23 ms·

Universal health coverage could save $1T and 114k lives a year: study

• anotherevan 2mo ago
  "You millennials and your obsession with public healthcare. Back in my day we just died."
• karakoram 2mo ago
  >A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.
  • jonplackett 2mo ago
    $1 trillion less profit.
    • garbawarb 2mo ago
      That would be a massive hit to our GDP.
      • nemomarx 2mo ago
        Think of all the insurance jobs that would be hit, too. Unfortunately we've bloated the healthcare industry to have a lot of employees
        • panzagl 2mo ago
          Somehow I doubt there would be fewer jobs in healthcare if the government takes it over.
      • bensyverson 2mo ago
        Just think about the boost to our GDP by having healthier consumers who live longer, don't go into medical bankruptcy, and continue to buy stuff.
      • triceratops 2mo ago
        Not necessarily, over the long-term. That's $1 trillion more in disposable income.
      • ovi256 2mo ago
        Not at all. Reducing a cost means the payer can spend the money on something else
      • brainwad 2mo ago
        Presumably not; the same national income would just be redistributed from shareholders to insurees (or shareholders of companies that pay for employee health insurance).
      • karakoram 2mo ago
        In all seriousness, this would be a massive stimulus to the economy. Americans are consumers at heart. All the money saved on insurance and/or other healthcare related costs would then be spent elsewhere. Cars, clothes, TVs, Labubu dolls. People will use the savings to buy things. In massive quantities.
        • arkh 2mo ago
          There is also some indirect bonus: if people's healthcare is not tied to their employer then it's easier to look for a new one. Also if the system is done well, then many companies would lose the incentives they currently have for not giving full-time employment.
        • garbawarb 2mo ago
          Some would, but some would just put that money into savings and investments instead.
          • DerArzt 2mo ago
            From a retirement standpoint I keep hearing that not enough Americans are saving for retirement, so this would still be a win for me.
      • oa335 2mo ago
        https://en.wikipedia.org/wiki/Parable_of_the_broken_window https://en.wikipedia.org/wiki/Parable_of_the_broken_window
      • dgellow 2mo ago
        Are you implying you would decide to sacrifice citizens health for a few GDP points, a somewhat useful but oversimplified metric that doesn’t reflect anything tangible?
    • dsr_ 2mo ago
      $1 trillion more efficient in allocation of resources, freeing up money for consumer spending on everything.
      • johndevor 2mo ago
        Are you saying the government is an efficient allocator of resources?
        • bobson381 2mo ago
          it's that it's 1 Trillion less in incentivized middlemen. A la Graeber.
        • no-name-here 2mo ago
          Per the study we are discussing -- as well as the results from every single other developed country I believe? -- more efficient when it comes to healthcare, yes.
          • johndevor 2mo ago
            If the government is so efficient, why don't we just have them run all our industries?
            • no-name-here 2mo ago
              Because both studies and real-world results from every other developed country show gov is more efficient at healthcare, is your argument that means gov is more efficient in every field?
        • deleted 2mo ago
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        • GolfPopper 2mo ago
    • ovi256 2mo ago
      Not profit, just income
      • secabeen 2mo ago
        And most of that income is salaries to existing healthcare administrators. Quickly ending the employment of the people working those jobs would be a significant shock.
    • cityofdelusion 2mo ago
      Not really. Private health insurance would still exist alongside for the more wealthy (including nearly everyone on HN) that doesn’t want to wait a year for their public system MRI. Same thing that plays out in other countries. The U.S. already has a form of this in so-called concierge / premium providers too. Lots of profit to be made.
      • intuitionist 2mo ago
        This isn’t true of the Medicare for All Act, for what it’s worth. That would ban private insurance altogether. Personally I think that’s a bug, not a feature, but if you’re very concerned with fairness then you probably think the opposite.
      • loeg 2mo ago
        If private health insurance was allowed, UHC would be stillborn. It only works if providers don't have better options than medicare reimbursement rates.
        • no-name-here 2mo ago
          > It only works if providers don't have better options than medicare reimbursement rates. 1. A number of other developed countries have UHC while also allowing a private system as well - what is unique about the US that other countries' existing approach couldn't work here? 2. Less importantly, in this world where everyone has medicare, but a smaller fraction have private coverage, your argument is that the existing healthcare providers would choose to give up most of their (medicare) patients? If so, why wouldn't providers choose to stop serving medicare patients under the pre-2026 system, where giving up medicare patients would be a far smaller loss than in a world where everyone has medicare?
          • maxlybbert 2mo ago
            > 1. A number of other developed countries have UHC while also allowing a private system as well - what is unique about the US that other countries' existing approach couldn't work here? Mainly, expectations. I understand that UHC in European countries doesn’t cover all the things Americans assume it does. Japan apparently keeps costs down by not using cutting-edge drugs. That’s not going to happen in the US. The US Congress just isn’t good at keeping costs down. > 2. ... why wouldn't providers choose to stop serving medicare patients under the pre-2026 system, where giving up medicare patients would be a far smaller loss than in a world where everyone has medicare? They absolutely do. Many providers don’t accept Medicare. Very few providers accept Medicaid. The payments just aren’t high enough.
    • RajT88 2mo ago
      $1 trillion less middle-men.
    • consensus1 2mo ago
      Total profits for US health insurance companies in 2025 were $50 billion. The other $950 billion has got to come from cutting: 1. money to providers 2. overall healthcare consumption 3. bureaucratic redundancy and waste 1 is going to piss off medical providers. 2 is going to piss of the general public. 3 is going to piss off the 20 million healthcare industry workers who are not direct care providers. So pick your poison. This is why it will never pass.
      • chaps 2mo ago
        Have you ever dared to dream of something that sounds impossible but isn't?
        • gadflyinyoureye 2mo ago
          The average Georgian plumber has higher purchasing power than the average German doctor. In order for the United States to balance its medical books, doctors will have to be paid dramatically less than they are at present. Perhaps there’s a deal to be made where doctors take the hit, but all of their debt is paid off by the state. Going forward medical school is free, but like in Germany you have to qualify, I mean really qualify to even get your foot in the college door. That’s an expectation change for the United States population on all fronts. We don’t do well with expectation changes.
          • chaps 2mo ago
            Yeah, a lot of these issues are felt in other fields too so it feels like there's a need for a larger, wider schism. Like I would love to go to law school but I can't afford it. So many possible but inherently unattainable futures. We'll get there.
            • nradov 2mo ago
              You can afford to go to law school if you're willing to prioritize it and make some sacrifices. There are plenty of law schools that have part time night or online options. Take one class at a time and you'll eventually get through.
  • elictronic 2mo ago
    [flagged]
    • java-man 2mo ago
      and what about the third yacht? who could afford the third yacht then? huh?
  • jandrewrogers 2mo ago
    FWIW, the methodology that produced this particular result is known to have significant issues. The claimed effect disappears after correcting for them. It also isn't the first time that these authors have published similar studies with these issues. They are not a credible source. Universal health coverage may save lives and money but this study doesn't provide actual evidence for it.
    • larkost 2mo ago
      Please cite and explain what those significant issues are. As it is your post is a "trust me bro", and is not contributing to the conversation.
    • devindotcom 2mo ago
      "known" by whom, and documented where? if you're going to just parachute in and say this paper by domain experts is dead wrong, at least link to what you believe shows this to be the case.
    • Someone1234 2mo ago
      > result is known to have significant issues. So well known you neglected to state or cite them? I'd invite you to do so now.
    • superxpro12 2mo ago
      ok so we're just dismissing the paper with zero substantive counterclaims then?
  • ChrisRR 2mo ago
    Studies: Investing in green energy would reduce our reliance on the middle east for oil and create jobs locally America: Sounds like communism
• lapcat 2mo ago
  This is why it doesn't happen: politicians get bought. "Jeffries co-sponsored Medicare for All legislation between 2013 and 2021, but in August 2026, he stated he shifted his stance and stated that he no longer supports or co-sponsors the proposal." https://en.wikipedia.org/wiki/Hakeem_Jeffries#Healthcare https://en.wikipedia.org/wiki/Hakeem_Jeffries#Healthcare
  • brainwad 2mo ago
    This could equally be explained by wanting to be perceived as more moderate/centrist. Which would make sense for someone in a leadership position.
