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

• lwb 7y ago
  Is this Bernie's plan? I know there are subtle but important differences between all the different varieties of "universal healthcare" that exist in the world. The Twitter account @BadEconTakes enumerated something about this in a recent post: https://twitter.com/BadEconTakes/status/1228143455399858176/photo/1 https://twitter.com/BadEconTakes/status/1228143455399858176/... Excuse their obvious bias against it; I wonder what the difference in expected savings (money + lives) might be between all these different variations on the same theme.
  • secabeen 7y ago
    The fundamental challenge of any universal health care system is that to cut our spending on health care to the level of other western industrialized countries will take $1 Trillion of annual revenue out of the existing system. There's going to be a lot of disruption and people who need new jobs when that revenue goes to other things in our economy.
    • Loughla 7y ago
      Real question, not snarky: Why is this sort of downsizing always wrong for white-collar workers when blue-collar workers have been dealing with it for decades?
      • koolba 7y ago
        There’s a huge difference between downsizing caused by economic forces of the private sector and downsizing caused by outright elimination of an industry by elected officials.
        • herbstein 7y ago
          But that line is massively blurred when said downsizing of blue collar workers is a direct (and known) result of free trade agreements made by elected officials. You're adding one step to the chain, but the chain is still there.
        • ablekh 7y ago
          Healthcare (as some other sectors) is full of inefficiencies and removing or, at least, reducing them cannot be seriously labeled as "elimination of an industry". I don't see how job market restructuring in healthcare industry due to proposed transition to the single payer model is different in its essence from potential significant job market restructuring across various industry sectors due to automation trend.
        • asdff 7y ago
          Sometimes you need the public government to step in and shut down malignant private industries.
    • tropo 7y ago
      Roughly, that is 20 million jobs lost. (assume $50,000 each) Cutting $1 trillion is a change that affects 5% of GDP. This issue is part of why Obamacare kept the insurance companies. Killing jobs didn't go over well.
      • n9 7y ago
        Looks like 1.7m jobs, not 20. I guess some folks make a whole lot more than 50k.
    • burkaman 7y ago
      > There's going to be a lot of disruption and people who need new jobs when that revenue goes to other things in our economy. From the paper: "Improvements in system efficiency, such as reductions in billing tasks, will involve a contraction of the workforce. Although the country will benefit from lower costs, 936 000 administrative positions and 746 600 positions in the health-care insurance industry are estimated to become redundant. However, detailed transition plans have suggested either funding for early retirement options, extensive severance, retraining programmes, and relocation expenses for all workers in these sectors. Implementation of such a plan is estimated to cost $61·5 billion annually over 2 years, a sum which would be recouped within the first year by the health-care savings estimated here." https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext#seccestitle90 https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
  • cagenut 7y ago
    Yes. The summary explicitly references the "Medicare for All Act", which is technically Pramila Jayapal's bill in the house[1]. That is the specific legislation Bernie is campaigning for when he says "our plan". It checks all four of those boxes in your linked tweet. The study also directly cites Sanders twice (to explain where they get their parameters). [1] - https://www.congress.gov/bill/116th-congress/house-bill/1384 https://www.congress.gov/bill/116th-congress/house-bill/1384
  • fernandotakai 7y ago
    i'm not american, so excuse me for the lack of knowledge, but i've heard that bernie plans to ban private insurance. is that right? i mean, that seems like a really bad idea -- if you have money, why wouldn't you get better health care? edit: btw i live in a country with the largest public health care system in the world https://en.wikipedia.org/wiki/Sistema_%C3%9Anico_de_Sa%C3%BAde https://en.wikipedia.org/wiki/Sistema_%C3%9Anico_de_Sa%C3%BA... and we never banned private health care because... well, even with the best public health care system, you will still have to wait a lot to get any procedure done. so if you can afford, you can pay for private health care and get stuff done faster. it doesn't mean that public health doesn't work -- it works quite well, it's just that you have to wait a lot sometimes for some procedures.
    • ameister14 7y ago
      I don't believe he'd ban supplemental insurance, just insurance that covers the same services the State option covers.
      • fernandotakai 7y ago
        but... why? i mean, if i can afford it, i would want private health care because it's usually less crowded and you can have stuff done a lot faster. for example: a friend of mine had to wait 6mo to do a vasectomy through our public health care system. another friend waited 2w to do his (through private health care) if you could afford it, wouldn't it be better to pay for it? for me (and maybe i'm completely in the wrong here) it's like public transportation vs cabs/uber. i know i can take public transportation everywhere, but sometimes i'm in a hurry so i just get an uber. it doesn't mean other people can't use public transportation, it's just that i'm in a hurry and i need to get somewhere faster.
        • ameister14 7y ago
          For the single payer system to work as Bernie has set it up, everyone must be within coverage.
• deleted 7y ago
  [deleted]
• oxide 7y ago
  I appreciate that they took the time and expense to create a proper study looking at the numbers.
