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What makes health insurance cheaper is a larger pool of people. There is no other mechanism by which costs can be reduced. This is why a single payer system is

What makes health insurance cheaper is a larger pool of people. There is no other mechanism by which costs can be reduced. This is why a single payer system is dramatically cheaper. It ensures complete coverage, reducing the cost of insurance to it's minimum. Furthermore, it leverages the collective bargaining power of all subscribers. There is no substitute for a national health insurance, and the United States slowly bleeds money, time, and health outcomes every day we continue with our current state.

fennecfoxen 7y ago
What makes health insurance cheaper is not paying for as many expensive operations per capita. While there are a host of factors making US health insurance expensive, the critical factor since 2008 is laws: laws which require that the insurance cover patients who will have very expensive operations, and do so at the same rates as other patients. The primary advantage of a national health insurance scheme is that it can ration its care for expensive operations, and people won't be able to yell "Greed, greed!" at insurance companies as a scapegoat (ignoring that the profit margins sit at about 4%, which is not exactly the sort of health insurance savings that would fix anything).
- shkkmo 7y ago
  There is little evidence to support the "US consumes too much healthcare" narrative and some good evidence that our total healthcare spending is inline with our level of wealth [0]. There is quite a bit of evidence to support the "Prices for equivalent healthcare are significantly higher in the US". [0] https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/ https://randomcriticalanalysis.com/2018/11/19/why-everything...
ksdale 7y ago
That doesn't necessarily follow. Whether or not it gets cheaper or more expensive depends on how likely the new people are to get sick compared to the other people in the pool. Adding a bunch of sick people raises the costs for everyone, adding a bunch of healthy, young people (and making them pay) lowers the costs for everyone else. I agree that at this point, we'd be far better off with a single payer system, but it's certainly not cheaper for everyone.
- kaibee 7y ago
  > Adding a bunch of sick people raises the costs for everyone Sick people without health insurance still get healthcare. They just don't pay, go bankrupt, probably cost the system way more than if they had preventative care paid for. Then they get a medical bankruptcy, the hospital eats the cost but raises prices on everyone else to stay afloat. Now, they might have a higher mortality rate and so end up not costing as much as if they had insurance from the beginning, but I think a large amount of the cost of the uninsured is already priced in.
  - ksdale 7y ago
    I agree with all of this, which is why I said I think a single payer system is the best way to go, but the parent mentioned insurance being cheaper, which it would not be. The total cost of the whole system is lower per capita when everyone participates, but the cost to certain participants is much higher, depending on what the system looked like before.
arcticbull 7y ago
Yep, it certainly does. Single-payer and socialized systems are cheaper for a lot of reasons: (1) Purchasing power of a large, single negotiating entity to reduce the cost of drugs (that's how Canada does it, and the US' solution was to allow importation of Canadian drugs, which, uh, seems circuitous). (2) No marketing expenses, no executive compensation, no claims denials, no billing, etc. This amounts to 15-20% of all healthcare spending in the US [1] -- so an instant 20% reduction right there. (3) National ability to set compensation, so you can reduce the cost of physician services too, as they're now public servants. Canadian doctors still make mid-6-figure salaries, and frankly, I'm okay with that. (4) Complete pricing transparency. Wanna know how much medical care costs in Ontario? It's all right here in one big PDF [2]. PET scan for Thyroid cancer? J702. $237.50 CAD. (5) Improved balance sheets and lower operating costs for corporations who now no longer have to deal with the medical care of their employees for no rational reason. Improved competitiveness of small businesses vs larger ones where small businesses need to offer medical care for competitive reasons and it represents a disproportionate burden. (6) People can take the risk of starting businesses without fear of death due to lack of medical care. The list of benefits goes on and on. It's time to take action. [1] https://naic-cms.org/cipr_topics/topic_medical_loss_ratio.htm https://naic-cms.org/cipr_topics/topic_medical_loss_ratio.ht... [2] http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20181115.pdf http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser...
chooseaname 7y ago
> What makes health insurance cheaper is a larger pool of people. There is no other mechanism by which costs can be reduced. They will just take the extra money and return it to shareholders. They won't reduce costs to people.
- greenonions 7y ago
  This is why I indicated that the United States needs a single payor natinoal insurance.