    • lapcat 2mo ago
      > This could equally be explained by wanting to be perceived as more moderate/centrist. I don't think anyone perceives a flip-flopper as anything except unprincipled. There's nothing "moderate" about corruption.
  • juiceland 2mo ago
    Universal healthcare doesn’t happen in the US because a certain subset of the American population would rather have worse health outcomes than guarantee abortions, HIV prevention, and gender-affirming care. Also, ~150M people with employer coverage plus seniors on Medicare fear disruption more than they value expansion.
    • nemomarx 2mo ago
      You can easily drop those from a universal healthcare system - look at the NHS and gender affirming care across the pond. So it can't only be that part - I think it's wanting the undeserving to not have healthcare.
      • Schnitz 2mo ago
        It’s not that easy. You have to make it through the primaries to stand for election. Both parties are increasingly dominated by their outside wings. If you said “I’ll try to get universal healthcare done and I’ll build the coalition needed for it, even if it means accepting painful compromises like not covering gender affirming care” you won’t make it out of the democratic primaries. That’s why there’s so many common sense positions that have majority support yet never a majority in political bodies.
• myfavoritetings 2mo ago
  How much would it save if you account for the fact that half of congress would sabotage it in to oblivion?
  • mejthemage 2mo ago
    And if not that.. healthcare then becomes monopolized. Maybe extreme but what prevents that entity from becoming the decider regarding who lives and dies?
• konaraddi 2mo ago
  Link to the preprint https://www.medrxiv.org/content/10.64898/2026.07.22.26358689v1.full.pdf https://www.medrxiv.org/content/10.64898/2026.07.22.26358689...
• digitalsurgeonz 2mo ago
  [dead]
  • basch 2mo ago
    or that trillion in health care isnt going into the oligarchs pockets, and could be..
  • t-writescode 2mo ago
    The last time we got similar results in the data (but not the text) was a Koch-backed study that a bunch of economists reviewed and went “so you’re saying we’d save 2 Trillion over 10 years relative the alternative?” https://pnhp.org/news/the-mercatus-analysis-of-bernie-sanders-single-payer-bill https://pnhp.org/news/the-mercatus-analysis-of-bernie-sander...
• afavour 2mo ago
  In a more sane world the Republican Party would be in favor of universal health coverage. How many potential entrepreneurs stay working at BigCorp because they need the health benefits? How many small businesses are crushed by the cost of providing healthcare to their employees? It would be great for business to remove any involvement they have in personal healthcare. But I suppose they are the party of big business, not the party of business in general.
  • RajuChacha108 2mo ago
    [flagged]
    • jalapenoj 2mo ago
      [flagged]
  • poncho_romero 2mo ago
    In what world is the Republican Party pro entrepreneur/small business enough to make these rhetorical questions meaningful?
    • fhdkweig 2mo ago
      When they make campaign promises, they go to small towns and talk about "Main St" businesses. Not sure why anyone believes them at this point (for the reasons you mention), but it is what they campaign on.
      • dboreham 2mo ago
        Oh dear. They make those statements for the benefit of people who don't own small businesses, but are "low information voters".
    • jvanderbot 2mo ago
      I think republicans could get behind some measure of portable health plans between employers. What they could not get behind is universal, in the sense of "everyone living in USA" health care footed by the US Government. The objection would be about centralization of health care funding and about, you know, who would get the benefits.
• ilamont 2mo ago
  There have been studies like this for decades, going back to at least the Clinton administration. And nothing will come of it. Too many entrenched interests, regulatory capture, and lobbying + political donations.
  • xhkkffbf 2mo ago
    If spending drops by $1t, it will come out of someone's paycheck. Yes, some are greedy folks who will be just fine making 20% less a year. But many will be nurses or hospitals or some combination of providers.
    • ThrowawayTestr 2mo ago
      That you actually believe that is so sad. No, the money would come out of the pockets of insurance CEOs.
      • Barrin92 2mo ago
        it would not because the margins in the insurance industry aren't high. The OP is entirely correct, insurers are a source of payment, not a driver of cost. Insurers don't benefit from hospitals charging them high prices, they try to negotiate cost down, that is their service. They don't enjoy paying hospitals more money. What is driving the actual cost is the high expenses hospitals have, and the biggest source of that is labour cost, as in any other industry. American healthcare workers, doctors and nurses, earn about 2-3x as much as their peers in the developed world. One of the biggest benefits of a national healthcare system for consumers is that the government becomes a monopsony buyer of healthcare workers. The British system is half as expensive because the government gets to set the prices for its healthcare workforce and that gets passed on to the patients.
        • ThrowawayTestr 2mo ago
          I'm sure the army of middle been between patient and doctor have nothing to do with it.
• solaarphunk 2mo ago
  What about quality of care tradeoffs? In Canada, for example, you are forced to use the government system, and if it doesn't deem you important enough, there is no private option.
  • intuitionist 2mo ago
    The private option is medical tourism to Buffalo or whatever.
  • t-writescode 2mo ago
    Is this quality improvements including or ignoring the 30-ish percent rejection rate of the most popular healthcare system, including such gems as insulin and pre-authorizations refusing surgery for necrotic tissue when “maybe they could PT it, have you tried?”
    • aidenn0 2mo ago
      PT? Luxury! My daughter had PT referred by her pediatrician, then the insurance didn't pay all of it and when I asked the insurance company for the EOBs they said they were not allowed to give them to me because it would violate my daughter's privacy.
      • deleted 2mo ago
        [deleted]
      • bcrosby95 2mo ago
        Our insurance paid for the bill from my wife's surgeon but spent 8 months refusing to pay for literally anything else, including the anesthesia. They said it was "medically unnecessary".
  • poncho_romero 2mo ago
    What about them? The Canadian healthcare system has better outcomes than the American healthcare system in several areas. Most simply, Canadians live longer.
• jvanderbot 2mo ago
  We've been down this road. ACA was predicated on studies like this, to no avail (it turns out that intense opposition chips away at it over time regardless of these studies). I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I'm not saying that this is what is happening now, but I am saying that calls for universal health coverage, no matter how correct and well supported, are going to probably face the same obstacles they did last time, so we need new coalitions and implementation proposals if we're going to give it a go again. It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to.
  • deleted 2mo ago
    [deleted]
  • _heimdall 2mo ago
    These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause. The problem with US healthcare isn't who pays for it, its how damn expensive it is. As always there are multiple factors at play, my list would include corruption, lack of legal accountability/responsibility, and a population that is much less healthy than reasonable. Go after any one of those and we'd make a lot more headway than trying to ram through a universal, government-run healthcare or insurance program. And yes, such a program could impact the above topics, but it doesn't have to and could make any of them worse.
    • loeg 2mo ago
      Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.
      • quacked 2mo ago
        That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.
• CurbStomper 2mo ago
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• ixtli 2mo ago
  This doesnt need yet another study. Instead of narrating the problem we should figure out whats actually stopping it. And people saying the ACA was universal health coverage or even an attempt at it should stop intentionally derailing this discussion.
  • nsxwolf 2mo ago
    Democracy is the biggest obstacle to universal healthcare in the US. A lot of people do not want it, and you've thus far failed to make them want it.
    • ixtli 2mo ago
      Cool system.
• RajuChacha108 2mo ago
  [flagged]
  • throw1234567891 2mo ago
    Right? What, are you all commies?
  • dbbk 2mo ago
    The government provides your police force and fire department. Why not?
    • 0xy 2mo ago
      Look no further than the UK, with 24 month waiting lists, the shunning of experimental treatments (many high profile kill decision cases) and skyrocketing costs. In the UK, a brain surgeon is paid less than the General Manager of a single Buc-ees Gas Station location in the United States. Absolutely diabolical.
      • dbbk 2mo ago
        I'm British. You're incorrect.
        • 0xy 2mo ago
          On which point? Brain surgeon pay? [1] [2] Waitlisting? [3] [4] There's literally over 7,000,000 Britons on a NHS waiting list right now. Please clarify what I'm incorrect about. [1] https://uk.indeed.com/career/neurosurgeon/salaries https://uk.indeed.com/career/neurosurgeon/salaries [2] https://finance.yahoo.com/news/buc-ee-offering-275k-salaries-161559187.html https://finance.yahoo.com/news/buc-ee-offering-275k-salaries... [3] https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis https://www.bma.org.uk/advice-and-support/nhs-delivery-and-w... [4] https://old.reddit.com/r/ADHD/comments/1nz7dt2/if_your_in_the_uk_waiting_on_the_nhs_2_year/ https://old.reddit.com/r/ADHD/comments/1nz7dt2/if_your_in_th...