• jays 7y ago
  It’s hard not to appreciate the cost savings, saved lives, and benefits employees and employers would see from universal healthcare. Has anyone seen any studies on the potential impact it would have on insurance and medical administration industries? i.e. lost revenue, jobs, etc.?
  • jkingsbery 7y ago
    Many of us appreciate these benefits, just we think that they would not come to fruition.
  • mullingitover 7y ago
    > Has anyone seen any studies on the potential impact it would have on insurance and medical administration industries? i.e. lost revenue, jobs, etc.? I wonder about this in the same way I wonder about a world where we have professional window breakers, and what effects it would have on the window repair industry if we stopped having people go around breaking windows.
    • ThrowawayR2 7y ago
      Unfortunately, they can protest, lobby, and, shall we say, make unfortunate voting choices even after being unemployed, so it might be wise to rethink that opinion. Any changes that are made need to be gradual enough to allow them to transition to other careers or political instability will follow.
    • throwawayhhakdl 7y ago
      New Jersey gas pumpers seem like a close approximation here. They provide a legally mandated service which I find makes my day worse.
  • aqme28 7y ago
    Yes, in the study. TLDR: extensive severance, retraining, relocation, and retirement programs for less than the amount of money saved. "Improvements in system efficiency, such as reductions in billing tasks, will involve a contraction of the workforce. Although the country will benefit from lower costs, 936 000 administrative positions and 746 600 positions in the health-care insurance industry are estimated to become redundant. However, detailed transition plans have suggested either funding for early retirement options, extensive severance, retraining programmes, and relocation expenses for all workers in these sectors. Implementation of such a plan is estimated to cost $61·5 billion annually over 2 years, a sum which would be recouped within the first year by the health-care savings estimated here."
• dboreham 7y ago
  As Churchill said... “You can always count on the Americans to do the right thing. After they have tried everything else.”
  • grayed-down 7y ago
    Would the right thing be single-payer or what would have to replace it once the economy and the medical profession have been destroyed?
    • scottmcf 7y ago
      Alarmist nonsense.
      • grayed-down 7y ago
        We'll see. I've got enough money to survive single-payer, do you?
        • codegeek 7y ago
          I am rich enough but running out of money every year to pay for Insurance Companies profits. So yea.
    • rdlw 7y ago
      When does this collapse happen? We've had single payer healthcare up here for 58 years, it looks like Germany's had some form of it for 137 years. Should I be buying gold to prepare for year 140?
    • ChrisClark 7y ago
      Will someone please think of the billionaires?
    • 1121redblackgo 7y ago
      https://en.wikipedia.org/wiki/Loaded_question https://en.wikipedia.org/wiki/Loaded_question
• mgraczyk 7y ago
  In the study, nearly all the computed savings comes from two sources. 1. Decrease in pharmaceutical costs as a result of better bargaining power. 2. Decrease in administrative overhead, calculated by extrapolating the overhead in medicare to the entire US healthcare economy. I don't have an informed opinion on either of these estimates, but my intuition is that #1 seems reasonable while #2 seems unlikely. The justifications they give include lower executive salaries and decreased fraud. From what I have been told by healthcare professionals, medicare has less incentive to negotiate cost, less incentive to investigate fraud, and therefore lower administrative cost.
  • ameister14 7y ago
    I believe they say $100 billion will come from the lower average reimbursement rates, something that is also pretty unrealistic to think will continue.
  • bduerst 7y ago
    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 believe me, the administrative savings potential is real.
    • anonsivalley652 7y ago
      IIRC, coding is on the order of a million jobs across insurance, hospitals and doctor offices. Then there's all the other non-value-add activities of negotiating of prices, authorizing/denying treatment, billing and management. Oh and there's going through bankruptcy while you have cancer... I forgot that one.
    • mochomocha 7y ago
      I once worked at a US biotech startup getting paid by insurers where we would build ML models just to reverse-engineer the inconsistencies of CPT coding & claim reimbursement by insurers & hospitals so we could get paid. Basically trying to automate "learn that Karen at insurer X processing claims wiht code Y from hospital Z usually decides to reimburse $XX". This whole idea of "free market is more efficient for healthcare" has to die. All the incentives are backwards. For example: insurers don't want efficient claim processing because that means less revenues for them.
• threeseed 7y ago
  Pretty disingenuous study. If you move to a Medicare for All policy it would shift employer health care costs to the government. Which they would never be able to financially support especially with the challenges of an ageing population and excessive debt. And so when they say it saves $450b it's not taxpayers. It's mostly employers. There is a reason that countries that started with M4A e.g. Australia, UK have all transitioned to a public-private mix because it's simply not sustainable otherwise.
  • aaomidi 7y ago
    No, it's because big interests have paid them to decrease taxation on the top earners. There is a reason the income gap between different classes of the population is growing larger. That income gap is what should be funding these. Policies of austerity are a direct result of the rich getting richer, not that it's not sustainable.
