In the US it's closer to $450,000. Nurses in the US will typically make 40%-50% more than nurses in Germany. Good luck hammering all of those pay scales back down without causing huge strikes. You have to remove a trillion dollars in cost from the system. Only about $100b can be removed from big pharma's cost share. You have to destroy a million jobs (eg the health insurance industry), and slash the pay for hundreds of thousands of healthcare workers by at least 20% to 30%. Even if some of those lost jobs can eventually be reclaimed, the upheaval will be epic.
• Retric 9y ago
  Medical billing is ~1/3 of all heathcare costs in the US. That's everything from doctors filling out extra paperwork to advertising and profit for insurance companies. It's not uncommon for close to half the man hours at private practice to be spent on billing related activities, doctors just get paid a lot more. Quality of care is not the only factor. Medicare spends a lot on end of life care without significant benifit. It's not a question of if there is rationing as we only have finite money, it's a question of what form it takes. Worse a lot of unnecessary procedures and medication degrade quality of life.
  • jquery 9y ago
    > Medical billing is ~1/3 of all heathcare costs in the US. Citation needed. Just looking up health insurance profits ($13B) vs. total healthcare spend ($2T) shows that profit for insurance companies is only 0.65% of the total healthcare spend.
    • hirsin 9y ago
      Medical billing would be a cost not a profit center, so I think this may support the idea, not reject it.
    • Retric 9y ago
      This takes a more restrictive view of medical billing and excludes said profits still: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/ "Conclusions: A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending." It also says "Morra and colleagues estimated annual BIR costs in physicians’ practices at $82,975 per physician in the U.S. versus $22,205 in Ontario, Canada [5], i.e., 73% lower." PS: I would say 100% of the insurance industry excluding doctor payments is medical billing and "Insurance carriers and related activities contributed $450.3 billion, or 2.6 percent, of U.S. gross domestic product in 2014, according to the U.S. Bureau of Economic Analysis." http://www.iii.org/fact-statistic/industry-overview http://www.iii.org/fact-statistic/industry-overview
    • Steko 9y ago
• atomi 9y ago
  A national single-payer spreads risk across the entire country, so states that are relatively healthy will end up paying for health care in states where people eat bbq ribs and sausage for breakfast. I like the idea of a county based single payer systems where counties manage healthcare and they are incentivized to promote healthy lifestyles.
  • BartSaM 9y ago
    This is a social responsibility. Most European countries do this, Canada does this. While not perfect, the system works. It is exposed to any other warfare system to cheaters, but I would say on a much smaller scale than unemployment benefits for example.
• bparsons 9y ago
  The United States pays more than twice per capita than Canada for healthcare, but with worse outcomes. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... The system in Canada isn't even close to the most efficient in the world. Many european countries manage to pay even less and produce even better outcomes.
  • refurb 9y ago
    You're link says nothing about outcomes. Have a source? It also depends on how you measure outcomes. The US exceeds other countries when it comes to things like cancer outcomes. It does poorly in things like life expectancy which is a terrible way to measure outcomes since so many other things other than medical care impact it.
    • bparsons 9y ago
      Access to primary care doctors, life expectancy, infant mortality, infectious disease rates. etc.
    • smcl 9y ago
      Every time US healthcare comes up the insane cost and relative poor quality is mentioned, it is met with "hmmm citation needed?" like it's not been covered to death already, then the citations are then generally ignored (like here: https://news.ycombinator.com/item?id=15136962 https://news.ycombinator.com/item?id=15136962). I do not understand why people are so defensive of such a plainly awful system
      • refurb 9y ago
        I'm asking because I'm curious how they measured outcomes. Most of the studies I've seen are pretty bad. They measure outcomes with a very blunt tool. I was curious if something better was out there.
• refurb 9y ago
  I agree with this take. A big reason why other countries have lower healthcare costs is because they ration care. I moved from a single payer system (Canada) to the US and saw exactly that. Want the best, experimental treatment for your cancer? A lot (not all) US insurance companies will pay for it. Canada? You need to wait until the gov't does it's review and says "yes". They often say no. Now, rationing is not all that bad, as obviously healthcare outcomes in the US aren't X% better (X% being the extra amount we pay for healthcare). The best analysis I've seen as to why healthcare is more expensive in the US is the McKinsey report.[1] It's a huge report, but what they did was breakdown spending in the US by category and compared it to the average across developing nations. Interesting findings: - 2/3rds of the excess spending are out-patient care (i.e. stuff that doesn't happen in the hospital). In other words, Americans get a lot more out-patient things done than in other countries - In-patient care is barely 10% higher than comparable countries - Health administration and insurance is ~50% higher, but it's not a big piece over the overall spending pie (~7%) - The US spends about ~20% less on long term care and 50% less on durables (this is shocking to me) - Finally, the US spends about 300% of other nations on healthcare investment (you'd need to look at the report to see what that means) [1]http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/accounting-for-the-cost-of-us-health-care http://www.mckinsey.com/industries/healthcare-systems-and-se...
  • stevenwoo 9y ago
    The weird stat that always sticks out to me is the maternal mortality rate being so bad in the USA versus other developed nations in spite of unrationed care. There's a big racial component in that but it doesn't explain the difference (You're more likely to die if you are a black mother in the USA, and there is no physiological reason for that.) https://www.scientificamerican.com/article/has-maternal-mortality-really-doubled-in-the-u-s/ https://www.scientificamerican.com/article/has-maternal-mort...
    • refurb 9y ago
      It's an interesting problem to find the cause of. I think some of it is due to unequal access to care, but that doesn't explain all of it. Some of it is due to how a country measures a "live" birth. Some countries say if the child dies within 24 hours of being born, it was never "alive". That certainly helps improve child mortality measures!