      • 2mo ago
• whimsicalism 2mo ago
  I'm honestly curious how we square this with the only experimental evidence we have on cost-sharing in the US, like the Oregon Medicaid Study and the RAND study which showed no impact on mortality or really any physical health outcomes at all.
  • loeg 2mo ago
    UHC proponents are just excessively optimistic about impact on health outcomes.
    • jacquesm 2mo ago
      No, they are excessively optimistic about the financial outcomes. Healthcare should not bankrupt people.
      • whimsicalism 2mo ago
        This study appears to just take observational mortality averages between insured and uninsured and then assume that UHC would close the gap. Patently absurd imo, but I guess I'm not a healthcare economist.
      • loeg 2mo ago
        They're excessively optimistic (as in, unrealistic) about both. (Healthcare mostly doesn't bankrupt people -- the vast majority are insured, and the rest pay ~nothing.)
• aidenn0 2mo ago
  I've become so cynical that I think even if universal health coverage would be passed, since it almost certainly would be run by the executive branch, it would become just another political football to be fucked with every 4 to 8 years. Just think, if we had universal health care in the US today, the MMR vaccine would not be covered by it!
• greenpizza13 2mo ago
  The US is far too broken for such a thing to ever come to be. Politicians are bought and paid for, and the impact on the insurance companies and their profits make this impossible. US legislators will never, ever, ever put the needs of the people above the needs of corporations, not as long as corporations can wield their massive wealth as "free speech" in the form of lobbying and political donations. Sounds nice, though.
  • whimsicalism 2mo ago
    I'm earnestly curious what the alternatives to CU look like and what that would mean for for-profit companies like The New York Times?
  • consensus1 2mo ago
    Nobody, including congress, gives a rat's ass about insurance companies and their profits. The truth is that someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision. After the CEO of United Healthcare was gunned down in the streets for doing that thankless job do you think congress is saying to themselves "hey, maybe we should get into that business"?
    • googaar 2mo ago
      Man I wish I could downvote a comment. This is what you’d see on Reddit. “Thankless job” is a crazy way to describe United Healthcare. No one cares about insurance companies and their profits?? This doesn’t even make sense, so many people rely on insurance and many stakeholders profit off the American insurance system.
      • whimsicalism 2mo ago
        You would never see content like that on Reddit as it is far outside of the political valence there.
      • strictnein 2mo ago
        > "Man I wish I could downvote a comment" I mean, you can do that here. The system just restricts what you can do until you've spent more time commenting.
• b3ing 2mo ago
  Won’t happen the big players make too much money the way things are, and that is more important than people’s lives or for our country
• loeg 2mo ago
  What UHC proponents never honestly admit is that these headline figures require incredibly optimistic assumptions and also much more rationing of care than our current model. We spend a lot on healthcare because we consume a lot of services. To save money, you have to buy fewer services. Yes, you can squeeze providers a little bit ("Medicare-level payments to providers" -- which they will absolutely hate, by the way), and you get another little bit by disposing of insurance provider profit margins ("reduced administrative overhead"). But the vast majority is coming from rationing, which people hate. And it would also cost massively increased taxes on the middle class, which voters also hate. "Fewer avoidable emergency department visits and hospitalizations" -- sheer optimism. "Less fraudulent billing" -- no reason to believe this would be true. There could be even more fraudulent billing! Medicare fraud has been a big problem, and solutions are largely reactionary.
• AlfredBarnes 2mo ago
  .....yeah
• ConceptJunkie 2mo ago
  Since when has a government projection of costs ever been in any way realistic? The estimates for the costs of Medicare when it was established were low by a factor of 10.
• jayess 2mo ago
  Who's gonna tell the doctors and nurses that they get a 50% pay cut?
  • qaq 2mo ago
    Do they need to get a 50% paycut? Dealing with insurance companies takes a ton of time and resources.
  • Lord-Jobo 2mo ago
    You think they’re getting so much money from out current system that cutting out insurance companies would result in a 50% reduction in their pay? Have you ever looked up the size of the health insurance sector here?
    • tptacek 2mo ago
      That's literally the premise of the report. The savings comes from getting Medicare's current rate sheet for every patient in the entire market.
    • 0xy 2mo ago
      You're being dishonest if you claim otherwise. UK brain surgeons get paid less than a Walmart general manager in the United States, let alone a like for like comparison.
  • jennnnx 2mo ago
    Cut their pay by 50% and get rid of malpractice lawsuits. Have some other system that doesn't incentivize lawsuits where doctors are still held accountable but I think that's a deal most doctors would take in a heartbeat.
• dotcoma 2mo ago
  Yeah, but how much would it cost in profits? That's the only thing that matters in Amerika.
• dboreham 2mo ago
  Ok but it doesn't save the donor class anything, so it won't happen.
• brandonb 2mo ago
  I'd like to believe this, but the study makes a bunch of really hasty assumptions. The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewer avoidable emergency department visits and hospitalizations. The buckets themselves don't necessarily survive much scrutiny. Take "Medicare-level payments to providers". Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch. The line item of "fewer avoidable emergency department visits and hospitalizations" assumes greater insurance coverage leads to greater access to primary care. It's true that great primary care prevents hospitalizations, and can be a net cost saving under certain assumptions [1]. But, we're actually in a primary care shortage. Existing insurance payments for primary care are low enough that private practices are going out of business and fewer residents are going into family medicine. Cutting rates (the paragraph above) would make this worse. For "less fraudulent billing," a lot of people in the industry believe that Medicare has a large amount of undetected fraud. That's unfortunately the flip-side of reduced administrative overhead. The authors assume an 8% savings here, but the 2003 paper they cite uses the word "fraud" only twice and doesn't give a number. Healthcare reform is hard. [1] Reasonable breakdown on the economics of advanced primary care models: https://olearykm.medium.com/the-cost-equation-for-new-primary-care-models-in-existing-frameworks-part-i-a31109f4dcbb https://olearykm.medium.com/the-cost-equation-for-new-primar...
  • RunSet 2mo ago
    Even if universal health coverage lost money it would be better than the current system that is based on a "causing cancer is better for the GDP than curing it" mentality.
    • tptacek 2mo ago
      The US has top-tier cancer survival-after-diagnosis outcomes. We spend too much to get there, and other countries in our cohort would "argue" that we get those numbers in part by diagnosing earlier and that our outcomes are broadly similar, but if you're going into these debates with "the US private health care system causes cancer deaths", that's a pretty rebuttable argument.
• bpt3 2mo ago
  There are many studies from reputable sources (one being the CBO) that say it would result in almost no savings or potentially even higher costs, just like there are many studies like this one that say there will be massive savings with no reduction in quality of care. I support universal health care, but each side just lobs whatever data supports their position at the other without any real thought. Most people in support of a universal health care system seem to be completely unaware that the vast majority of households are happy with their current coverage (whether they should be or not isn't relevant really) and are not looking for someone who claims to know better to "improve their medical care" through a entity (the US federal government) that is generally not known for improving almost any situation it interacts with. I personally would like to see Medicare opened up to the public as an option. It's simple, doesn't require anything of anyone who doesn't want to participate, and should be a reasonable test for the claims of cost savings. If it's truly a better option, people will move to it. If not, then the conversion will not happen. Barring some sort of catastrophic financial or medical event, there is a 0% chance that anyone can make a radical change to the status quo.
• calvinmorrison 2mo ago
  Baumol's cost disease is the simple answer. until healthcare stops improving outcomes and or we reduce labor cost will go up
• Taikhoom10 2mo ago
  Bro nothing is free, if the goverment pays for all of us, then it is our own money being used for that, we have the most liberal tax code in the world, we spend the most in healthcare.
• jheriko 2mo ago
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• richwater 2mo ago
  There is already a healthcare program run by the US government and it's called Veteran Affairs. Veterans can't even access the care they need resulting in almost twice the risk of suicide. I'll pass on mandated, outlaw-private-insurance government healthcare, thanks.