  • three_seagrass 7y ago
    That's why the Medicare for all will still be funded, in part, through a business tax. The difference being you've removed the for-profit middlemen, so the healthcare costs are less for businesses than the privatized hybrid version we have now.
    • fjp 7y ago
      The important issue with Warren's "plan" is that it's essentially a $8,000 per year per employee head tax, so it's a regressive tax. An afterthought in the expense of hiring a very highly-paid employee, but a not-insignificant expense of hiring a lower-paid employee. Not to mention that her plan exempts contractors and business under 50 employees, so it incentivizes businesses to to lean on contract labor or reorganize themselves into smaller sub-companies - a small paperwork expense in the scheme of things. The business tax should be universal to stamp out avoidance and scaled to all payroll spend so it's at least not regressive, even if it's not a progressive tax.
      • threeseed 7y ago
• jkingsbery 7y ago
  > "Furthermore, we estimate that ensuring health-care access for all Americans" From many anecdotes I've read about medicine in socialized countries, it's unwise to assume that having insurance is the same as access. Many procedures are made unavailable due to being considered cost effective by The Single Payer, and the wait time for specialists can often be long. Further, what counts as "costs" in US health industry is kind of funny - health care providers have a book-price that is often inflated, so that insurance companies can claim to their customers (mostly employers) what a good job they do in reducing costs. For the opposite perspective, some of these points are discussed in much more detail in these two recent EconTalk episodes: * https://www.econtalk.org/marty-makary-on-the-price-we-pay/ https://www.econtalk.org/marty-makary-on-the-price-we-pay/ * https://www.econtalk.org/keith-smith-on-free-market-health-care/ https://www.econtalk.org/keith-smith-on-free-market-health-c...
  • notatoad 7y ago
    >Many procedures are made unavailable due to being considered cost effective by The Single Payer whether the insurance is coming from a single payer or a private company, access to health care does not mean unrestricted access to any medical procedure you want. Private insurers also deny treatments that aren't considered to be cost effective.
    • Loughla 7y ago
      That's what I've never understood about the arguments against single payer: >You can't pick your own doctor I already can't. If they're in network, I'm good, but if they're out of network - like my doctor was - then I have to find a new one. >You can't pick your treatments My spouse was denied medication by an insurance company because it was too new. So. >You don't get to have all the healthcare you want I already have to have pre-approval for anything up to and including emergency surgery according to my annual medical contract. So that's out the window, too. And I have good insurance through a respectable company who may or may not have a name that rhymes with smue-smoss smue-smield. Not sure what other arguments there are.
      • 7y ago
• newguy1234 7y ago
  What I don't get is how do 37 million Americans not have health insurance when the ACA was suppose to fix that issue? All of the plans are adjusted based on your income level and you get a tax credit if you are low income. If you are very poor then you get free healthcare....
  • opencl 7y ago
    You have to be really poor to get Medicaid in most states. Yes there are relatively cheap subsidized insurance options for people not quite poor enough to get Medicaid but the deductibles are so high that these same people will end up broke before the insurance even starts paying out so they see no point in buying it.
  • ar-nelson 7y ago
    When I was working as a software development contractor, I went without health insurance for a year. I'm young and I don't have any medical problems, so I could get away with this. Because I'm a software developer and I make decent money, I didn't qualify for any tax credits or discounts. The cheapest health insurance plan that I could find cost twice as much as just paying both the ACA penalty and the Massachusetts state penalty. It made more financial sense to just go without insurance. I can imagine that a lot of young software developers and other people who do contract work find themselves in similar situations.
    • newguy1234 7y ago
      That may work but only if you don't have any significant assets. If you do then you risk getting a massive medical bill and then the hospital will go after all your assets.
  • foota 7y ago
    I don't believe anyone but the very impoverished get free health care, and I believe the subsidies vary by state. See the bottom of this for a graphic: https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca https://www.commonwealthfund.org/publications/issue-briefs/2... also the removal of the individual mandate probably contributed to the gap.
• deleted 7y ago
  [deleted]
• Olscore 7y ago
  Fundamentally, it is disgusting we are forced by government to buy insurance products (e.g., car, health) provided by for-profit companies; however, I do not support universal healthcare either. The government has zero ability to control its expenditure, because the electorate vote themselves benefits. The long-term financial incentives to maintain a functioning society are all broken because of the misaligned short-term (vote for me, get free stuff) and long-term incentives (debt reduction, financial management, business planning and other investments.) Voters are simply looting the treasury at this point. It is a shame. I cannot believe anyone actually buys into the notion that government will fix problems, or somehow do a better job than what already exists. The candidates are just handing you money from your own pockets, and skimming off the top. It's so damn dumb.
  • pjc50 7y ago
    So that makes it OK for how many people to die due to lack of insulin?
  • SketchySeaBeast 7y ago
    > The government has zero ability to control its expenditure, because the electorate vote themselves benefits. Could you give me some examples of this? Living in a nation with universal healthcare, I've never seen this.
