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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 acco

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.
  - elicash 7y ago
    And you think if she wasn't allowed to either have private health insurance (which is subsidized by others with health insurance) or have government-paid insurance, that she would suddenly stop smoking?
    - macinjosh 7y ago
      Insurance and single-payer aren't the only two choices. It is possible to not like either.
    - dx87 7y ago
      I think she'll keep smoking as long as she doesn't face any repercussions for it. Right now, she keeps getting free medical care to fix anything wrong with her, so she has no incentive to get better. If she didn't have that, then she'd have to make the choice between continuing to smoke, or having to be immobile and in pain because she couldn't keep getting medication and surgery to mask the health problems she's bringing on herself.
      - throwawayhhakdl 7y ago
        But... she does have repercussions? She has chronic back pain and deteriorating health... Pain pills are either A) not going to be strong enough B) harshly addictive. Probably opioids.
      - fzeroracer 7y ago
        Speaking as someone who has parents whom smoke a lot, I think you don't understand the mentality of smokers or the addictive behavior of smoking. Nothing is going to stop her from quitting smoking, even if she was denied pain medication or surgery. They'd find other ways to numb the pain and just walk straight into an early grave.
  - jeremyjh 7y ago
    Wow, she is living the dream.
  - 7y ago
- macinjosh 7y ago
  You must live in a pretty blissful bubble. I have known or known of many people who continue bad habits in their life (e.g. excessive drinking and smoking) using government provided subsidies like disability, medicaid, and local programs. Besides, if the prospect of lung cancer was enough to scare everyone off tobacco there would be no one smoking still. People are not always rational and yes I can see someone rationalizing their decision to smoke, in part, on the fact that if they do get sick they won't have to worry about paying for it. Or from the other direction if you know doing something could make you sick the prospect of simultaneous health and financial problems will be enough to push a larger portion of the public into making the healthy decision.
burkaman 7y ago
Did you read it? Also, are you familiar with any modern nations where a single-payer healthcare system has been tried? Perhaps we could use them to predict the effects. > Is waste, fraud, and abuse taken into account at all in this study? From the paper: "In addition to savings on overheads, a comprehensive database of health-care charges would facilitate detection of fraud, which extracts $85·7 billion every year. Following the transition to a single-payer system in Taiwan, an 8% reduction in overall national expenditure was attributed to the reduction in fraud. By moving from a fragmented health-care payment system to a unified system, irregularities in provider claims can be more easily detected. For example, under the fragmented system excessive claims for physician time can be spread across patients with several different insurance providers. However, acknowledging that improvements have been made in fraud detection since Taiwan's transition, we conservatively assume that the improved fraud detection would garner savings amounting to half that observed in Taiwan, corresponding to 4% of total health-care expenditure." https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext#seccestitle50 https://www.thelancet.com/journals/lancet/article/PIIS0140-6... > 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. Is this a significant problem in countries with single-payer systems? > Why should I subsidize other people's bad decision making? You already are? That's how health insurance works. What this study is showing is that you'll have to subsidize other people less, because the whole system will be less expensive.
- macinjosh 7y ago
  > You already are? That's how health insurance works. I am not a defender of the insurance system. It blows. But single-payer is not the only other choice. I want a freer healthcare market where prices are known before consuming services. Real market competition could actually occur to bring down prices. For drugs, research and development for less profitable cases could be a very worthy target of government funding. I don't have all the answers but neither does single-payer.
  - burkaman 7y ago
pjmorris 7y ago
Somehow, the current US health system is the most expensive on the planet [0], for outcomes that aren't better (and in some cases worse) than the rest of the developed world. Have you considered the possibility of waste, fraud, and abuse being high in the present system? [0] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
- macinjosh 7y ago
  I am not defending the current system. My point is that insurance and single-payer are not the only 2 possible models. A freer healthcare market, not encumbered by the inefficiencies of insurance, could actually put market forces to work in the industry. If prices were known prior to service competition would begin and people could vote with their feet. Right now we have a overly consolidated monstrosity in the insurance and drug industries sucking profits out of the public, and these guys just want to switch it out for a different monstrosity.
- macinjosh 7y ago
  > Somehow, the current US health system is the most expensive on the planet You know why? Because we pay for most of the R&D, done by industry, that the rest of the world benefits from. For example, other developed nations like Canada have been able to benefit from new drugs invented in America's more capitalist system by restricting prices in their country even though we don't.
  - pjmorris 7y ago
    US pharmaceutical company R&D spending is ~80B per year [0]. Healthcare spending is ~3.6T, making pharma R&D about 2% of overall healthcare spending. Based on the above back-of-the-napkin math, I'm inclined to think pharma R&D isn't really the main factor. What is your support for believing it is the case? [0] https://www.biopharmadive.com/news/phrma-research-development-spending-industry-report/529943/ https://www.biopharmadive.com/news/phrma-research-developmen...
codegeek 7y ago
"Why should I subsidize other people's bad decision making?" You already are through record high premiums, deductibles and what not to private insurance companies. The problem is that those companies are in it to make money which means everything is inflated and not to mention the bullshit of in-network/out of network and fighting with billing/administration to get bills corrected. No. I am sick of that and I would gladly pay to subsidize other people's decision making because we all already are. If you really don't want to pay for other people, then no insurance should exist and everything should be out of pocket straight. Free market baby. But not gonna happen in the US when it comes to healthcare.
mrcu5 7y ago
My wife is a pediatrician and sees about 80% medicaid patients. People absolutely go in more often than they need to because they don't pay a single cent. I'm talking going to the ER because their kid has a cough or is running a fever. These are usually also the most demanding patients.
- refurb 7y ago
  I found this part of the paper to be unreasonable: Available ER visits and hospitalizations can be avert through improved access to primary care
  - n9 7y ago
    Have you ever gone to a busy urban ER? It is absolutely full to the brim 24/7 with people visiting with chronic ailments that don’t have health insurance, which is literally the most expensive possible way to treat something like asthma or chronic emphysema.
    - refurb 7y ago
      Look up the Oregon Medicaid study. Basically did a lottery, half get Medicaid, half don’t. No change in outcomes, it just cost more.
- codegeek 7y ago
  Medicaid is not the same as Medicare. Medicaid is literally Free stuff so yea, it can be abused. Medicare is not free. People pay into it through taxes. 2 different things.
  - senordevnyc 7y ago
    Free at the point of sale is what’s important. The fact that I know I theoretically pay for it with my taxes does nothing to curb abuse.
yongjik 7y ago
> Why should I subsidize other people's bad decision making? This is what you already do when you live in America. Other people made a bad decision to make healthcare a private industry, creating a billion dollar insurance business, and you are writing their paycheck out of yours.
- macinjosh 7y ago
  And how is writing paychecks for government bureaucrats any different? I would like to pay my doctor, and my hospital, and my pharmacy for my healthcare costs not some borg.
  - yongjik 7y ago
    > And how is writing paychecks for government bureaucrats any different? It's (supposedly) CHEAPER. That's right in the title. If you want to argue whether it's actually cheaper or not, that's another thing, but this kind of feigned ignorance is really not helping the debate. > I would like to pay my doctor, and my hospital, and my pharmacy for my healthcare costs not some borg. In South Korea, with its universal healthcare system, I always visited a hospital and paid them directly right there. Usually a few to a dozen bucks for common cold, inflamed ears, that kind of stuff. Here in the free world of America, I go to hospital and three weeks later a faceless insurance company sends me a ridiculous bill and I don't even understand how they arrived at such a price.
n9 7y ago
Read the article. Look at prior art. Stop spreading FUD.