  • bhelkey 2mo ago
    Who said anything about outlawing private insurance? The UK has a single payer healthcare system but folks may purchase (or obtain through work) private insurance.
    • richwater 2mo ago
      The Bill's primary advocate...? https://ballotpedia.org/Sen._Bernie_Sanders%27_Medicare_for_All_Act_of_2017 https://ballotpedia.org/Sen._Bernie_Sanders%27_Medicare_for_...
• Aunche 2mo ago
  People talk about policies like they're something like can be picked up off the shelf at supermarket. If you could take the policies and Sweden copy-paste them to the US, then sure, we could save $1T and a hundred thousand lives. This would be a very difficult thing to replicate if you're a country without any existing healthcare system. It is impossible in a country with an extremely mature healthcare system, which accounts for nearly 20% of GDP. No politician is going to want to deal with the fallout of massive layoffs or millions of people having their coverage changed (e.g. no free chiropractor appointments or GLP-1s for weight loss), especially since the Democrats suffered one of the worst Congressional losses in US history the year the ACA was passed. There are ways to make this transition less painful, but the only people interested in health policy are those who make money from healthcare, so you generally only see solutions that involve throwing money at the problem. We need regular people to develop an understanding of health policy or else we'll end up with a policy that merges the worst parts of a planned economy and capitalism even more than today.
  • jaltekruse 2mo ago
    The US already has a national health insurance network that pays the vast majority of all providers, and as far as I know it is widely popular and covers everyone legally present in the US for a portion of their life, Medicare. Old people experience just about every ailment young people do, we can just get rid of the age restriction on Medicare, it's already fully integrated with our medical system. No need to copy-paste from Sweden.
    • Aunche 2mo ago
      Medicare also isn't something that you can copy paste from covering only old people to everyone. For one, margins from Medicare patients are much lower and often negative for hospitals, and that money has to come from somewhere. Medicare doesn't cover a lot of drugs that people are already used to their private insurance covering like GLP1s for weight loss. Of course, a transition from point a to point B is possible, but there will inevitably be a lot of kinks and bugs to work out, which MFA proponents seem to be unaware of.
• th0raway 2mo ago
  Most of the problems of the US system aren't really a matter of who pays, but the fact that so much is paid for services, at every level. Any really significant savings, cutting bureaucracy and pressuring providers to make costs resemble those of other developed countries, are taking money out of someone's pocket. Many hundreds of thousands of them, if not millions. This makes any significant reform very difficult, as those people vote, and will know exactly who made them worse off, even if the country in general was made much better off. Read The Logic of Collective Action by Mancur Olsen. It wasn't written thinking of healthcare. but anyone looking at the US healthcare system will see that what is going on is stacks upon stacks of collective action beating overall societal efficiency, over and over and over again, in such a way that it's basically in none of the decision makers best interest to actually increase overall efficiency.
  • junofan 2mo ago
    It’s also geographically distributed. Substantially all congressional districts count a healthcare system as a top-5 employer. Those 70k/yr butts-in-seats admin jobs are occupied by voters, making them difficult to eliminate nationally. You’d have to go down to the state level at least to get anything done.
    • gadflyinyoureye 2mo ago
      I think it’s because Americans been taught that were democracy, not a federal system, but that’s exactly where we expect to do these kinds of reforms. The federal government could reasonably set certain regulatory requirements. The states would need to make sure that any provider within it conforms to the federal levels, you know like auto manufacturing and exhaust emissions. Seems doable. Unfortunately we’re gonna have to wait for the boomers to die because they’re the ones that have gotten theirs and they’ve screw everyone else. Also, unfortunately, the millennials are gonna have to take it on the chin like we have for so much else and realize there is going to be some lost jobs.
• gryfft 2mo ago
  I wonder how many people would be on board for a program to make Medicare available for free for households making over $100,000 annually with 1-3 children. We're talking about families that are provably not lazy or sucking up handouts: taxpaying citizens with beautiful, healthy children. The job creators and professionals driving America, securing their future and their children's future. If the government were to focus on these first-class citizens, who knows what could be accomplished once the drag is taken off the system of the useless eaters and the welfare queens.
  • fragmede 2mo ago
    That's a very funny way of looking at the world.
    • gryfft 2mo ago
      Many people feel that winners should be rewarded and losers should be punished. Systems thinkers may try to push notions of connectedness in societies, and moralists may try to push notions of universal equality of human dignity, but in the end, both are overwhelmingly outnumbered by tribal thinkers, who wish to harm the outgroup at absolutely any cost.
      • Supermancho 2mo ago
        Ironic
  • AngryData 2mo ago
    First class citizens? Wow, that is both disgusting and sad. What do you do that you think is so important and irreplacable that sets you above the average person?
  • tredre3 2mo ago
    Why do you limit it to people with children? Why do you assume that the children are beautiful and healthy? > Medicare available for free for households making over $100,000 annually Sure, why not try it? It's still 50% of America getting coverage. After a few years maybe they'll realize that not having to think about health care insurance is a good thing actually (tm) and start supporting it for lower brackets of the population too.
• rohan_ 2mo ago
  How on earth have administrative costs been soaring when there have been so many healthtech startups propped up in the past 10 years to bring down the cost of administration? Also - given the rate of AI progress, shouldn't we see this cost go to zero essentially.
• hathawsh 2mo ago
  Last time I joined a discussion about US health care on HN (years ago), the picture looked bleak: secret chargemasters in every hospital, no realistic way for patients to compare options because the options are too complicated, and lots of people still falling through the cracks. I can't help but think the picture looks very different now. There is growing awareness that chargemasters can not be secret. LLMs offer a way to overcome the complexity of choosing options, opening doors for real competition. I sincerely hope we can take advantage of this changed landscape to provide better care. Universal health care remains an interesting possible direction, but I now have hope that we can do a lot better within the existing laws.
• deleted 2mo ago
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• lettergram 2mo ago
  Ah yes, the claim free money would save lives! The truth is once systems like this are implemented they change the dynamics of the study and as such could hurting lives. As a simple example, the biggest cost to the healthcare system in the US is dialysis. Many of those folks already have health issues, and by both dialysis and for all the issues that caused the need for dialysis in the first place is a massive strain. The direct cost of dialysis is $33B annually [1], but indirectly is probably at least another doubling. Further, the way the government has imposted monopolies in the space already has caused costs to balloon. While making it "universal" could mean the government gets control, and can limit the explosion. It can also could result in weird incentives like Canada, where they're promoting MAID. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8729831/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8729831/
• etchalon 2mo ago
  It will never not be funny that whenever universal health coverage comes up, Americans will act as if it's some impossible task that wouldn't solve any problems when the rest of world seems to have sorted it out just fine.
  • timbit42 2mo ago
    For the most part, those countries aren't as corrupt as the US.
• DrScientist 2mo ago
  As I understand it - ~30% of US federal spending is on health care. In the UK it's about 20%. Yet apparently the UK is mostly nationalised under the NHS, while in the US there is huge additional spending on private insurance. Can somebody from the US explain to me how that's the case and why American's still put up with it?
  • remyp 2mo ago
    We hate it and are more and more powerless to change it every day. The parties are entrenched and swing districts are becoming increasingly rare. Those competitive districts that remain are flooded with unlimited campaign funds from big business and plutocrats, thanks to Citizens United.
  • loeg 2mo ago
    US federal budget is 23% of GDP, while UK is 44% of GDP. You can't compare fractions of the fractions directly. (Total spend is something like 11% vs 18% GDP.)
    • DrScientist 2mo ago
      Sure it's difficult to compare - but from your figures - the 11% is UK and the 18% is US ( total spend )? With the UK spend roughly 80:20 government:private and the US spend about 50:50. So as percentage of GDP government spend is about the same percentage of GDP but the much bigger private spend in the US what makes the difference.
  • HDBaseT 2mo ago
    Because the US buys medicine at absurd pricing. Something that should cost dollars, costs hundreds. [0] [0] https://aspe.hhs.gov/reports/comparing-prescription-drugs https://aspe.hhs.gov/reports/comparing-prescription-drugs
    • DrScientist 2mo ago
      Don't believe that - not that the US doesn't pay well over the odds - that's clear - but it's the major cause to overall higher healthcare costs. Typically health care is massively human capital intensive with like 50% on wages, and only 10% on drugs. I suspect the blame lies with a broken market and inflated prices costs across the board ( ie the higher drug prices are a symptom of a wider systemic problem ).
