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Health care is so broken that I think it will unbreak itself. You can eliminate most of the problem by mandating true cost billing by hospitals (get rid of the

• mekdoonggi 7mo ago
  You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old. If the US had the equivalence of Canadian health insurance, the spending reduction would be so big, that as a working person, your health insurance bill would go to zero, out of pocket costs to zero, and everyone would have health insurance.
  • Projectiboga 7mo ago
    Medicare's admin cost is around 5%, private insurance is around 33% of claim dollars. There are around 27-28% uninsured. The money is already there who pays needs to be moved to the Billionaire and Multimillionaire class to reduce the annual costs for those who work for a living.
    • onlyrealcuzzo 7mo ago
      > private insurance is around 33% of claim dollars. The Medical Loss Ratio (MLR) requirement established by the Affordable Care Act (ACA) is 20%. Typically it's closer to 15%. As these are private companies, some percentage of that is obviously profit. It doesn't cost that much more to run private insurance than Medicare. The problem is the incentive of insurance to drive up cost to get a larger fixed cut, and the lack of a public option (which would require private insurance to actually be worth it).
    • rexroad 7mo ago
      Those figures are in the right range, and the full picture is larger. The CMS NHE 2023 data puts total US healthcare administration at roughly $1.1-1.7T annually (depending on methodology), building on Woolhandler and Himmelstein's 2020 Annals paper ($812B in 2017 dollars). The per-capita comparison against 10 OECD peers: US $4,983 vs. a peer average of $884. That 5.6x gap is the number Issue #5 of this series will examine in detail, covering three separate computation methodologies and why the estimates range so widely. All source code will be in the repo: https://github.com/rexrodeo/american-healthcare-conundrum https://github.com/rexrodeo/american-healthcare-conundrum The policy lever that addresses this is billing standardization, not just insurer reform. Countries like Germany and Switzerland run much lower admin under private insurance through standardized claims formats and all-payer rate setting.
  • 46493168 7mo ago
    The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people. See, for example, “Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland” by Jonathan Metzl
    • some_random 7mo ago
      [flagged]
      • 46493168 7mo ago
        What does this comment mean?
        • mekdoonggi 7mo ago
          I think that some_random is saying sarcastically, "46493168, keep doing libel on people of white blood by stating that they vote against health insurance reform because they are racist, and maybe it will solve the problem."
      • buellerbueller 7mo ago
        That's good, love how you're co-opting anti-semitism for your own political ends. "Blood libel" refers to a specifically anti-Jewish trope of alleging that Jews murder Christians, especially children, to use their blood for religious rituals. Grandparent comment is 100% not blood libel.
    • jkestner 7mo ago
      But they’re a subset. It can happen. The more critical, and yet smaller, subset is the people making bank from the current system. Get their money out of politics and watch resistance crumble.
      • 46493168 7mo ago
  • onlyrealcuzzo 7mo ago
    > You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old. I strongly think that covering everyone in the existing system is not the best way to go. The existing system is designed to cost as much as possible, and we have way too much demand for treatment (as is) and not enough supply. ER wait-times aren't 2-4 hours just because. First, that needs to break. Then, you can cover everyone. We simply do not have enough doctors for how many old and unhealthy people we have. We should be thinking about how to keep people from going to the hospital that don't really need to be there. Do you really need to go to the ER because you stubbed your toe? If you didn't have insurance, you'd go to a low-cost clinic and get the same treatment for 1/10th the price. We are slowly getting there already. Low cost clinics weren't widely available, but they are becoming more and more available as the cost of health care even WITH insurance is too high for most people. The infrastructure for the bottom ~50% of people needs to exist to break free from a system that is not designed for them BEFORE they can move off it. It's almost there. Since One Medical became widely available, I basically have not gone to the hospital in 5+ years. Before, you kind of needed to go even for routine things (or at least I didn't know of a viable alternative). More and more places like this are springing up all over the US.
    • throwaway173738 7mo ago
      Who would you choose not to cover? The sick? I hate to break it to you but insurance is meant to be a tax on the entire risk pool. What changed after the ACA is we couldn’t kick anyone out of the risk pool for getting sick.
      • onlyrealcuzzo 7mo ago
        > Who would you choose not to cover? The sick? You didn't read the post. The sick are mostly the old (if you're looking at total spending), and they are already covered by Medicare. The sick young are a minority, and are often times covered by Medicaid. If the state covers the tail end and assuming they aren't covered already by Medicaid, there just isn't that much spending remaining. They can get private insurance to cover the under $10k per year - but there's not really a product that covers that effectively - so unless a new insurance evolves, it still wouldn't make much sense. The sick, young, non-medicaid tail is VERY small compared to the rest of the tail the state already covers. Just add it in. A 1% global tariff could easily cover it. You've still got 9-14% left to spend on more bombs, tax breaks for the rich, paying people to get underwater basket weaving degrees, whatever.