    • Olscore 7y ago
      What else would you call students voting for loan forgiveness? Point blank the candidate is effectively saying, "we will give you $xx,xxx" in the form of loan forgiveness. It is the same for healthcare. This is a literal voting for benefits; and, this creates perverse incentives for the electorate to vote for whomever will "pay them" the most for their vote. Candidates are simply buying votes by offering free stuff with taxpayer monies. It is completely broken at this point with one candidate trying to out-give the next.
      • fzeroracer 7y ago
        So let's say that the roads in my town are broken. No one can drive on them because they're filled with potholes. One candidate says that they're going to reorganize the local government so that our roads will be fixed. With your argument, that candidate is trying to bribe voters in order to get into office and the voters are simply voting for benefits.
• fmakunbound 7y ago
  Well there you have it, I guess. Thinking in the small, I wonder how it would have affected that Rabies shot treatment I had to get that ended up costing me $25,000 and the fucking thing wasn't even infected.
• macinjosh 7y ago
  I am sure, on paper, it is a brilliant plan. Unfortunately, reality and human behavior almost never follow the plan. Is waste, fraud, and abuse taken into account at all in this study? What about the inevitable changes to consumers' motivation, behavior, and decision making around healthcare? It will change drastically as the cost of their care is even further removed from them than it is now. People who have a proclivity to go to the doctor too much will go even more when its 'free'. Younger people who eschew doctors because it interferes with their current lifestyle will feel even safer continuing bad health habits because free care will be there for them later in life. Why should I subsidize other people's bad decision making? EDIT: All healthcare is really too broad of category for government funding. Obvious things like cosmetic surgery and others are already excluded from consideration because they are not necessary. But IMO even when medical care is necessary I don't think it always falls into the category of something society should pay for. How many ER visits, ambulance rides, and surgeries a year can be attributed to purposeful recklessness by an individual? If someone decides it is a good idea to stand on a motorcycle's seat on the freeway and then crashes, why should the public pay for that? On the other hand people who have medical issues that are no fault of their own do deserve care.
  • elicash 7y ago
    Let's take smoking as an example. You think there are people out there who will smoke, knowing that it causes lung cancer, because they figure government will pick up the tab for the chemo? Bizarre, but ok, if so, why doesn't having insurance give them the same incentive?
    • dx87 7y ago
      My wife's aunt has been on disability for years because she hurt her back and refuses to quit smoking. The doctors said the smoking is preventing her back from healing correctly, and 3 back surgeries later, she still hasn't quit. Because she's poor and on disability, she doesn't have to pay for any of it, and is pefectly content sitting in her trailer watching TV and taking pain killers as her health deteriorates.
      • 7y ago
• legitster 7y ago
  The net savings would be $450B, but the total cost would still be in the 10s of trillions of dollars (Edit: 30-50 over 10 years), bigger than all of our federal spending combined. It's one thing to have as an objective, and another as a plan for getting there. The proposal they cite would make federal healthcare expenditures 69%(!!!) of the GDP (Edit: total federal expenditures). It's simply not realistic to convert our entire economy into a government and healthcare first system within only 4 years. These calculations also ignore any affects of changed consumer preferences if you eliminate copays and deductibles, something no other universal healthcare system has done. This is one of those calculations that is entirely accurate, but also entirely misleading.
  • nbp160130 7y ago
    The "10s of trillions of dollars" estimates you see are for 10 years of projected spending, not for one year.
    • legitster 7y ago
      Thanks. Good correction.
  • deleted 7y ago
    [deleted]
  • Denvercoder9 7y ago
    > but the total cost would still be in the 10s of trillions of dollars Source? The linked study gives it at $3.034 trillion/year. That's on the lower end, but consistent with all other studies for single-payer healthcare I've seen, which price it in the $3-$5 trillion/year range. Note that the US is already spending $3.5 trillion/year on healthcare.
  • cameronh90 7y ago
    "eliminate copays and deductibles, something no other universal healthcare system has done." Scottish NHS has no deductibles or copays in general, dentist has an fee for some people though. English system has a flat prescription fee of £9 or so for a minority of the population up to £100ish a year. It's very close to free at the point of use, however.
• zombieZygote 7y ago
  Deregulate the business side of the industry, tell the government to govern and stop worrying about health insurance, and let the market cull the inefficient, overpriced providers. The health care system has been jacked since government/employers got involved. Insurance is a product. Health is ultimately up to the individual. The whole ting is a smoke and mirrors racket imo.
• markroseman 7y ago
  That also doesn't factor in the indirect benefits to the economy, like all the people who can't start a new business (etc.), being stuck in jobs they don't want because if they left they'd lose their benefits.
  • bduerst 7y ago
    Or the boon from not having one of the highest infant mortality rates in the developed world.