• satnhak 2mo ago
  Come to a country with universal healthcare (England) and realise that if you work then you're paying 5x the market price for the worst healthcare imaginable. MRI scan - we don't know, one month wait, maybe two. Operation - are you going to die tomorrow with out it? No, ok then that could be years. You need to pay rock bottom wages to doctors to make it work, so guess what all the good doctors leave for private healthcare and you end up with the dregs from the third world.
  • tptacek 2mo ago
    One of my favorite health care facts: there are more MRI machines in the state of Massachusetts than there are in the entire country of Canada.
    • loeg 2mo ago
      I think this one might not be true anymore. Canada has 432 machines as of ~2023 (340 in 2015) and MA is on the order of ~300 (can't find exact figures). It's still a lot lower per capita (10.8 per million vs 42 per million).
      • tptacek 2mo ago
        So the new comparison is Canada and Illinois. I can remember that! :) (Thanks for catching this! I had no idea.) This is super weird, isn't it? Some of it is obviously overprescription on the US side, but also: Canada could just get more machines.
        • loeg 2mo ago
          It's kinda weird, yeah! Not sure if Canada thinks the rest of the world overuses MRI machines in a cost x diagnostically inefficient way, or what, but I'm sure months-long waiting lists aren't optimal either.
    • tredre3 2mo ago
      I know that you tend to be balls deep in American Exceptionalism, but the truth is that reasonable countries with reasonable health care average 15-30 MRI machines per million inhabitants. America is a wild outlier, and unless you have data to back that those machines are put to good use, I'd trust the rest of the world who decided the sweet spot is 15-30 mer million, not 60.
• rlewkov 2mo ago
  For the study, "which has not yet been peer reviewed"
• vondur 2mo ago
  Hard to believe, currently Medicare/Medicaid make up around 23% of the budget. If you opened that to all, there would have to be a huge tax increase to pay for it. I suppose if you are very poor then it would be good, but the middle class would be the ones having to foot the bill for this.
• deleted 2mo ago
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• davidfekke 2mo ago
  "You can have state of art Healthcare, or you can have Universal healthcare, you can't have both." -- Malcolm Gladwell The way that universal health coverage saves money is by rationing care. You do not save lives when you ration care.
  • jimt1234 2mo ago
    What's the point of "state of the art healthcare" if it's only for rich people? If Jeff Bezos and I get the exact same health issue - say, some form of cancer, we're going to have radically different treatments and mostly likely outcomes. His will be "state of the art", mine will (hopefully) be good, but definitely not be like his.
  • logravia 2mo ago
    That's a very weird framework and dichotomy you have there. Try untangling yourself out of it by considering some empirical facts, for example, hospitals acquired by private equity often have worse outcomes. > private equity acquisition was associated with a 25.4% increase in hospital-acquired conditions, which was driven by falls and central line–associated bloodstream infections https://pmc.ncbi.nlm.nih.gov/articles/PMC10751598/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10751598/ > Medicare beneficiaries in the emergency departments of private equity hospitals experienced seven additional deaths per 10,000 visits after acquisition relative to hospitals that were not acquired by private equity, the team found. This rise represented a 13 percent increase from a baseline of 52 deaths per 10,000 visits https://hms.harvard.edu/news/deaths-rose-emergency-rooms-after-hospitals-were-acquired-private-equity-firms https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft...
  • HDThoreaun 2mo ago
    This is certainly true to an extent, but it ignores some big problems with fee for service. The biggest one is that incentives between patients and providers are not aligned, which means more than 10% of healthcare provided in the US is wasteful stuff the provider knows is unnecessary but prescribes anyway because it makes them money. There are real opportunities to save money without making outcomes worse, in fact, if we stop doing useless stuff that leaves more time to treat people with real issues.
• deleted 2mo ago
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• seanmcdirmid 2mo ago
  Universal Health Coverage has a lot of other benefits: 1. It detaches health insurance from the employment market. This means those minimum wage walmart jobs just became more feasible, or any low end job really, since their is no pressure to provide "benefits" anymore. This would seriously lubricate the labor market, because the friction to providing, taking, and changing a job is reduced. 2. It ends a bias for group plans. If you are poor or are a trades worker and need to buy insurance outside of a group plan, you are going to be in an expensive high risk pool. 3. Its a benefit we can fund socially with taxes that will immediately have a positive impact on lower income workers, as well as poorer regions of the country (e.g. red states).
  • vivekd 2mo ago
    As a Canadian, I would caution against the kind of universal health plan we have. But yes I agree there should be some kind of public healthcare. Perhaps more as a government owned hospitals and clinics alongside the private ones rather than the fully public system we have here which comes with its own host of problems. I think it's easy to shout free healthcare as a slogan but I think the important bit is how it's implemented.
    • seanmcdirmid 2mo ago
      I don't think anyone really envies the American system. We have all the capacity problems that you guys do up north, and we pay a lot more out of our own pockets for the pleasure. Our results are also worse. I don't think anyone from any country thinks their healthcare system is perfect or even sufficient. It all kind of stinks although some countries it is easier to solve problems with above average money (but not if you are average). We need to fundamentally figure out how to do more with less, automation (AI) could help out a lot here and I don't care about purists who want hand crafted artisanal advice about how they need to lose weight or they will die of a heart attack. But otherwise, a lot of problems exist just due to bad incentives.
    • HaloZero 2mo ago
      I'm curious how Taiwan operates. It's a public side insurance system with mostly (if not all private hospitals). Obviously very different population case though, much smaller island.
• jandrese 2mo ago
  The thing studies like this never take into account is the degree to which all of these administrative jobs are corporate welfare. The inefficiency means a lot of people get a regular paycheck for work that is ultimately nonproductive. If you kill off those jobs by eliminating waste there will be millions of people looking for a new job. But the bigger problem is the current system is really profitable for the millionaire and billionaire owners of those companies. They're well connected in Congress. Attempting to change the system is extremely difficult when it means so many rich people might lose their gravy train. These people go to expensive campaign dinners. Even when the ACA came out and the first versions had universal healthcare provisions those were quickly and quietly eliminated.
  • tptacek 2mo ago
    Administration is ~25% of provider expense; billing and insurance is ~8.5% of provider expense. Administration is: * Billing and claims management * Compliance * Customer service * Operations * IT You can drive billing all the way down to zero and you're still going to be spending a lot of money on administration just like any large enterprise does. Those jobs aren't really "corporate welfare" and they exist in every system, although the single-payer systems get a bit of a break on them because they can and do trade responsiveness off for customer service (at likely little cost to outcomes, to be fair!)
    • jandrese 2mo ago
      That ~25% is compounded at every step of the way. 25% of your doctor's office. 25% of the insurance company. Plus don't forget the brokers, which are almost all overhead effectively. 25% of pharmacy. 25% of drug companies. The people providing actual healthcare end up being a minority in the system.
      • tptacek 2mo ago
        No, insurance spending is broken out separately in the NHE. https://nationalhealthspending.org/ https://nationalhealthspending.org/
• ktzar 2mo ago
  What about all the new unemployed lawyers and bureaucrats that feed on the broken American system?
• lokar 2mo ago
  It looks like this does not even include the current disincentive for insurers to treat chronic issues effectively early on. Since people switch insurers so often the odds you will be their “customer” in 5 or 10 years is low, so investing if your long term health won’t generate a return for them.
• tptacek 2mo ago
  The mortality numbers in this paper appear to be extrapolated from an observational study of 9,000 cases from 1988-1994. That paper distinguished between "privately insured" and "not privately insured". This paper distinguishes "adequately insured", "underinsured", and "uninsured", and applies the original paper's hazard numbers to everybody but the "adequately insured", with a coefficient modifier for the "underinsured" that they came up with themselves.
• jsrozner 2mo ago
  For the most part, any time one person in the economy saves money, another person loses money. So, what about all the insurance company, private equity, and hospital system profits that would be eroded by a system that better serves individual humans? /sarc
• westurner 2mo ago
  How many employees trapped in a job for health benefits for their families would universal health coverage free up? Quantify the impact on productivity
  • timbit42 2mo ago
    What makes you think they would no longer work? They still need money to live. They would either get another job or start their own business.
