Economic Analysis of Medicare for All

You are not entitled to a living as bureaucratic waste. We should of course help retrain those who lose their jobs, just as we're doing for coal workers who are going to be out of a job within the next five years. I want my healthcare dollars going to healthcare providers (doctors, nurses, nurse practitioners, CNAs, drug research R&D, medical technology innovators), not private insurance companies, not administrators or third party billers, and most assuredly, not shareholders. I want the AMA to be handicapped from preventing us from dramatically increasing the number of doctors in the US (the American Medical Association operates as a cartel/cabal, attempting to limit supply to keep wages high); they also attempt to reduce the authority given to nurse practitioners [1].

> I would love for some sort of centralized system to push down costs, but I fear it's not realistically every going to happen.

The majority of Americans say the government should be responsible for ensuring health care coverage for all Americans [2]. Universal healthcare will arrive in the US eventually, the question is when. The current model is unsustainable, and will reach a tipping point.

[1] https://www.modernhealthcare.com/article/20171214/NEWS/17121...

[2] http://www.pewresearch.org/fact-tank/2017/01/13/more-america...

Having family in healthcare and being a lifelong patient due to a congenital defect, a job in software (including management obv) is a breeze compared to health care worker jobs across the board. They require more "schooling" (via mind-numbing training), are underpaid, have much more serious consequences from mistakes, have less oversight, work longer hours and under worse conditions. It's disheartening.

It looks like there was $47 Billion, (~9%) in profit in healthcare companies in the US in 2018. https://www.axios.com/health-care-industry-on-track-massive-...

Healthcare administrators! Drug companies! Device companies! Trial Lawyers! Insurance companies! Doctors (especially specialists)!

They're all the problem, and yes lots of them should make less money. I know cardiologists pulling down 500k+ and that is ridiculous. I can see highly skilled surgeons making that much, but pill pushers?

I also view that job loss as a foregone conclusion due to insurance companies fighting even moderate changes tooth and nail. If even minor improvements to a nakedly broken system are going to get fought against with such ferocity, it’s not surprising that their opponents would try and move the Overton window in response.

How much white collar employment comes from healthcare inefficiencies? Probably a good percentage of the sector.

These workers will need to acknowledge they are part of the problem and willingly give up these positions (or their absurd payouts from them) and vote accordingly. Or not and continue being part of the problem, which I think is your concern.

Reference Table S1.

Cost controls would account for ~14.5% of the total savings.

Hardly seems onerous. Medicare's medical loss ratio is approx 4% (?), whereas ACA caps private insurers at 15%. So clearly there's plenty of fat to be trimmed.

TL;DR: Single payer is cheaper, people live longer. Transition will be painful.

What if America's education problem is that the children don't have parents who can nurture them?

Because we have stagnant or decreasing real wages? Because the cost of daycare, housing, health, and advanced education have all gone up? Because we're making it harder to declare bankruptcy? Because we're criminalizing activities, and ripping families apart?

Maybe it shouldn't be a surprise that our education is ranked poorly.

And pointing to education, as though it's a system we can study in isolation, and claim that it's a failure, therefore other state-run systems must also be failures, isn't really being honest?

And maybe it's worthwhile to look at other countries with the economic conditions we're proposing. Like single payer healthcare. Because we can look at them.

You're absolutely right that "just because something is run or controlled by the state does not mean it will magically be either efficient or high quality."

But people like you seem to delight in using that as an argument against government programs that have been shown to be effective, again and again, in country after country.

So then I can say, "just because something is run or controlled by the state does not mean it will be either inefficient or low quality."

And we've both said something completely meaningless, and now can we please get back to looking at examples from other countries, and try to learn from them?

And who am I going to trust to decide that? Not a politician. Not someone who strongly favors one side or the other, either. And not just somebody at a bar, nor even a media personality. I want someone who actually knows some economics, and actually is attempting to be impartial. In fact, I want several independent ones of that.

American healthcare being more expensive than anywhere else fits the pattern. It also apparently costs more to build a rail line or any other work of infrastructure here than anywhere else in the world.

I'm not sure why this is, but health care is not exceptional.

Theorists set the groundwork. They come up with a lot of vague notions and then move to work with experimentalists to figure out how they can test these notions. How to "prove" it.

But saying they are "worthless"? That's just hogwash. Even if wrong, they aren't worthless. (Hint: most of the time they are wrong) And yes, economics isn't as rigid as something like physics. But it is pretty complicated stuff and they don't have as much of a history and basic principles. They may not be a hard science (or some might say not even a science), but calling an analysis worthless is just bad. And saying that in "normal science" (it's just science) things need to be testable to be useful is also just wrong. I'd call string theorists mathematicians, but what they do isn't worthless.

If this is really the way people think science is done, we've got a big problem.

I do not understand why people have this idea that it's the job of the government to do things like speculate on the economy via quantitative easing, or save money overall on healthcare costs. The federal government ought to have a few simple jobs --- the ones laid out in the constitution, and everything else can be left up to the people and to the states.

I would rather live in a country where healthcare maybe costs more than it otherwise could, and where the economy maybe recovers slower than it otherwise would have, than to live in a country where the government takes lots of our money trying to fulfill promises that it cannot keep.

Medicare is projected to be insolvent in 2026, and Social Security is projected to be insolvent 8 years later. We're due for an economic downswing in the next few years (if not the next few months). Our economy will not keep up with the developing world powers; NATO is increasingly irrelevant and the petrodollar is threatened.

What are we going to tell the people who depend on these dying programs? "I know that you worked your whole life in a factory, and I know that you are too old to work, and I know that you paid into this system your entire career, and I know you aren't getting enough to get by. But we had the best intentions in mind!"

America is rich because we won WWII, not because of American Exceptionalism. The comfortable life that American culture was built on (while the rest of the world needed half a century to recover) is going away quickly. The social programs that we already have in place have less than 6,000 days remaining before they fall apart, and in these last hours, we're seriously talking about adding on?

No thanks. I'm okay with living in a poor country. I'd prefer for my government to not fail as a result, though.

https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-med...

Combined with research on how wealth, family status, social status, access to sex partners, etc. etc. correlate with health outcomes even after controlling for access to doctors, hospital care, etc., it raises a lot of questions.

It seems most of the money we spend on medicine as a society is just a form of signalling. We “care” if we give X dollars worth of medical service, regardless of whether that led to a positive outcome or if the outcome could have been obtained more effectively through less “showy” ways or unglamorous things that don’t involve medical procedures or treatment.

It goes along with the idea of “betting is a tax on bullshit.” If we paid medical entities based on successful outcomes, including at the population level, then it might incentivize creative, cost-effective solutions instead of providers shoveling more ineffective treatment and demanding high pay just based on administering it.

On the other hand, how else are you going to do it? Do you know what the second-order effects are going to be? How sure are you? Can you prove it to someone who doesn't hold the same intellectual framework or political leaning that you do?

What is legal is not always fair, and what is fair is not always legal.

Also if everyone has healthcare they’ll get treated earlier before a condition blows up and... they get stuck at the ER getting a bill they’ll never be able to repay.

Our US healthcare system just sucks compared to other countries UNLESS you are well off.

I wouldn’t short change arguments saying covering everyone is actually less expensive.

http://review.chicagobooth.edu/economics/2017/article/never-...

If you have the time, could you please clarify what you mean by 'meaningless'?