    • burkaman 7y ago
      The US also has the highest rate of maternal mortality in the developed world. https://www.propublica.org/article/lost-mothers-maternal-health-died-childbirth-pregnancy https://www.propublica.org/article/lost-mothers-maternal-hea...
      • sjg007 7y ago
        Yeah that's because a lot of US obgyns don't follow standard checklist protocols. They don't even study it properly. I think the UK has the best one and I know California uses it. Is it a question of treating the birth as a medical event or as something else? I've read about doctors who have given birth at a hospital and died and the death was preventable. Other possible factors could be a lack of prenatal care or (and this is separate) births outside of a hospital / medical setting.
    • harambaebae69 7y ago
      I'm not defending the US healthcare system, which is deeply broken, but the particular statistic on infant morality rate can be deceiving. For example: "...very low-birth-weight infants who are at high risk of dying within the first day tend to be counted as live births. In countries where the health care system does not place the same emphasis on neonatal intensive care, the outcomes of such pregnancies are not likely to be recorded as live births. Hence, it appears that the more resources a country's health care system places on saving high-risk newborns, the more likely its registration will report a higher IMR" [0] [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193257/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193257/
• deleted 7y ago
  [deleted]
• VHRanger 7y ago
  The study's methodology is awful as described here: https://www.reddit.com/r/neoliberal/comments/f4uk13/a_critique_of_the_lancets_medicare_for_all_study https://www.reddit.com/r/neoliberal/comments/f4uk13/a_critiq... Not sure how it even got published
• ve55 7y ago
  I dislike how often I see justifications for the sources of inadequacies of current systems supposedly shown by comparing different countries to the US. An example of this in the paper is when they state that the US has more expensive healthcare, but yet worse metrics such as life expectancy. As the differences in healthcare systems between the US and these other comparison countries are obvious, they want to clearly imply causation here. But, when comparing one country to another country, you are changing so many variables at once that it doesn't allow you to conclude the source or causality of these differences. They may still be partially right, but it is nowhere near proven. While the US does have more expensive health care, it also has higher real incomes, which seem to correlate strongly with this (see the first two images on https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/ https://randomcriticalanalysis.com/why-conventional-wisdom-o...). While the US does have a worse life expectancy than many 'comparable' countries, it also has significantly worse problems of obesity and drug overdoses, which when controlled for eliminate a large amount of the discrepancy. Some parts of the paper are definitely reasonable and generally agreed-upon, but it's quite clear they had a specific goal and political call-to-action set in their minds when writing it.
  • zanny 7y ago
    > has significantly worse problems of obesity and drug overdoses Which can easily be caused by a destructive and broken healthcare system leaving the ill unable to seek treatment and thus left to fend for themselves. Even for those with insurance the costs - in time, in bureaucracy, in often money when your insurance provider refuses to cover - are unreasonable to consider seeing a doctor in a thousandfold situations that Europeans never even second guess. Because they don't need a waist deep paper trail to go to their physician, because they won't get a dozen different bill collectors harassing them in every legally gray way possible, because they don't need to break out the checkbook on the way out to pay the minimum barrier to entry extortion at the end.
    • ve55 7y ago
      The reason I disagree with this is because our healthcare system is largely built upon treating someone after they have an apparent issue, instead of preventing the issue. It seems very difficult for a healthcare system to stop someone from becoming obese to begin with, or stop someone from abusing drugs that is intent on it and not seeing anyone intentionally, or stop problems like depression by their root cause instead of attempting to fix all of these things afterwards. I'd be surprised if you really think a healthcare system by itself could be powerful enough to stop obesity.
• stuff4ben 7y ago
  why is this on HN? Leave the political discourse to Reddit and other ilk like it. This is my safe space!
  • skrowl 7y ago
    Because a lot of liberals post here and liberals love telling you about their opinions on stuff like this. Flag, hope that mods do the right thing and realize this isn't on topic for HN, and move on.
• onemoresoop 7y ago
  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 it again and again the month after when the bill was sent to us the third time. This is been happening for 6 months and don't take it seriously anymore, I don't have time to waste. I realize that a lot of money goes to waste on a system that is not working even if you're paying a lot. It is utterly broken. Downright revolting. And on top of it I get a better deal if I use no insurance at all for prescriptions. Then what am I paying for? Emergencies? I am paying nearly 20k a year for possible emergencies? It's become so complicated that nothing can be reasoned about it, this is a monster that has to be killed with fire then drowned in deep waters.
  • pfarnsworth 7y ago
    I was in the hospital over Christmas because of a very severe infection. I was there for 2 weeks, and am lucky to be alive. The costs were over $150k, but I ended up paying $1500 in various deductibles to Kaiser, etc. I was happy to pay $1500 and am alive because of the care that I got. I pay about $6000 a year in medical insurance per year through my employer and it ended up being totally worth it. Not a few weeks previous, one of my children was rushed via ambulance to the same hospital because of an anaphylactic reaction. So yes, much of your costs are for possible emergencies and especially as you get older, your costs increase.
