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Universal healthcare doesn't change the overall cost. To a large degree, the ACA/Obamacare was a good stab at getting universal healthcare! The change in this a

Universal healthcare doesn't change the overall cost. To a large degree, the ACA/Obamacare was a good stab at getting universal healthcare! The change in this article is about undoing universality, by changing the subsidies for those with lower income. To structurally reduce the fraction of GDP devoted to healthcare, we need to make far bigger changes. A lot of the setup right now is to subsidize those on Medicare by those on private insurance programs. The cross-subsidization goes very deep, and anything that might reduce costs also has the risk of undoing cross-subsidization. With half the country refusing to reform health care for the past 30 years, and the other half having their hands tied behind their back on trying to improve health care, we have built a gigantic overly complex system that's very hard to unwind.

lazide 1y ago
Yup. Eventually it’ll likely be burned to the ground (uh, I mean ‘reformed’) but folks are trying to squeeze what they can out now.
narrator 1y ago
Whatever the problem with health care in America is, the solution is not more money. We already spend double what all other countries spend as a percent of GDP and we have worse outcomes. There are a lot of similar mysteries in America. For example, why does it cost a billion dollars a mile to do subways which is 20x almost everywhere else.
AnimalMuppet 1y ago
> Universal healthcare doesn't change the overall cost. It can, at least to some degree. Every doctor's office has people who run through the insurance maze, trying to get services paid for. And every insurance company has people on the other side, trying to find ways to not pay for stuff. Having only one organization to deal with would simplify that; having one organization with clear, transparent rules would simplify it more.
the_gastropod 1y ago
> Universal healthcare doesn't change the overall cost I get the sense I'm probably preaching to the choir here. But, the U.S. spends almost 2x what comparable countries (with universal healthcare) spend on healthcare. And we get worse than average results on virtually every measure. This, of course, makes sense. When you're running healthcare as a for-profit business, part of our expenses are... profit to pay out shareholders. And advertisement budgets. And middlemen (insurance). And employees to do things like decline coverage. Medical employees to deal with insurance companies declining coverage. Etc. etc. There's a whole industry that only exists to support our private healthcare system that would cease to exist in a universal healthcare system.
forgotusername6 1y ago
Surely the complete removal of insurance and advertising from the US healthcare system would have an impact on the overall cost. Not to mention the amount of early preventative care that could be carried out instead of people waiting until it was really serious due to fear of medical bills.
- andy99 1y ago
  Yes, the problem is insurance, not who pays for healthcare. There's not universal government funded car maintenance and it works just fine for the most part. Insuring predictable, recurring costs is a scam. There's room, either private or public, to backstop catastrophes, but not the rest.
- epistasis 1y ago
  We are about twice as expensive as healthcare system from other similar countries. Eliminating all administrative fees from insurance, all advertising, does not close that gap. There's a lot more going on!
runako 1y ago
> Universal healthcare doesn't change the overall cost. Something like 15% of US healthcare spending goes towards administrative fees just around insurance. That's order of $800 billion annually, roughly $1,500 per American, that does not contribute in any way to improving health. This is roughly the size of the US defense budget that we spend on gating healthcare. There are knock-on effects of our system that increase some costs, such as people skipping preventative care or medications due to high costs or lack of insurance and then ending up in higher-cost emergency care. Or see the recent trend of physicians documenting how much of their time spent arguing with insurance companies on behalf of patients, time not spent providing medical care (and thereby increasing costs).
- franktankbank 1y ago
  > Something like 15% of US healthcare spending goes towards administrative fees just around insurance. True parasites.

lazide 1y ago

Yup. Eventually it’ll likely be burned to the ground (uh, I mean ‘reformed’) but folks are trying to squeeze what they can out now.

narrator 1y ago

Whatever the problem with health care in America is, the solution is not more money. We already spend double what all other countries spend as a percent of GDP and we have worse outcomes. There are a lot of similar mysteries in America. For example, why does it cost a billion dollars a mile to do subways which is 20x almost everywhere else.

AnimalMuppet 1y ago

> Universal healthcare doesn't change the overall cost. It can, at least to some degree. Every doctor's office has people who run through the insurance maze, trying to get services paid for. And every insurance company has people on the other side, trying to find ways to not pay for stuff. Having only one organization to deal with would simplify that; having one organization with clear, transparent rules would simplify it more.

the_gastropod 1y ago

> Universal healthcare doesn't change the overall cost I get the sense I'm probably preaching to the choir here. But, the U.S. spends almost 2x what comparable countries (with universal healthcare) spend on healthcare. And we get worse than average results on virtually every measure. This, of course, makes sense. When you're running healthcare as a for-profit business, part of our expenses are... profit to pay out shareholders. And advertisement budgets. And middlemen (insurance). And employees to do things like decline coverage. Medical employees to deal with insurance companies declining coverage. Etc. etc. There's a whole industry that only exists to support our private healthcare system that would cease to exist in a universal healthcare system.

forgotusername6 1y ago

Surely the complete removal of insurance and advertising from the US healthcare system would have an impact on the overall cost. Not to mention the amount of early preventative care that could be carried out instead of people waiting until it was really serious due to fear of medical bills.

andy99 1y ago
Yes, the problem is insurance, not who pays for healthcare. There's not universal government funded car maintenance and it works just fine for the most part. Insuring predictable, recurring costs is a scam. There's room, either private or public, to backstop catastrophes, but not the rest.
epistasis 1y ago
We are about twice as expensive as healthcare system from other similar countries. Eliminating all administrative fees from insurance, all advertising, does not close that gap. There's a lot more going on!

runako 1y ago

> Universal healthcare doesn't change the overall cost. Something like 15% of US healthcare spending goes towards administrative fees just around insurance. That's order of $800 billion annually, roughly $1,500 per American, that does not contribute in any way to improving health. This is roughly the size of the US defense budget that we spend on gating healthcare. There are knock-on effects of our system that increase some costs, such as people skipping preventative care or medications due to high costs or lack of insurance and then ending up in higher-cost emergency care. Or see the recent trend of physicians documenting how much of their time spent arguing with insurance companies on behalf of patients, time not spent providing medical care (and thereby increasing costs).

franktankbank 1y ago
> Something like 15% of US healthcare spending goes towards administrative fees just around insurance. True parasites.