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Comment by prostoalex | Hacker News Reader

> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers.

That story needs to come with a caveat that Medicare's anti-fraud efforts are covered by law enforcement budgets, namely FBI https://news.google.com/news/search/section/q/medicare%20fra...

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Anti-fraud enforcement is a tiny nit compared to the overall poor performance of US healthcare compared to other single payer nations. We pay roughly double per capita, cover fewer people (which means the people who do pay in our system are paying more than double), and have lagging health measures such as life expectancy and infant mortality rates (2-3x higher in the US!).

https://ourworldindata.org/the-link-between-life-expectancy-...

Anti-fraud measures can be evaluated for cost-benefit in isolation, but when the fundamental cost structures are so completely out of whack then we should prioritize discussion of the fundamental problems - which is lack of single payer universal healthcare in America.

> infant mortality rates (2-3x higher in the US!).

https://www.theatlantic.com/health/archive/2014/10/why-ameri...

"The researchers compared data on infant health and mortality in the U.S.; Austria, whose rate of 3.8 is roughly average among European nations; and Finland, whose rate of 2.3 is one of the lowest in the world. One of the biggest differences, they found, was in the definition of what could be considered a live birth. “Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries,” they wrote. Although the chance of survival for babies born before 23 weeks is low (the American Academy of Pediatrics recommends that doctors don’t resuscitate babies born before that point), they’re recorded as live births in the U.S."

This is often brought up, so show the corrected or aggregate miscarraige and mortality numbers to get some point of comparison. Leaving it just open seems incomplete...

Edit: Absent more aggregated numbers, it looks like Canada records similar to the US, while also having some similar issues with a higher pre-term birth rate, and US rate is still 50% higher than Canadas.

http://data.worldbank.org/indicator/SP.DYN.IMRT.IN

They do discuss the adjusted data a few paragraphs down:

"This difference in reporting, they found, accounted for around 40 percent of the U.S.’s relatively high rate compared to Austria and Finland, a result supported by the CDC report—when analysts excluded babies born before 24 weeks, the number of U.S. deaths dropped to 4.2 per 1,000 live births.

...

When the researchers broke the statistics down by age, they discovered that neonatal deaths were actually less frequent in the U.S. than in Austria and Finland."

Good find, but aren't neonatal deaths are a subpopulation of the overall infant mortality stats, so there is unfortunately, still no clarity. Canada it was noted had similar pre-term birth rate as America (and presumeably higher than Austria and Finland).

It's like a grim logic puzzle where one gets a pile of facts and try to discern the answer.

Country A has higher infant mortality rate than country B. Country A has higher preterm birth rate than country C. Country B has a higher neonatal death rate than country A. etc..

And that doesn't happen with private companies? There's loads of fraud that goes on there too.

Which is why those companies hire entire departments dedicated to fraud. If a government agency stepped in and instead offered to do fraud investigation for free, that would provide a rather nice reduction to their overhead costs.

Really? So all private insurance fraud is covered by those companies. I find that hard to believe.

That's his point. The story doesn't include fraud prevention for Medicare because it's paid for by another agency.

Switching to a single payer would reduce fraud. Because simplified rules are easier to adult. A cynic might even say the USA's healthcare system is purpose built to maxmize fraud.

https://www.amazon.com/Healthcare-Fraud-Auditing-Detection-G...

Here's the other thing about administrative costs: Medicare's patients cost a lot more per person than private insurance.

In other words, if it costs you $500 in administration costs and one patient has care that totals $5,000 and another has care that totals $10,000, then their administrative costs are 10% and 20%.

And yet we think that if we shifted more people onto a Medicare-like system, we'd save money.

Medicare patients are more expensive because of who it currently covers: elderly and disabled people, two groups that use more services than the general population. The whole point of a single payer AKA Medicare for all system is to cover the entire population, which would (because math) bring down the average cost per person.

I've always read that the problem with Medicare is that it's unfair to hospitals because they pay lower than the average rate (but can't negotiate on medicine). Do the savings from lower care costs not balance out the higher drug costs? (From a steady state of 1 surgery can lead to a lifetime of drugs, I'd guess the balance isn't great)

Medicare is also currently prevented by law from negotiating for drug prices. If we shift more people onto Medicare, we need to fix that problem too. The overall structure of a single payer/administrator is most likely to save money, but we need to be vigilant about the specific rules it is imposed with too.

Further it is not a good argument by itself. One could imagine a program with no administrative overhead that because of that lack of administration ended up costing far more than a program with higher administrative overhead. I'm not saying that's the case here, but the argument needs to be made that it isn't.

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