    • onemoresoop 7y ago
      Yes, I know and that's why I am still paying. But seriously, we are paying for emergencies, this should be stated when paying for the insurance. Second, why were the costs $150000?
      • nthj 7y ago
        It’s right in the name. It’s called Insurance, not Healthcare as a Service.
• xmly 7y ago
  Universal Care = Medicare + Medicaid + ObamaCare + Employment sponsonered care ??? My opinion is that we should first optimize the existing system to lower the medical cost first. Health insurance is just prepaid medical costs. If the cost is lowered, no system would work.
  • ogre_codes 7y ago
    No, this is talking about single payer healthcare which would mean the current insurance industry would be out the door. No Obamacare, just one government agency paying for healthcare. Employment sponsored healthcare will likely still exist in some form, perhaps to ensure speedier access to some care.
    • jandrese 7y ago
      Probably no employer sponsored healthcare for the most part. That money would go towards the Medicare coverage. There might be some supplemental plans for people who want to skip lines but most people will just use Medicare.
      • xmly 7y ago
        Is that what Canada has right now? For US, the real problem is still health cost is too high. The market regulation seems doe not work, at least for this decade.
        • n9 7y ago
          From what I see about half the cost is the admin overhead and another huge chunk is providers billing very high rates because they end up paying a lot less to the insurance companies. If you want to optimize the lowest fruit is the admin overhead, which means just go single payer.
          • xmly 7y ago
            For admin overhead, my understanding is that each insurance firm has its own standard and processing protocols, which brings a huge burden to providers. The simple solution is having a simple and shared standard enforced by law.
• grayed-down 7y ago
  My neighbor, a colorectal surgeon and very into what he does, has remarked on several occasions that if single payer ever happens, he and most of the other surgeons he knows will likely walk away from the profession very shortly thereafter. There would be no financial or professional motivation to continue practicing.
  • mrfusion 7y ago
    People say a lot of things.
    • n9 7y ago
      You are my favorite for today.
  • markroseman 7y ago
    Because all the doctors in countries that have single payer are so horribly done by...?
    • refurb 7y ago
      20-30% decrease in reimbursement will tick doctors off big time.
  • jandrese 7y ago
    This makes no sense. What is he going to do instead? Flip burgers? Go to Canada? Go to the UK? Go to Germany? If he wanted to make the argument that it would discourage people from seeking surgical degrees that is something worth discussing with current students, but that guy's costs are sunk. It's too late to change now.
  • codegeek 7y ago
    Tell your neighbor he is already been taken for a ride by insurance companies. It may actually be better for him once private insurance does not have a say in EVERYTHING he does as a doctor. He may even be able to make more money. Ask him is he really free today when seeing patients ? The answer is No. He has to listen to everything the insurance company approves.
• dcolkitt 7y ago
  > Employer contributions to health insurance currently average $10446 per employee and cover 71% of a household’s premium. These employer premiums are equivalent to a 12.29% tax on payroll exceeding the first $2 million... Therefore, any payroll tax less than 12.29%, our upper bound in the SHIFT interface, would result in savings for employers. This excerpt makes it glaringly obvious that no economists were consulted when writing this paper. Checking the list of authors confirms this. While they may be experts in public health, they're making one of the most elementary errors in Econ 101. That is they're assuming that a private expenditure (employer provided healthcare insurance) can be transformed into a public tax with no loss of efficiency. Deadweight loss[1] is the very first consideration in tax policy analysis. The reason it exists is very simple. Private actors have an incentive to minimize taxes in a way they do not with private expenditures. If you cut your company's health insurance plan, your employees will be unhappy and you'll either lose workers or have to raise compensation in other forms. If you restructure your company to avoid payroll taxes, your employees still enjoy the same access to single-payer healthcare. Many M4A advocates try to hand-wave away this problem. It's the equivalent of declaring "Then a miracle occurs". In this case the authors assume that the current employer-paid premiums are equivalent to replacing with a uniform payroll tax matching this aggregate. While 12.29% is the average across the entire economy, there's still wide variance between employers. Approximately half of employers are currently paying less than this. A significant proportion are paying substantially less than this. If the current system was replaced with a uniform payroll tax, the cost of labor for employers falling into this category will rise. In response that means those employers will lower their demand for labor, which results in either both economy-wide reductions in employment, wages and ultimately investment and GDP. Those results will mean that not only will the hypothetical new payroll tax not raise the revenue the authors are projecting, but current pre-existing taxes, like income and capital gains, will also see revenue shortfalls relative to baseline. [1] https://en.wikipedia.org/wiki/Deadweight_loss#Tax https://en.wikipedia.org/wiki/Deadweight_loss#Tax
  • Denvercoder9 7y ago
    Why won't the rising cost of labor for the employers that currently pay less be offset by the falling cost of labor for the employers that currently pay more?