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.
- elicash 7y ago
  And you think if she wasn't allowed to either have private health insurance (which is subsidized by others with health insurance) or have government-paid insurance, that she would suddenly stop smoking?
  - macinjosh 7y ago
    Insurance and single-payer aren't the only two choices. It is possible to not like either.
  - dx87 7y ago
    I think she'll keep smoking as long as she doesn't face any repercussions for it. Right now, she keeps getting free medical care to fix anything wrong with her, so she has no incentive to get better. If she didn't have that, then she'd have to make the choice between continuing to smoke, or having to be immobile and in pain because she couldn't keep getting medication and surgery to mask the health problems she's bringing on herself.
    - throwawayhhakdl 7y ago
      But... she does have repercussions? She has chronic back pain and deteriorating health... Pain pills are either A) not going to be strong enough B) harshly addictive. Probably opioids.
    - fzeroracer 7y ago
      Speaking as someone who has parents whom smoke a lot, I think you don't understand the mentality of smokers or the addictive behavior of smoking. Nothing is going to stop her from quitting smoking, even if she was denied pain medication or surgery. They'd find other ways to numb the pain and just walk straight into an early grave.
- jeremyjh 7y ago
  Wow, she is living the dream.
- 7y ago
macinjosh 7y ago
You must live in a pretty blissful bubble. I have known or known of many people who continue bad habits in their life (e.g. excessive drinking and smoking) using government provided subsidies like disability, medicaid, and local programs. Besides, if the prospect of lung cancer was enough to scare everyone off tobacco there would be no one smoking still. People are not always rational and yes I can see someone rationalizing their decision to smoke, in part, on the fact that if they do get sick they won't have to worry about paying for it. Or from the other direction if you know doing something could make you sick the prospect of simultaneous health and financial problems will be enough to push a larger portion of the public into making the healthy decision.

burkaman 7y ago

Did you read it? Also, are you familiar with any modern nations where a single-payer healthcare system has been tried? Perhaps we could use them to predict the effects. > Is waste, fraud, and abuse taken into account at all in this study? From the paper: "In addition to savings on overheads, a comprehensive database of health-care charges would facilitate detection of fraud, which extracts $85·7 billion every year. Following the transition to a single-payer system in Taiwan, an 8% reduction in overall national expenditure was attributed to the reduction in fraud. By moving from a fragmented health-care payment system to a unified system, irregularities in provider claims can be more easily detected. For example, under the fragmented system excessive claims for physician time can be spread across patients with several different insurance providers. However, acknowledging that improvements have been made in fraud detection since Taiwan's transition, we conservatively assume that the improved fraud detection would garner savings amounting to half that observed in Taiwan, corresponding to 4% of total health-care expenditure." https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext#seccestitle50 https://www.thelancet.com/journals/lancet/article/PIIS0140-6... > 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. Is this a significant problem in countries with single-payer systems? > Why should I subsidize other people's bad decision making? You already are? That's how health insurance works. What this study is showing is that you'll have to subsidize other people less, because the whole system will be less expensive.

