4 ms·

Medicaid in particular is managed by states and the service, reimbursement and access varies wildly between different locales. There is an elephant in the room

by munk-a 2y ago

Medicaid in particular is managed by states and the service, reimbursement and access varies wildly between different locales. There is an elephant in the room that rarely gets the attention it deserves is that 17.3% of the US GDP is contained in the healthcare system. This problem has grown so large that if we fixed it suddenly we could see a tenth of our GDP simply vanish overnight and it'd cause economic shockwaves across America. Twenty years ago this problem could have been solved in a relatively smooth manner - at this point I don't even know if my personal dream of a perfect solution would cause more harm to average people's lives than it'd help. We are up a creek and determinedly throwing every paddle we find as far as we can manage.

alistairSH 2y ago
Somewhere between 15-30% of health care spending in the US can be classified as "waste" or "administrative overhead" (values and descriptions vary by study). Even if we cut that 15% waste in its entirety, that's moving us from 17.3% to 14.8%. Is that going to leave some administrative staff looking for jobs? Absolutely. But, I don't see that totally crashing the economy, not when that money is freed up for productive spending (more cars, more travel, more dining out, whatever).
- deleted 2y ago
  [deleted]
- munk-a 2y ago
  In the long term the market will absolutely adjust to more efficiently using that potential - but that's the long term. If America suddenly socialized health insurance millions of people[1] would be out of a job. The long term outlook of the economy would much better - but the short term would be extremely painful. 1. UHC appears to be about 440,000, CVS about 300,000, Elevance (aka Anthem) 104,900 - those are just a trio of the larger insurers out of hundreds.
  - alistairSH 2y ago
    That's assuming every job at those companies is absolute waste/overhead. I'm not convinced that's true. If we kill private insurance and move to Medicaid-for-All (I'm not suggesting this is the right approach, just thinking aloud here), the size of the Medicaid bureaucracy would have to grow, offering some of those former UHC/CVS/Anthem employees an "easy" transition into similar work. Anyways, no change this big would ever be made overnight. So, phase in changes over 5-10 years. Problem "solved".
    - stackskipton 2y ago
      It's not solved. I know many on this website have probably changed technology they used and used to learning but that's not the case for vast majority of people. They just want a job, pushing the buttons/emails, collecting a paycheck and doing not work thing. As non FAANG person, the number of developers I've met who continue to greenfield in Java 8 and .Net Framework is mind blowing and any attempt to make them learn something new falls on deaf ears.
IncreasePosts 2y ago
Wasn't Obama swayed against a single payer system, because eliminating all the middle men would end up with like 2 million people going unemployed?
- alistairSH 2y ago
  More likely he was swayed because ACA was closer to a sure thing than anything remotely socialized.
- mrguyorama 2y ago
  Obama was "swayed" because there were several "democrats" whose vote was required to pass anything who explicitly said they would not vote for single payer. People get this weird idea that democrats "aren't doing anything", but you need votes in the US system to do anything and democrats consistently lose elections. The people who stayed home and didn't vote will then insist that democrats didn't do enough to win their vote. But you can't do anything in the US without votes.
  - semiquaver 2y ago
    > whose vote was required to pass The 111th Congress had a historically large majority that has not been seen by either party since. https://en.m.wikipedia.org/wiki/111th_United_States_Congress https://en.m.wikipedia.org/wiki/111th_United_States_Congress They had more than enough votes: the ACA passed the senate 60-39. The senate filibuster that led them to compromise on the public option is a procedural rule that can be altered by simple majority, not a law.
    - alistairSH 2y ago
      Removing the filibuster is a "nuclear option" - once it's gone, when the Senate inevitably swings the other way, the new majority will make use of it's absence to ram through whatever they want. There are arguments that this would actually be preferable and moderating, but that's a whole other debate. The 60 member supermajority was also fragile. And only lasted 72 days. There was a time limit on passing anything major. None of which is to say your wrong, only that there was a bit more nuance than "Dems had majority and flubbed".
dgfitz 2y ago
I had to look it up, defense spending is 2.3ish% of GDP, and healthcare is 17.3% of GDP. There does seem to be a lot more fat to cut in healthcare than defense. I have never seen that number before, that is fascinating.

by munk-a 2y ago

alistairSH 2y ago

Somewhere between 15-30% of health care spending in the US can be classified as "waste" or "administrative overhead" (values and descriptions vary by study). Even if we cut that 15% waste in its entirety, that's moving us from 17.3% to 14.8%. Is that going to leave some administrative staff looking for jobs? Absolutely. But, I don't see that totally crashing the economy, not when that money is freed up for productive spending (more cars, more travel, more dining out, whatever).

deleted 2y ago
[deleted]
munk-a 2y ago
In the long term the market will absolutely adjust to more efficiently using that potential - but that's the long term. If America suddenly socialized health insurance millions of people[1] would be out of a job. The long term outlook of the economy would much better - but the short term would be extremely painful. 1. UHC appears to be about 440,000, CVS about 300,000, Elevance (aka Anthem) 104,900 - those are just a trio of the larger insurers out of hundreds.
- alistairSH 2y ago
  That's assuming every job at those companies is absolute waste/overhead. I'm not convinced that's true. If we kill private insurance and move to Medicaid-for-All (I'm not suggesting this is the right approach, just thinking aloud here), the size of the Medicaid bureaucracy would have to grow, offering some of those former UHC/CVS/Anthem employees an "easy" transition into similar work. Anyways, no change this big would ever be made overnight. So, phase in changes over 5-10 years. Problem "solved".
  - stackskipton 2y ago
    It's not solved. I know many on this website have probably changed technology they used and used to learning but that's not the case for vast majority of people. They just want a job, pushing the buttons/emails, collecting a paycheck and doing not work thing. As non FAANG person, the number of developers I've met who continue to greenfield in Java 8 and .Net Framework is mind blowing and any attempt to make them learn something new falls on deaf ears.

IncreasePosts 2y ago

Wasn't Obama swayed against a single payer system, because eliminating all the middle men would end up with like 2 million people going unemployed?

alistairSH 2y ago
More likely he was swayed because ACA was closer to a sure thing than anything remotely socialized.
mrguyorama 2y ago
Obama was "swayed" because there were several "democrats" whose vote was required to pass anything who explicitly said they would not vote for single payer. People get this weird idea that democrats "aren't doing anything", but you need votes in the US system to do anything and democrats consistently lose elections. The people who stayed home and didn't vote will then insist that democrats didn't do enough to win their vote. But you can't do anything in the US without votes.
- semiquaver 2y ago
  > whose vote was required to pass The 111th Congress had a historically large majority that has not been seen by either party since. https://en.m.wikipedia.org/wiki/111th_United_States_Congress https://en.m.wikipedia.org/wiki/111th_United_States_Congress They had more than enough votes: the ACA passed the senate 60-39. The senate filibuster that led them to compromise on the public option is a procedural rule that can be altered by simple majority, not a law.
  - alistairSH 2y ago
    Removing the filibuster is a "nuclear option" - once it's gone, when the Senate inevitably swings the other way, the new majority will make use of it's absence to ram through whatever they want. There are arguments that this would actually be preferable and moderating, but that's a whole other debate. The 60 member supermajority was also fragile. And only lasted 72 days. There was a time limit on passing anything major. None of which is to say your wrong, only that there was a bit more nuance than "Dems had majority and flubbed".

dgfitz 2y ago

I had to look it up, defense spending is 2.3ish% of GDP, and healthcare is 17.3% of GDP. There does seem to be a lot more fat to cut in healthcare than defense. I have never seen that number before, that is fascinating.