• refurb 7y ago
  The US Department of Veterans Affairs (VA) has the capacity to negotiate prices that align with the therapeutic value of pharmaceutical drugs and could be a potential model for the federal single-payer health-care system. This bargaining power results in pharmaceutical prices that are 40% lower in the VA system than those under Medicare This is a terrible proxy. The VA doesn't really negotiate, the discounts are mandatory to do business with the VA, which is an incredibly small slice of the entire US healthcare system. When they do negotiate, it's because they promise to exclude other drugs. As a result, there are many drugs you can't get at the VA.
  • briandear 7y ago
    And, if the VA is an example of single-payer, then we're doomed. The VA is awful. That's the single best argument against single-payer.
• LordFast 7y ago
  The problem has never been about what system works, that's always been clear. The problem has been, and will continue to be about all the people that are currently employed by the dysfunctional system. Managing that situation is the meat of the challenge.
  • UnFleshedOne 7y ago
    It was never a problem when companies started outsourcing to developing countries in droves...
    • LordFast 7y ago
      "Hey if you join me in this scheme to make more profit by squeezing other people out of what they have today, I'll give you a cut of that profit. What do you say? I promise you'll keep getting a cut until it makes sense to squeeze you out as well." Less obvious, and more eloquent, of course. Better choices, better opportunities, and real innovative solutions to solve real problems. Those are the rising tides that will raise our boats instead of sinking them. I concede though that it's easier when we're talking about 10 people and a startup, rather than 330 million human beings across 3.8 million square miles. I want to see more leaders focus on the real crux of the problem, taking into account human nature while we're at it. I'm not holding my breath.
• riazrizvi 7y ago
  Currently that money is flowing from the pockets of everyone into the pockets of investors, legislators and workers tied to the healthcare industry. What is the correct amount of profit? Who is to say the healthcare industry was making enough before they started hiking prices? Perhaps they saved their industry? Other countries have cheaper healthcare costs, but maybe they have less healthcare? Sure other countries might be living longer but perhaps that is tied to diet/lifestyle. Maybe Americans are living less because they are working harder, are being destroyed by a bountiful food industry that they can't resist, maybe the healthcare industry is picking up the slack... The solution offered here is a state-controlled market, which didn't work well for the Soviet Union so is it good now, or is this just our last desperate attempt to pick the lesser of two evils? But then is that the solution for out of control internet charges? For out of control property prices? The single issue we should be focusing on in America, across healthcare, tech, government contracts, is fair markets, not free markets. Free markets are the flag which incumbent industry rallies behind because they can rig the system when there are no rules. Similar to the Glass-Steagall Act which enabled a fairer market for average investors competing against financial institutions, the hospitals, pharmaceutical companies and insurance companies need to be broken up, so that we can restore a fair market for healthcare. Politically it is our best strategy for an improved service. Since it will raise industry allies, those with solutions that are being unfairly crushed by an uncompetitive industry. Remember we are living in the Citizens United era, corporations have very strong political power. Universal Healthcare is going to cause the healthcare industry to stop infighting, they will circle their wagons, and collude with better effect by engineering supply shortages, confusing legislators using bribery and misinformation, and doubling down on pricing loopholes...
  • bazooka_penguin 7y ago
    Is profit the problem here? Not a horde of unnecessary make-work jobs and overpaid workers?
• protomyth 7y ago
  I just want an explanation of how this would work out better for the general population of the US than Indian Health Service has worked out for the tribes? I just don't trust any of these studies when the refuse or are ignorant of what the government is currently doing and how problematic the governments approach is.
• markroseman 7y ago
  People seem to think that if you move to single payer that the single payer would behave like any of the existing payers, i.e. you call to fight for approval for everything you do, argue about fees for each item, denying things is routine, blah blah blah. If you have a single payer system, it doesn't have to work that way. Not even close!
  • refurb 7y ago
    No, you wouldn’t have to fight for everything. With a single payer, there would be a list - this is what we pay for, this is what we don’t pay for.
• cmollis 7y ago
  It’s a complete scam run by insurance companies who operate with ostensibly a government mandate (although with seemingly zero oversight). I work for myself and and have historically been paying about 20k per year in premiums for my family with a family deductible which I’ve never gotten remotely close to hitting. I have an hsa which I use to pay for out of pocket expenses pre tax and there is a tax deduction for health care premiums. This year I decided to test the system.. and didn’t purchase health care for myself. It turns out that many of the services and drugs we all pay through the nose for are so much cheaper If you ‘self pay’. I spoke to admins at both my doctor and the affiliated hospital and they all have programs to help alleiviate payment hardship if you don’t have insurance (translation: you’ll just have to pay the actual cost of the procedure. Not the bullshit one that the insurance company tells you that you saved a bunch on by overpaying for their insurance). Ridiculous. Inevitably someone will figure out that it’s the insurance companies ripping everyone off and do something that removes their intermediation state-sponsored fleece-job. Ultimately you’re actually paying for catastrophic insurance, oh and Medicaid and long term elderly Medicare, but the rip off of your standard, healthy consumer is a travesty. Maybe someone should be reviewing the actuarial models (or whatever they are) to determine an apporopiate cost for someone who’s ‘heathy’. Me? I’ll just continue to pay like I’m poor... and save some cash.
