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- Hacker News
- 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.
by ilamont - 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.by xhkkffbf
- 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.by solaarphunk
- The private option is medical tourism to Buffalo or whatever.by intuitionist
- Does American private insurance pay for everything? And if you say "but they can pay out of pocket", well Canadians can come to America and pay out of pocket too.by triceratops
- I'm in Canada. The only time I ever needed a doctor in my life it was denied. I ended up having an issue that took ~5 years to resolve, which could have been prevented easily by any competent doctor in a 30 minute session.
I'm originally from Mexico. With what I have paid in tax here over the years I can afford to set up and operate my own small hospital over there, with new equipment, this is not an exaggeration.
"Free" healthcare, as with many other free things, turns out to be the most expensive kind of healthcare. Anyone who thinks otherwise doesn't really know what they're talking about or they're just stupid.
What could work, imo, and since we're all giving opinions here, is private healthcare with a ceiling on profits. Let players take 2x-5x, but not 50x which is what they do now, bring and enforce usury laws into healthcare.
by moralestapia - I don't know about Canada, but here in Spain you have both. You have public health guaranteed, but many people also have different levels of private coverages, usually to get quicker appointments.
As I understand Medicaid, it would just be open Medicaid for 100% of the US population regardless of the income, remove Medicare (they are now under Medicaid), leave the private sector as it is. Do you think Medicaid is too slow, too low quality, too terrible in general? Pay for private insurance, but you can still go to Medicare if needed.
by otherme123 - Same here in the UK. If you need to see a specialist, you regularly have to wait months, assuming you can even get a referral in the first place.by skuzye
- There are private options for lots of things in Canada, depending on the province.
Without data on what proportion of people are denied and what the consequences are, this isn’t a good faith argument.
On the flip side, cases that would get care in Canada are denied in the USA by private insurance. Private options are far outside the means of most people.
by ses1984 - 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?”by t-writescode
- Interesting. In every European country I know of, the private option is still available. Just vastly cheaper and more beneficial due to having to compete with a public option which covers basic necessities, surgery etc.by dbspin
- 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.
by th0raway - 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.by junofan
- 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.
by shdh - Won't matter unless service providers are forced to have one single rate for all payers. Which we can't even manage at grocery stores.by Glyptodon
- 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
- Just had a kid, navigation all the procedure codes and everything was insane. I just wanted to figure out what they were charging us for. I just gave up b/c we thankfully hit out out of pocket max for this year.by HaloZero
- Yeah I'd like to see this before universal healthcare. I think we can do better than universal healthcare if we start with transparency on pricing to kill graft.
- > 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.
by chimeracoder - >Legislate transparent pricing for all medications and procedures first.
This is an impossible ask. Truly impossible. The medical care providers have spent the last 50 years or more honing the art of making costs inscrutable. Not really to make it harder for you or I to know the costs, but for the insurance companies to know the cost. 50 years is a long time, that's not just one set of workers who have done this, it's 4-6 career spans now... the first to learn it taught it to their underlings and coworkers, who invented new sophisticated techniques and bureaucracies and taught that to the third career generation, who did the same and so on.
Even if we had universal healthcare, you're not getting rid of that. It's now a culture. A transmissible, everlasting culture.
For any political ask you might come up with, absurd and difficult and even intractable as it might be, this is light years beyond that. God himself couldn't make these prices transparent.
- For hospitals (where the majority of US healthcare spending occurs), pricing transparency has been the rule for more than 5 years:
https://www.cms.gov/priorities/key-initiatives/hospital-pric...
by twoodfin - Fix the principal/agent problem by decoupling health insurance from employment by not having health insurance be paid for with pre-tax dollars.by mhb
- >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.by karakoram
- Studies: Investing in green energy would reduce our reliance on the middle east for oil and create jobs locally
America: Sounds like communism
by ChrisRR - $1 trillion less profit.by jonplackett
- 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.
- 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.
by afavour - BigCorp gives money to politicians and gets to depress worker wages because they can't leave — sounds perfectly sane to tie your insurance to your employer under capitalism.by jkestner
- Republicans are the party of pulling up the ladder behind you.
They don't give any shits about free market economics or struggling entrepreneurs. They care about protecting their own money.
And it isn't about big business; that's the Democratic Party. It is about hoarding wealth and gaining more.
by dualvariable - Decoupling health insurance from your job and going single payer are separate things. You can have one without the other. You can have a very healthy system with private insurers (like in Switzerland) and you can have completely dysfunctional single payer system (like in Poland and I guess many other countries).
Main problems are elsewhere: doctors gatekeeping the market, lack of transparency when it comes to pricing, regulation making it impossible to compete for smaller players etc.
by bluecalm