3 ms·

I agree with your assessment that single payer is necessary, but as for the millions of job losses claim, I don’t agree. Those millions of jobs are for doing so

by ok_dad 4y ago

I agree with your assessment that single payer is necessary, but as for the millions of job losses claim, I don’t agree. Those millions of jobs are for doing something right now, so do you think that something will be eliminated just because the government took over and what is that something? I don’t believe that many jobs could be effectively useless, but I stand to be corrected.

missedthecue 4y ago
If they all get jobs with Government Healthcare inc, where are the actual savings coming from? Who is going to be earning less? The profit margins of healthcare insurance companies are almost nothing. Look at Humana for instance... 2.5% net margins. Cut that out and every american saves $5 a month.
- ok_dad 4y ago
  That’s my point, kinda. I expect there to be some savings, but I’m not sure where from and how much. I feel like millions of jobs is a lot though.
  - mjevans 4y ago
    Best case: they're not kept on as 'No men' (contrast, 'yes men' for underlings who are just empty enablers), but transferred to scientifically evaluating and seeking the best treatments. Worst case: we go back to what things were before the ACA where if you had a preexisting condition you were screwed.
    - ok_dad 4y ago
      Yea, I'm thinking that there might be a lot of administrative work that could be eliminated by a centralized electronic system for single payer care, but the way I see this going right now is the government adding another layer of administration on top of the current system to operate it (literally privatising it), and then adding a centralized directory of service charges and moving towards eliminating the parts of the system that are unnecessary under this scheme while also working with the same companies as currently exist to merge all EHRs into one common system. I expect most of the cruft of the current system to remain for several decades or more, plus more government cruft, but the upside is that we can eliminate the profit as a goal and probably balance half or more of the government cruft with eliminating inefficiencies. If they privatized pharma and the EHR software companies, too, then that would probably immediately lower prices due to the insane profit motives for investors in those areas, but that would never happen. I think we might save some money right away, but more likely we'll lose a bit, gain the ability for our citizens to not have to worry as much about their jobs being their literal lifeline, and over time we'll save more and more versus the current system due to an increased quality of living due to better health outcomes and longer lives.
- noelsusman 4y ago
  There wouldn't be much actual savings without massive disruption for providers. Right now Medicare and Medicaid are cheaper per patient largely because they pay below cost for the same services. They are subsidized by private insurance. A move to Medicare for all at current reimbursement rates would require drastic budget cuts at every healthcare provider in the country. That may be what's necessary to fix the broken system, but it would involve a lot of pain.
  - rdtwo 4y ago
    Yeah i don’t think Medicare even pays enough to covers the providers wages much less they building overhead and equipment
- nn3 4y ago
  Margins != overhead. The overhead of insurance is much higher than the margins, and a lot of it is wages and related expenses.
- tomrod 4y ago
  2021 report: https://humana.gcs-web.com/static-files/78c99040-2eed-4231-89f9-e12b3e9ec333 https://humana.gcs-web.com/static-files/78c99040-2eed-4231-8... Net income: 2.9B USD HOWEVER: 1. They paid 3.6B USD in dividends in 2021 2. They paid 10B in operating costs and receieve ~70B in premiums on top of other streams 3. They increased their interest expense for the KAH acquisition 4. They hold $44B in assets and $28B in liabilities The story they are clearly telling investors is they are seeking to consolidate Payers with Providers to improve efficiencies, which ignores that they they could improve operational efficiencies today.
317070 4y ago
David Graeber has a long book on this, called "Bullshit Jobs". It turns out many of those people do think _their own_ job is useless and could effectively be removed with no impact. In the book he offers some numbers on the healthcare system in the US, where in administration and insurance there are indeed many such bullshit jobs. What is worse, they often bring a bureaucratic burden on people like nurses, who do have real work to do. (All by the assessment of the people doing the bullshit job) He offers quotes to show this was even the point of view of Obama > Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” Graeber describes this comment as a “smoking gun” of bullshittization. “Here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs,” he writes. Politicians are so fixated on job creation, he thinks, that no one wonders which jobs are created, and whether they are necessary. Unnecessary employment may be one of the great legacies of recent public-private collaboration.
- ok_dad 4y ago
  I think a lot of people think we can eliminate a lot of things, but cannot properly pick the things to eliminate. I think there is a lot of bullshit we hate to do, that is still necessary; or alternately, we can't eliminate it due to some sort of momentum or systemic reliance on that bullshit. In healthcare, I imagine there is a lot of bullshit that would still have momentum in a post-single-payer world that we couldn't eliminate right away, but I still want that. See my other recent comment, I went into more detail on why I think single-payer would be great, but isn't a panacea for healthcare costs and efficiency.