  • codegeek 7y ago
    I wish i could upvote you 1000 times. Why is it so hard for many people to understand all of this ?
    • gen3 7y ago
      Part of the point of insurance is to offset risk. He says that he doesn’t have insurance for himself. While he is probably fine, he is taking the gamble that he will not require any expensive procedures. Depending on your risk tolerance, it could pay off for people to do this... But it’s certainly not for everyone.
    • TheAlpacalypse 7y ago
      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.
• gridlockd 7y ago
  Single payer creates an unnecessary monopoly. One of the best health care systems (Switzerland) is both private and not single payer - but purchase is compulsory. Obamacare and especially Trumpcare simply can not work when people delay purchasing insurance until it's too late. You can't have your cake and eat it too. Furthermore, insurance plans should not be tied to employment/employers. It's a bad incentive structure.
• OrgNet 7y ago
  The worst thing for me is if you go, for example, to the emergency room, the hospital charges you something like $200 and you think that is the end of it, but about a month later, other bills start coming in: $300 for xray, $350 for doctor X, etc... health insurance in the US sucks.
  • n9 7y ago
    ER visit as a foreigner in Switzerland. Saw a dr. Saw a neurologist. Had a full bank of blood tests. Had an MRI of my head and neck. In and out in five hours. I was billed $400.
• api 7y ago
  The fact that it would save money may be part of the problem. The massive and very redundant health insurance bureaucracy employs a lot of people. In the realm of government contracting and large scale policy decisions like this, efficiency is often politically inconvenient since it means jobs may be lost.
• jahaja 7y ago
  > Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo. That this has been allowed to go on in a land of plenty is an utter disgrace that I can only hope will not go down well in the pages of history.
• thecleaner 7y ago
  The answer is simple, vote for a candidate that campaigns on universal healthcare. That candidate may not be the politically purest one.
  • usaar333 7y ago
    Isn't every Democrat supportive of universal healthcare? (Which at the minimum is just ACA + technical fixes on it) There are differences through whether it should be single-payer or not.
    • codegeek 7y ago
      ACA is not universal healthcare. It only made things worse overall except the fact that people cannot get denied due to pre-existing conditions. Obama should have pushed for a public option with ACA at the time. In 2020, fuck that. We want to go straight to Universal healthcare, single payer. No middle ground. Only 1 democrat supports that so I am voting for him.
      • usaar333 7y ago
        Why is ACA not universal? (Ignoring technical problems it had that prevented that from actually happening). It guaranteed affordability, coverage, and prevented you from opting out.
• ghostpepper 7y ago
  Can anyone post the article? The site doesn't load without cookies enabled
• partiallypro 7y ago
  I don't know why the idea of a "public option" fell out of favor with Democrats. It's a good stop along the way, and doesn't risk completely destroying an industry overnight...and therefore has a much higher chance of passing. Eventually employers would push people onto the public option plan, but it wouldn't be overnight. Bernie's plan, imo has so much room for error, it's not even worth considering without a stop along the way. It's also ironic he wants to ban private insurance completely (I assume that even means supplemental) when pretty much every single country he cites as a model doesn't do that.
  • senordevnyc 7y ago
    100% agree. People are totally delusional to think that there’s a snowball’s chance in hell of single payer happening from where we are. And given that healthcare is like a fifth of the economy, it’s completely reckless anyway! Plus, if nothing else, it’d never get through the Senate, and that’s unlikely to change for decades. Public option, it’s by far the best path forward.
  • foolbiter 7y ago
    the end result of the public option is employer-based plans offloading their least valuable (and most vulnerable) customers onto the public option, leading to much higher costs for everyone. the abolition of private insurance is necessary for the efficiency and bargaining power of a maximalist medicare-for-all system.
• spaginal 7y ago
  If you think healthcare is expensive now, just wait until it's "free".
• naveen99 7y ago
  Why don’t they just move the Minimum age for Medicare down from 65 gradually, and see what happens... change the speed of lowering the age depending on how the market responds And How the public likes it.
• twodave 7y ago
  The biggest problem I have with health insurance is that it’s nearly impossible for either the insurance or a provider to tell me how much something other than a routine visit will cost me until after services have already been rendered. Forget the high costs, I can’t even make an informed decision half the time unless I just go by the uninsured rates.
• winstonewert 7y ago
  What I wish is that everyone would be given a choice. Either opt completely out of all government regulations/taxes/programs related to healthcare or opt into a universal healthcare program. Think that you'd better off without government involvement in your healthcare? Put your body/wallet where your mouth is. Think you'd better off with a universal healthcare system, put your body/wallet where your mouth is. But no, we'll just keep the crappy status quo which nobody thinks is a good idea.