    • westurner 2mo ago
      By "free up", I mean "allow to job hop until they find a comfortable healthy fit" like hermit crabs. With their health expenditure potential liabilities reduced by universal health coverage, people would be more able to take good risks in developing small businesses for example.
• ck2 2mo ago
  let's imagine an impossible country where somehow Democrats pull this off in 2029 and the 2030s start with actual healthcare for all and not just "insurance" DOGE 2.0 will destroy it overnight because somehow funding is not exempt from executive manipulation look at what they did to ACA (and everything else) all it takes another apathetic Congress and poof it will be gone so billionaires can get a few million off their taxes there's absolutely no way to harden it against that
• exabrial 2mo ago
  I don't want it. I don't want to pay for it either. anything the fed government does is utter crap.
  • jimt1234 2mo ago
    That's basically my concern, too. If we had a "Medicare for all" system, would it end up like Social Security, a system that started out with great intentions, but has since ballooned into an expensive, bureaucratic nightmare?
    • exabrial 2mo ago
      precisely.
• deleted 2mo ago
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• dzonga 2mo ago
  they're tryna convince the populace who don't like to read with useless studies. get rid of medicare etc, then let it be handled on a city / state level. if some states wanna provide for public hospitals clinics - let them do so. even more if cities too wanna provide for public healthcare. then we can gladly reduce taxes too. the amount spent on medicare vs outcomes is already scam level. trying to solve this at a national level won't work - too many middleman, too much politics and perverse incentives.
• chermi 2mo ago
  I would like to know if anyone has a method or resource to cover rough calculations on things like: 1) how much cost comes from "friction" like middleman, administrative bloat, shitty digitalization/note sharing, all the time the nurses and doctors have to spend on paperwork... Etc. 2) how much drug development is subsidized by the US patient via higher domestic vs. foreign pricing. Or even how much of the cost total is drugs? 3) how much roughly every added year of life past some marker of "high quality of life" is spent just keeping people alive. And if there's any trends there, cost going up or down total and per person. 4) some basic accounting of where the spend is actually going. A lot of people in this thread are talking about hospital margins. There's much more to health care than that. Labs, hospice, mental health, labs/diagnostics, drugs, r&d, nursing facilities and many things I probably don't even know about. Basically an equivalent of david mackays "without the hot air" but for health care. Also if anyone has some good reading on ideas around kind of SEZs for drug/treatment development where people opt in to riskier care. Not quite the same thing but I know for example that lots of medical device development and proving is done in spain to gather evidence for the FDA since the FDA process for devices is legitimately insane. Oh and if there has been any proposals or even adoption of better health record management, digitization. Especially access to your own health record. Im not a crypto guy but it seems like maybe it could be an application for it?
  • themantalope 2mo ago
    I’m a physician in the US. In my experience main cost drivers are administration (documentation is part of it but the way billing works is you basically do the job, document what you did, then submit to the payer. This process can take 6+ months and they often just don’t pay for parts of it). And then ICU/end of life. Way too many Americans don’t ever talk about what will happen when they die and what they do or don’t want at the end of life. Then they become incapacitated, family pursues all advanced therapies because they don’t know what to do and they spend a long time in the ICU getting things done for an unclear goal
    • chermi 2mo ago
      Thanks! I half-jokingly want to come up with a mental health/memory + physical health test for myself where if I ever fail it my wish is to not be a burden, don't extend my life.
• alanwreath 2mo ago
  If this were at all true, now read it like the big wig or law maker holding the on/off lever who’s eyes see “Universal Health Coversge Could reduce $1T in available/taxable income”. Did you notice the gorilla walk by? They sure didn’t.
  • jaltekruse 2mo ago
    Should The Government Stop Dumping Money Into A Giant Hole? - https://m.youtube.com/watch?v=JnX-D4kkPOQ https://m.youtube.com/watch?v=JnX-D4kkPOQ
    • alanwreath 2mo ago
      This is hilarious.
• whatever1 2mo ago
  Universal health coverage will asymptotically reach infinity costs (same as private health insurance). This is the harsh reality. No system (private or public) can save all of the lives. We are debating who will make the decision of who gets to get a chance to live longer.
• ConanRus 2mo ago
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• DataDive 2mo ago
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  • ohlookman 2mo ago
    > The first issue with this is that the gap between the uninsured and insured is not necessarily due to the lack of insurance. It could be due to factors associated with not having insurance, like living on the streets, being schizophrenic, being poor, and so on. Made up perspective to justify his angle. Not having healthcare access for a lot of people is 100% a policy choice. Waved off here by a list that really says why we should have universal healthcare; some people are mental and not aware they could have access without the stupid policy decision. Just strings together sentences to ultimately make a reductive point about arithmetic and their own literacy. Despite Yale's issues they're still a better source than random blogger with high school math literacy.
    • martythemaniak 2mo ago
      > random blogger with high school math literacy He's actually a well-known and widely promoted political activist on X. His niche is using technocratic language and a whiff of 'analysis' to advance MAGA policies.
      • sjsdaiuasgdia 2mo ago
        [dead]
      • ohlookman 2mo ago
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    • DataDive 2mo ago
      The point he is making is valid: these groups are not randomly selected and are not representative of one another. Hence, it is not that simple to extrapolate from one to the other. Would free healthcare reduce deaths in uranium miners that are smokers? Probably some, but would it bring that to the same levels as non-smoking, non miners? Unlikely so. Hence it would be silly to pretend all the cancer deaths are due to lack of health care. The smoking uranium miner example has a surprisingly realistic story, comes from real data; the dangers of radon in the basement were deduced from comparing cancer rates in smoking uranium miners with high radon in their basements, then they removed what they thought was the smoking and uranium contribution, then fitted to the general population.
• GratiaTerra 2mo ago
  There aren't enough Physicians, they don't make much and they all seem to be working 12 hour days but being paid a salary that would equate to an 8 hour day. Doctors see downsides of a universal coverage are mostly about loss of autonomy and increased demand because when care becomes free demand rises along with pressure to expand access without extra staff.
  • trollbridge 2mo ago
    Yeah, having lived under universal care, the dark side of it was atrociously long waits to see a specialist and having a GP who is obviously overworked and barely spends any time seeing you.
    • fader 2mo ago
      And yet that's exactly my experience in the US healthcare system.
      • magicalist 2mo ago
        Indeed: https://arstechnica.com/health/2026/08/us-wait-times-for-cancer-surgeries-are-getting-longer-and-longer/ https://arstechnica.com/health/2026/08/us-wait-times-for-can...
    • dbbk 2mo ago
      If you want to be seen immediately (even when triage determines it not necessary) you can just supplement with private insurance
      • trollbridge 2mo ago
        But that’s not universal care. “Triage determines it not necessary” is a cold comfort to someone waiting years for a procedure they actually do need.
        • dbbk 2mo ago
• worik 2mo ago
  Very interesting reading the comments here from USAnians. You are really hurting, and your system is objectively very bad. Inappropriate application of capitalism. A market failure of epic proportions. Do something about it! You live in a democracy, act like it!!
• axus 2mo ago
  A perfect Communist economy could save even more money, eliminate most ads, duplication, and poverty. But they never figured out how to make it work. I'm not opposed to a peaceful transition, but we'll need a big surplus and more idealism to make it happen.
  • techbrah9000 2mo ago
    "They" never intended for it to work and never tried. Do away with the finance ledger. Accurately measure where the people are. Ensure enough resources flow there. Special interests with a social moat to protect can pound sand or be hung from ports as a warning. I would like to be free from hallucinated social belief Jeff Bezos is meaningful to humanity when mfer just gonna die and be forgotten like everyone else.
• flenserboy 2mo ago
  impose universal health coverage & the jockeying will commence to see who is in charge of it. medical & diet fundamentalists will rejoice at the opportunity to seize control & force everyone to take certain drugs, eat or not eat certain foods or types of foods, exercise a particular way, surrender their organs at a particular age, or whatever else their hearts desire for everyone else. there have been so many rabbit trails taken, so much malfeasance, so much misinterpreting of data, etc., which has been uncovered just in the last decade or two to give anyone the ability to harm or control entire populations in this way. the increase in suffering will be great, & the long-term effects devastating.