fennecfoxen 7y ago

What makes health insurance cheaper is not paying for as many expensive operations per capita. While there are a host of factors making US health insurance expensive, the critical factor since 2008 is laws: laws which require that the insurance cover patients who will have very expensive operations, and do so at the same rates as other patients. The primary advantage of a national health insurance scheme is that it can ration its care for expensive operations, and people won't be able to yell "Greed, greed!" at insurance companies as a scapegoat (ignoring that the profit margins sit at about 4%, which is not exactly the sort of health insurance savings that would fix anything).

shkkmo 7y ago
There is little evidence to support the "US consumes too much healthcare" narrative and some good evidence that our total healthcare spending is inline with our level of wealth [0]. There is quite a bit of evidence to support the "Prices for equivalent healthcare are significantly higher in the US". [0] https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/ https://randomcriticalanalysis.com/2018/11/19/why-everything...

ksdale 7y ago

That doesn't necessarily follow. Whether or not it gets cheaper or more expensive depends on how likely the new people are to get sick compared to the other people in the pool. Adding a bunch of sick people raises the costs for everyone, adding a bunch of healthy, young people (and making them pay) lowers the costs for everyone else. I agree that at this point, we'd be far better off with a single payer system, but it's certainly not cheaper for everyone.

kaibee 7y ago
> Adding a bunch of sick people raises the costs for everyone Sick people without health insurance still get healthcare. They just don't pay, go bankrupt, probably cost the system way more than if they had preventative care paid for. Then they get a medical bankruptcy, the hospital eats the cost but raises prices on everyone else to stay afloat. Now, they might have a higher mortality rate and so end up not costing as much as if they had insurance from the beginning, but I think a large amount of the cost of the uninsured is already priced in.
- ksdale 7y ago
  I agree with all of this, which is why I said I think a single payer system is the best way to go, but the parent mentioned insurance being cheaper, which it would not be. The total cost of the whole system is lower per capita when everyone participates, but the cost to certain participants is much higher, depending on what the system looked like before.

arcticbull 7y ago

Yep, it certainly does. Single-payer and socialized systems are cheaper for a lot of reasons: (1) Purchasing power of a large, single negotiating entity to reduce the cost of drugs (that's how Canada does it, and the US' solution was to allow importation of Canadian drugs, which, uh, seems circuitous). (2) No marketing expenses, no executive compensation, no claims denials, no billing, etc. This amounts to 15-20% of all healthcare spending in the US [1] -- so an instant 20% reduction right there. (3) National ability to set compensation, so you can reduce the cost of physician services too, as they're now public servants. Canadian doctors still make mid-6-figure salaries, and frankly, I'm okay with that. (4) Complete pricing transparency. Wanna know how much medical care costs in Ontario? It's all right here in one big PDF [2]. PET scan for Thyroid cancer? J702. $237.50 CAD. (5) Improved balance sheets and lower operating costs for corporations who now no longer have to deal with the medical care of their employees for no rational reason. Improved competitiveness of small businesses vs larger ones where small businesses need to offer medical care for competitive reasons and it represents a disproportionate burden. (6) People can take the risk of starting businesses without fear of death due to lack of medical care. The list of benefits goes on and on. It's time to take action. [1] https://naic-cms.org/cipr_topics/topic_medical_loss_ratio.htm https://naic-cms.org/cipr_topics/topic_medical_loss_ratio.ht... [2] http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20181115.pdf http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser...

chooseaname 7y ago

> What makes health insurance cheaper is a larger pool of people. There is no other mechanism by which costs can be reduced. They will just take the extra money and return it to shareholders. They won't reduce costs to people.

greenonions 7y ago
This is why I indicated that the United States needs a single payor natinoal insurance.