by ok_dad 4y ago

missedthecue 4y ago

If they all get jobs with Government Healthcare inc, where are the actual savings coming from? Who is going to be earning less? The profit margins of healthcare insurance companies are almost nothing. Look at Humana for instance... 2.5% net margins. Cut that out and every american saves $5 a month.

ok_dad 4y ago
That’s my point, kinda. I expect there to be some savings, but I’m not sure where from and how much. I feel like millions of jobs is a lot though.
- mjevans 4y ago
  Best case: they're not kept on as 'No men' (contrast, 'yes men' for underlings who are just empty enablers), but transferred to scientifically evaluating and seeking the best treatments. Worst case: we go back to what things were before the ACA where if you had a preexisting condition you were screwed.
  - ok_dad 4y ago
    Yea, I'm thinking that there might be a lot of administrative work that could be eliminated by a centralized electronic system for single payer care, but the way I see this going right now is the government adding another layer of administration on top of the current system to operate it (literally privatising it), and then adding a centralized directory of service charges and moving towards eliminating the parts of the system that are unnecessary under this scheme while also working with the same companies as currently exist to merge all EHRs into one common system. I expect most of the cruft of the current system to remain for several decades or more, plus more government cruft, but the upside is that we can eliminate the profit as a goal and probably balance half or more of the government cruft with eliminating inefficiencies. If they privatized pharma and the EHR software companies, too, then that would probably immediately lower prices due to the insane profit motives for investors in those areas, but that would never happen. I think we might save some money right away, but more likely we'll lose a bit, gain the ability for our citizens to not have to worry as much about their jobs being their literal lifeline, and over time we'll save more and more versus the current system due to an increased quality of living due to better health outcomes and longer lives.
noelsusman 4y ago
There wouldn't be much actual savings without massive disruption for providers. Right now Medicare and Medicaid are cheaper per patient largely because they pay below cost for the same services. They are subsidized by private insurance. A move to Medicare for all at current reimbursement rates would require drastic budget cuts at every healthcare provider in the country. That may be what's necessary to fix the broken system, but it would involve a lot of pain.
- rdtwo 4y ago
  Yeah i don’t think Medicare even pays enough to covers the providers wages much less they building overhead and equipment
nn3 4y ago
Margins != overhead. The overhead of insurance is much higher than the margins, and a lot of it is wages and related expenses.
tomrod 4y ago
2021 report: https://humana.gcs-web.com/static-files/78c99040-2eed-4231-89f9-e12b3e9ec333 https://humana.gcs-web.com/static-files/78c99040-2eed-4231-8... Net income: 2.9B USD HOWEVER: 1. They paid 3.6B USD in dividends in 2021 2. They paid 10B in operating costs and receieve ~70B in premiums on top of other streams 3. They increased their interest expense for the KAH acquisition 4. They hold $44B in assets and $28B in liabilities The story they are clearly telling investors is they are seeking to consolidate Payers with Providers to improve efficiencies, which ignores that they they could improve operational efficiencies today.

317070 4y ago

David Graeber has a long book on this, called "Bullshit Jobs". It turns out many of those people do think _their own_ job is useless and could effectively be removed with no impact. In the book he offers some numbers on the healthcare system in the US, where in administration and insurance there are indeed many such bullshit jobs. What is worse, they often bring a bureaucratic burden on people like nurses, who do have real work to do. (All by the assessment of the people doing the bullshit job) He offers quotes to show this was even the point of view of Obama > Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” Graeber describes this comment as a “smoking gun” of bullshittization. “Here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs,” he writes. Politicians are so fixated on job creation, he thinks, that no one wonders which jobs are created, and whether they are necessary. Unnecessary employment may be one of the great legacies of recent public-private collaboration.

ok_dad 4y ago
I think a lot of people think we can eliminate a lot of things, but cannot properly pick the things to eliminate. I think there is a lot of bullshit we hate to do, that is still necessary; or alternately, we can't eliminate it due to some sort of momentum or systemic reliance on that bullshit. In healthcare, I imagine there is a lot of bullshit that would still have momentum in a post-single-payer world that we couldn't eliminate right away, but I still want that. See my other recent comment, I went into more detail on why I think single-payer would be great, but isn't a panacea for healthcare costs and efficiency.