  • rwyinuse 2mo ago
    Universal healthcare works just fine in Europe without major issues like that. It's the American political system that is broken. Your de facto two-party political system lets idiots take total control way too easily, as we can see with current US administration. My country has universal public healthcare, and nobody forces you, or even your children to get vaccinated, monitors what you eat, or any other form of control that you're worried of. Organ donations are voluntary too, you can opt-out easily. And if you think the system sucks, nothing prevents you from taking extra insurance and using whatever private healthcare provider you want.
  • ideashower 2mo ago
    Source on... any of that?
    • techbrah9000 2mo ago
      Fox News and 2010s Info Wars
  • AIorNot 2mo ago
    WTF are you talking about dude - we average white collar/blue collar people are so desperate for a unified healthcare system in this country not tied to our (constantly unstable) jobs We are so desperate that someone murdered a Healthcare CEO - ie resorting to violence We are so desperate that many is (myself included travel to cheaper countries for dental and other healthcare) Its a simple calculus but one that is obtuse to conservatives and richer people
• bcaulfield 2mo ago
  _could_
• Taikhoom10 2mo ago
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• drums8787 2mo ago
  It boggles the mind when you hear people defend the US healthcare system in terms of efficiency (OK, granted, maybe people have long stopped doing that). It has to be one of the most bureaucratic and paperwork overloaded systems of all time. It's hard to imagine somebody who've had an actual health crisis would think otherwise, unless they can afford people who can shield them from the BS.
• grahar64 2mo ago
  Of course it does, but only one country has to keep commissioning and ignoring studies to work out a group of 300million people can get better prices for everything if the incentive for the government is to decrease the price rather than increase it for their buddies
• carabiner 2mo ago
  But how can we support israel? /s
  • throw387322 2mo ago
    The Jews are obviously to blame for the lack of universal health care. The USA spends the equivalent of about $10 per citizen per year on Israel. Medicaid spends about $10,000 per recipient per year. But antisemite math has its own rules.
    • carabiner 2mo ago
      Literally everything in the federal budget costs $10 or 10 cents per us citizen. Do you know calculus, or arithmetic? By this reasoning we cannot cancel anything.
• bentt 2mo ago
  There are a lot of people making a lot of money on the inefficiencies of the US system. They won’t give up their revenue streams without a fight, and they are filthy rich on the backs of sick people. You better believe they will play dirty.
  • patcon 2mo ago
    Aside from war, there is likely no other place where one class "winning" means so certainly that countless others are dying.
  • joering2 2mo ago
    this is a great example. What a horrible human... https://www.miamiherald.com/news/politics-government/article288431251.html https://www.miamiherald.com/news/politics-government/article...
    • Detrytus 2mo ago
      This is a top-level example but you do not have to look at the top, really. The whole private insurance system is a scam at every level. I mean: I immigrated to US couple years ago, and I can tell you that any hospital visit, or a diagnostics, such as CT scan or ultrasound are 15-20x more expensive here than in my home country (which is in the EU). Funny thing is: if you tell the hospital that you do not have an insurance they will charge you a price that actually sounds reasonable, say $700 for a CT scan (which is still like 2x more than in my home country, but then the US is a high cost of living place), but if you do have insurance they will try to extort as much money as possible from your insurer: initial bill will be like $10k, and then they will settle for, say, $6k.
      • opo 2mo ago
        >...Funny thing is: if you tell the hospital that you do not have an insurance they will charge you a price that actually sounds reasonable, say $700 for a CT scan That has not been my experience. Insurance negotiates lower rates and without insurance, the full fare price suggested price has always been higher.
• Alien1Being 2mo ago
  Pretty obvious... This is why almost every wealthy country and most middle income countries and many poor countries have universal health Canada,UK, Australia, almost every European country, Cuba, Costa Rica, Kyrgyzstan, Sri Lanka, and Rwanda. There are a few minor weird oligarch run kleptocratic exceptions like America, but in the global context they are irrelevant. Universal health care by country: https://en.wikipedia.org/wiki/Universal_health_care_by_country https://en.wikipedia.org/wiki/Universal_health_care_by_count...
• NoImmatureAdHom 2mo ago
  1) U.S. healthcare spending subsidizes the rest of the world, much like U.S. defense spending. New drugs wouldn't be developed at the same rate if it wasn't profitable to do so, and it's profitable largely because it's profitable in the U.S.. Some proportion of the high U.S. spending relative to other countries is this. It's pretty stark. In revenue terms, for new drugs 2018-2023: 67.1% of total sales in the USA alone, 15.8% in Europe, 3.9% in Japan, and 13.2% for the entire rest of the world ( https://www.efpia.eu/media/2rxdkn43/the-pharmaceutical-industry-in-figures-2024.pdf https://www.efpia.eu/media/2rxdkn43/the-pharmaceutical-indus... ) 2) I believe the U.S. is willing to go to greater lengths to save people. So they will spend obscene amounts of resources keeping a cancer patient alive for an additional six months, or saving a borderline case of a premature baby, etc.
• shdh 2mo ago
  Legislate transparent pricing for all medications and procedures first. Paying 40 dollars for lozenges in the ER is insane. Right now the system has an opaque pricing structure which makes no sense. Force hospitals to expose API's with transparent pricing.
  • nobodyandproud 2mo ago
    Also legislate transparent negotiated pricing for medications and procedures for each insurance plan, as well as rejection rates for medications and procedures. Oh yes, and patient/coverage drop rates
  • chimeracoder 2mo ago
    > Force hospitals to expose API's with transparent pricing. Unless you're uninsured (which is a whole separate clusterfuck), the hospitals aren't the ones who decide how much you pay for any service - the insurance companies are. The sticker price that hospitals charge is almost meaningless and is intentionally high because it's used as the starting point for negotiations, which always bring the price down (never up). There isn't any expectation that any insurer is actually going to pay the billed amount as-is.
    • reverius42 2mo ago
      It should be illegal to charge different prices for the same thing to different customers.
      • DesiLurker 2mo ago
        [dead]
      • knollimar 2mo ago
        It's how they negotiate? otherwise you get take it or leave it deals with insurers.
        • reverius42 2mo ago
• mhb 2mo ago
  Who Will Pay for Democratic Socialism’s $200 Trillion Cost? https://www.cato.org/blog/who-will-pay-democratic-socialisms-200-trillion-cost https://www.cato.org/blog/who-will-pay-democratic-socialisms...
  • JoshTko 2mo ago
    ah, the Koch brother's PR firm the CATO org. Brilliant spin org.
    • mhb 2mo ago
      Shooting the messenger usually works.
      • timbit42 2mo ago
        You are the messenger. CATO is the biased, lying, and manipulative message creator.
• gigatexal 2mo ago
  American living in Berlin: insane to me that in the US if I would rather stick it out in an abusive or otherwise terrible job just to keep my benefits. Taxes here are high. They pay for a lot of things. Is it the best of the best? No. There’s private insurance for that. But does it work? Yup. And it’s just another thing we don’t think or care about while we take all of August off. ;-)
• oliyoung 2mo ago
  It's crazy that universal health is the political third rail in most modern countries but for the opposite reasons In most of the world it's the policy that cannot be touched, just in Europe, Canada and Australia its _existance_ is invoilable, in the US the _introduction_ seems to be the unwinnable war
  • karakoram 2mo ago
    Very good point. In the UK, the NHS is on the same level as a religion. The NHS can NOT be meddled with whatsoever. Complete political suicide.
    • oliyoung 2mo ago
      Medicare is the first scare campaign bought up in any Australian election
• karim79 2mo ago
  As a person living in Germany I find it insane that this hasn't been solved by the US of A. What the actual hell is going on?
  • BirAdam 2mo ago
    Regulatory capture of our legislature and regulatory bodies, intense bribery, proof of need legislation, and people consistently providing an obviously corrupt system with more money and power thinking that somehow, magically, the people who’ve obviously been corrupt and dishonest will be made angels when given more money and power.
  • cesarvarela 2mo ago
    I think it comes down to the healthcare trilemma: cost, access, and quality (or "cutting-edge-ness"); the US optimizes for quality and access, while countries with universal healthcare optimize for access and cost. You can only pick two.
  • subscribed 2mo ago
    Plenty of bribes to go around. For politicians, press, "think-tanks".... They make sure system is not changing.