  • Taikonerd 7mo ago
    > You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it Most Medicare recipients do get supplementary private insurance though? It's called "Medigap." Medicare pays for 80% of patients' costs, but even the remaining 20% is a lot. (You get a $100,000 procedure -- you're on the hook for $20,000.) That's why people get Medigap coverage.
    • mekdoonggi 7mo ago
      By "the insurance" I was referring to Medicare. I'm a working, healthy person and rarely use healthcare outside of preventative care. You could raise my Medicare taxes by hundreds monthly and still be less than what I pay for private insurance. In a Medicare-for-all scenario, the individual price of a given procedure doesn't need to be so high, because the reimbursement is guaranteed. Right now, the "list" price of the procedure has to be high to subsidize the uninsured and Medicaid who lose money. I'm sure there are single payer health insurance countries in which people still purchase insurance, which should inspire debate about the universal insurance cost-sharing. Regardless, the only viable solution in the US is a single payer insurance model.
      • SoftTalker 7mo ago
        Your private insurance isn't there (ideally) to pay for your preventative care, which you can easily pay for out of pocket. It's there to pay for the low-probability but very expensive scenarios, such as cancer, major accident/injury, etc. that would otherwise bankrupt you.
        • mekdoonggi 7mo ago
          I understand how insurance is supposed to work. The problem is that private insurance captures all of the value I pay in during my working life, and doesn't have to pick up the tab when I inevitably get old and sick. To use car insurance as an example, it would be like if we had a government program for cars over 150k miles. You have to pay for both private and government insurance. The private company collects more money than the government, but the government pays for all the expensive stuff because that's when cars break down. It's completely pointless. If you want a medicare-for-all scheme where working people have a higher cost-share than children/retirees, fine, that's reasonable. Having private companies rake in profits from a system that has no business being a profit enterprise is insane.
• WarmWash 7mo ago
  The actual true problem is that there is a mismatch between the value the average person generates in their life, and the value of them staying alive. A handful of SOTA treatments can easily blast through a year of someone's total earnings. And this isn't even some kind of gouging or scam, anything SOTA tends to be the most expensive. Insurance is the natural solution to this, but to be effective it requires most people to not need it while still paying into it. This is what Obamacare tried to fix by mandating insurance, but healthy/young people got sticker shock and bailed.
  • onlyrealcuzzo 7mo ago
    > Insurance is the natural solution to this, but to be effective it requires most people to not need it while still paying into it. Yes, and you can fix it by the state covering ONLY tails - which it ALREADY essentially does, just as expensively as humanly possible. Democrats and Republicans spend all their time arguing about whether to have sweeping changes that won't drive down costs or do nothing (which obviously won't bring down costs). You could spend less money and get better outcomes by officially covering the tails instead of un-officially. Instead of ~50% of young, healthy people paying a MASSIVE tax for "insurance for all" which doesn't really do what it says - you could just officially cover the tails, use the existing tax dollars, and accept that instead of ~30% of people "not having coverage" everyone would have tail coverage and ~50% of people wouldn't have "coverage". You get a better, fairer system - that costs less overall, and that I think the American people could actually vote for. Republicans would like it because it costs less and doesn't cover abortions or whatever they bitch about. Democrats would like it because it officially covers everyone and prevents medically bankruptcies, and it doesn't FORCE anyone off insurance, and it would bring down private insurance costs significantly. They'd bitch that we should just do Universal Healthcare instead, but it's hard to argue it's a step in the wrong direction. Pipe dreams don't pass. Reality does. You're never getting anything passed that massively fucks over a huge relatively popular special interest (like doctors). You might be able to pass things that piss off unpopular powerful special interest like Health Insurance (or, previously, Fossil Fuel companies).
• LorenPechtel 7mo ago
  And this is supposed to be an answer? 1) In many cases you are paying that high "markup" for the handling rather than the product. 2) Hospitals are typically not making much money. Available 24/365 costs. Deadbeats cost. 3) Yes, most people don't pay much healthcare in any given year. But you don't know what year they are going to. 4) I like the idea of it as a tax--but in the real world this always ends up with the fox guarding the henhouse. Because most people don't need much care in a given year it's easy to satisfy the majority of the population with poor quality care. The ones that see the failure aren't enough to change the outcome of the ballot box.