macinjosh 7y ago
> You already are? That's how health insurance works. I am not a defender of the insurance system. It blows. But single-payer is not the only other choice. I want a freer healthcare market where prices are known before consuming services. Real market competition could actually occur to bring down prices. For drugs, research and development for less profitable cases could be a very worthy target of government funding. I don't have all the answers but neither does single-payer.
- burkaman 7y ago

pjmorris 7y ago

Somehow, the current US health system is the most expensive on the planet [0], for outcomes that aren't better (and in some cases worse) than the rest of the developed world. Have you considered the possibility of waste, fraud, and abuse being high in the present system? [0] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

macinjosh 7y ago
I am not defending the current system. My point is that insurance and single-payer are not the only 2 possible models. A freer healthcare market, not encumbered by the inefficiencies of insurance, could actually put market forces to work in the industry. If prices were known prior to service competition would begin and people could vote with their feet. Right now we have a overly consolidated monstrosity in the insurance and drug industries sucking profits out of the public, and these guys just want to switch it out for a different monstrosity.
macinjosh 7y ago
> Somehow, the current US health system is the most expensive on the planet You know why? Because we pay for most of the R&D, done by industry, that the rest of the world benefits from. For example, other developed nations like Canada have been able to benefit from new drugs invented in America's more capitalist system by restricting prices in their country even though we don't.
- pjmorris 7y ago
  US pharmaceutical company R&D spending is ~80B per year [0]. Healthcare spending is ~3.6T, making pharma R&D about 2% of overall healthcare spending. Based on the above back-of-the-napkin math, I'm inclined to think pharma R&D isn't really the main factor. What is your support for believing it is the case? [0] https://www.biopharmadive.com/news/phrma-research-development-spending-industry-report/529943/ https://www.biopharmadive.com/news/phrma-research-developmen...

codegeek 7y ago

"Why should I subsidize other people's bad decision making?" You already are through record high premiums, deductibles and what not to private insurance companies. The problem is that those companies are in it to make money which means everything is inflated and not to mention the bullshit of in-network/out of network and fighting with billing/administration to get bills corrected. No. I am sick of that and I would gladly pay to subsidize other people's decision making because we all already are. If you really don't want to pay for other people, then no insurance should exist and everything should be out of pocket straight. Free market baby. But not gonna happen in the US when it comes to healthcare.

mrcu5 7y ago

My wife is a pediatrician and sees about 80% medicaid patients. People absolutely go in more often than they need to because they don't pay a single cent. I'm talking going to the ER because their kid has a cough or is running a fever. These are usually also the most demanding patients.

refurb 7y ago
I found this part of the paper to be unreasonable: Available ER visits and hospitalizations can be avert through improved access to primary care
- n9 7y ago
  Have you ever gone to a busy urban ER? It is absolutely full to the brim 24/7 with people visiting with chronic ailments that don’t have health insurance, which is literally the most expensive possible way to treat something like asthma or chronic emphysema.
  - refurb 7y ago
    Look up the Oregon Medicaid study. Basically did a lottery, half get Medicaid, half don’t. No change in outcomes, it just cost more.
codegeek 7y ago
Medicaid is not the same as Medicare. Medicaid is literally Free stuff so yea, it can be abused. Medicare is not free. People pay into it through taxes. 2 different things.
- senordevnyc 7y ago
  Free at the point of sale is what’s important. The fact that I know I theoretically pay for it with my taxes does nothing to curb abuse.

yongjik 7y ago

> Why should I subsidize other people's bad decision making? This is what you already do when you live in America. Other people made a bad decision to make healthcare a private industry, creating a billion dollar insurance business, and you are writing their paycheck out of yours.

macinjosh 7y ago
And how is writing paychecks for government bureaucrats any different? I would like to pay my doctor, and my hospital, and my pharmacy for my healthcare costs not some borg.
- yongjik 7y ago
  > And how is writing paychecks for government bureaucrats any different? It's (supposedly) CHEAPER. That's right in the title. If you want to argue whether it's actually cheaper or not, that's another thing, but this kind of feigned ignorance is really not helping the debate. > I would like to pay my doctor, and my hospital, and my pharmacy for my healthcare costs not some borg. In South Korea, with its universal healthcare system, I always visited a hospital and paid them directly right there. Usually a few to a dozen bucks for common cold, inflamed ears, that kind of stuff. Here in the free world of America, I go to hospital and three weeks later a faceless insurance company sends me a ridiculous bill and I don't even understand how they arrived at such a price.

n9 7y ago

Read the article. Look at prior art. Stop spreading FUD.