• purplepatrick 2mo ago
  This would be much easier to sell if everyone stopped referring to it in the context of “healthcare” and instead used “universal health insurance” or “universal health insurance rates”. The number of politicians that conflate healthcare and health insurance (notwithstanding the actual convergence of the two through payers’ purchasing provider entities) is mind boggling. Striking the word “healthcare” from the conversation would make this much more digestible for folks afraid of the “socialism boogeyman”…
  • tty456 2mo ago
    Brilliant. I also like "health-related bankruptcy protection"
• Jimega36 2mo ago
  Switzerland has the system closest to the US in my experience, but with universal coverage. As individual, you buy basic insurance costing roughly $500/month with a $2500 yearly deductible (LAMal/KVG). Applicants must be accepted even with pre-existing conditions. Post-deductible, you pay 10% co-insurance capped at roughly $800/year (no medical bankruptcy). Insurers operate basic plans as non-profit. They make their profit on optional supplemental insurance (private hospital rooms, extra benefits...) The state subsidizes basic premiums for low-income individuals. A doctor's visit is a $150 minimum, similar to the US. What was most surprising compared to here in the US is employers pay $0 toward premiums. Funding is entirely decoupled from employment. You don't lose coverage or change plans when changing jobs. On the negative, basic insurance does not have dental, so dental stuff is out-of-pocket and expensive. In terms of stats, the US spends 18% of GDP on healthcare vs. 12% for Switzerland and the gain is lower stress too. Not perfect but maybe the best of both worlds.
  • limagnolia 2mo ago
    Where are you getting the 150 to visit a Dr. in the US? The copay is usually much, much lower than that.
    • forestrywat 2mo ago
      Depends on where you work. And what "see a doctor" means.
    • cocoa19 2mo ago
      I thought you were going to say out of pocket costs are much much higher than that. I’ll be lucky if I get a specialist for under 500 until I meet deductible of 3k+ for a family of 3. One emergency room visit and we reach it in one or two days.
    • tmp10423288442 2mo ago
      Really depends on your insurance, and whether you're visiting for a yearly physical or for an actual concern.
  • HeavenFox 2mo ago
• doodlebugging 2mo ago
  That $1T that it might save is currently hitting lots of quarterly or annual reports as profits. With that much on the table I think the chances of seeing Universal Health Care here in the US are not great. The ones banking that money now will fight hard to keep it flowing into their pockets. Real lives don't factor into their decisions, even if there are more than enough to fill a large city in this country - every year.
• Acrobatic_Road 2mo ago
  Even if the headline claim is true (other people have already critiqued it), this would dramatically increase the federal deficit without massive tax increases - and as far as I know, none of the advocates of a M4A-style program have ever explained how they would pay for it.
• jennnnx 2mo ago
  As a Canadian ex-pat I've seen the following: 1) 2 friends had to wait over a year for gallbladder surgery. 2) A friend with autistic child had to wait 2 years for any type of therapy. He couldn't afford the $80k/yr for private care. Ontario has 70,000 autistic children on the waiting list for treatment. 3) Another friend had to wait several years to find a PCP in Ottawa, the capital city of Canada. He has a golf ball sized lump on his head and he can't see anyone without a referral from his PCP but he has none and no one was taking new patients. He put himself on a list to get the first PCP available anywhere in the city. After that he has to wait a year for a consult and who knows when surgery is. 4) Another friend had to wait 9 months to get an MRI for a pain in his neck. After that it was another 4 months to see a neurologist. You don't pay in money but you pay in time and suffering.
  • evan_a_a 2mo ago
    Healthcare worker shortages are a problem in the US and other developed countries with universal systems. The type of system doesn't really influence the waiting time.
• thelastgallon 2mo ago
  Cuba achieves similar life expectancy and infant mortality rates to the U.S. despite spending a fraction of the cost, focusing heavily on free community prevention. Cuba has one of the highest doctor-to-population ratios in the world—roughly 6 to 8 physicians per 1,000 people: https://www.reddit.com/r/dataisbeautiful/comments/r468au/oc_cuba_has_a_lot_of_doctors/ https://www.reddit.com/r/dataisbeautiful/comments/r468au/oc_...
• Gareth321 2mo ago
  I think the evidence is quite clear that universal health care reduces aggregate costs, but the public cost in aggregate is enormous. 1. This means large new taxes for everyone. For those on lower incomes, they might end up better off. For those on middle-upper+ incomes, they will unequivocally end up paying more. 2. The U.S. already has unbelievably high deficits and debt. This would make that worse without significant spending cuts elsewhere, and without very large new taxes. And before someone says "just tax the rich!", even if every billionaire in the U.S. had all their wealthy confiscated today, it would barely cover U.S. federal spending for *one year.* Then the party's over and the government collapses. "Just tax the rich" is an absurdly superficial position. European taxation is broad and deep. Everyone pays high tax - even those who do not earn much. 3. U.S. society is built on rugged individualism. Acceptance of immigrants under the premise that they will work hard and contribute. For this reason, U.S. success at integrating immigrants is better than anywhere else in the world, by a wide margin. Our issues re immigration in Europe are numerous and unbelievably contentious. Should the U.S. become a "welfare state," like European countries, it would no longer have a natural filter for immigrants. It would realise the type of immigration that we get in Europe, where for many groups, a majority refuse to work - for life. For this reason, it would require a MUCH tougher filter on immigrants - much more so than what the current administration is doing. I do not see the U.S. materially reducing spending in other areas, including the military. I do not see general public support for large taxation increases across the board. I do not see public consensus on strict new immigration requirements and enforcement. For these reasons and more, I do not think public health care is a realistic prospect for the foreseeable future.
  • bhelkey 2mo ago
    > universal health care reduces aggregate costs, but the public cost in aggregate is enormous. This means large new taxes for everyone. If the US could spend healthcare dollars as efficiently as the UK, the US could pay for a single payer healthcare system covering every resident using only existing Medicare + Medicaid spending. Is the US willing to reduce the price of healthcare? I observe a large appetite in congress to increase the visibility into US healthcare spend. I observe rather more limited effort spent to use this data to reduce the aggregate costs (e.g. negotiating drug prices [1]). The math: The US spends $2 Trillion dollars on Medicare + Medicaid a year [2][3]. $2 Trillion dollars / a population of 342.7 million [4] = ~$5800 per resident per year. NHS (UK's universal healthcare system) costs ~£3,500 or ~$4800 per person per year [5]. [1] https://www.kff.org/medicare/key-facts-about-medicare-drug-price-negotiation/ https://www.kff.org/medicare/key-facts-about-medicare-drug-p... [2] https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo... [3] https://www.kff.org/medicaid/medicaid-financing-the-basics/#870ed126-45c3-4465-8b9a-ae0eea487dcf https://www.kff.org/medicaid/medicaid-financing-the-basics/#... [4] https://www.census.gov/popclock/ https://www.census.gov/popclock/ [5] https://www.bbc.com/news/articles/cwy7zvp5xrqo https://www.bbc.com/news/articles/cwy7zvp5xrqo
• up2isomorphism 2mo ago
  The deep problem is that insurance is a highly profit driven business in the US which basically go against what a good insurance should look like.
  • timbit42 2mo ago
    Profit-based, dividend paying insurance should be banned. Only non-profit insurance should be permitted.
    • mhb 2mo ago
      If you think the solution to the world's ills is to organize businesses as non-profits, you're delusional.
• NotGMan 2mo ago
  At this point I'm 90% convinced that any kind of a healthcare system will work as long as the politicans and everyone involved is not corrupt. Alas... The real question is then: since corruption seems to be everywhere, which system is the most resistant to it in terms of the price + quality for the end user. And the real real question is: what can be done so that every country has a political class that has the same strict rules of law for corruption etc... as Singapore does?
• marcusverus 2mo ago
  Brought to you by the guys who said Obamacare would lower premiums.
• asimpleusecase 2mo ago
  The UK is the counter example to this analysis. The NHS was a marvel in the early years, now however it is bogged down with so many layers of bureaucracy it is massively inefficient.
• testemailfordg2 2mo ago
  How will the capitalists survive then, they would go extinct as a species. Healthcare and defense are the two prominent sectors where the options available are kept artificially scarce / high in demand (wars), thereby reaping money unfairly from both taxpayers and individuals.
• provma 2mo ago
  [dead]