Single-payer healthcare would save $450B and 68k lives a year: study

So yes, much of your costs are for possible emergencies and especially as you get older, your costs increase.

Yeah, so between my employer and I, it is $20k for my HDP for family of 4. Then I sock away the HSA max of $7k every year to pay for the actual costs (including dental, which I don’t have).

This madness has to end and I don't give a shit that we are trying Single Payer. Everyone talks about Cost but what about Administrative issues ? Fighting incorrect claims, billing errors and what not. As far as I am concerned, this is one area where I am totally against Profit making motive. Let me correct myself. I am totally ok with Doctors and Hospitals directly making some profit but not insurance companies. Private insurance companies can go suck it. I am sick and tired of paying for their profits. Status quo has to change, that's it.

EDIT: I am not against Insurance of some sort but they should only exist for Catastrophic illnesses. I need to go see my doctor for preventive care ? No need to involve Insurance company and wasting time on filing a claim that by definition requires more money to pay for the people involved unnecessarily.

But the fact that the people with money and good insurance are suffering from the system as well as the poor seems to be lost on Democrats, and the Republicans are just paralyzed by the whole idea of fixing health care. It's a massive political failure for both parties.

Interesting. So is it also the case that you can "negotiate" medicine prices? Is the actual price then different from what is on the tag?

Kind of, yes. The vast majority of healthcare spending is, unsurprisingly, on very sick people.

Insurance is for the outlier cost. The difference from other insurances is that almost everyone faces that outlier cost eventually in their lives, assuming they don't get hit by a bus in their 20s.

I broke my nose, was seen within 5 minutes and it was straightened (after anaesthetic).

I got hit by a car on my bike, was seen in 5 minutes, no worries.

Needed and x-ray for my lugs to get residency. Took 10 minutes. Free.

My brother broke his leg horribly. Multiple surgeries, a month in hospital, etc. etc.

There are no bills, just taxes - though it's very manageable.

Consumers do not see it because it's typically off-site from the main hospital care facilities, but believe me, the administrative savings potential is real.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

From the paper: "In addition to savings on overheads, a comprehensive database of health-care charges would facilitate detection of fraud, which extracts $85·7 billion every year. Following the transition to a single-payer system in Taiwan, an 8% reduction in overall national expenditure was attributed to the reduction in fraud. By moving from a fragmented health-care payment system to a unified system, irregularities in provider claims can be more easily detected. For example, under the fragmented system excessive claims for physician time can be spread across patients with several different insurance providers. However, acknowledging that improvements have been made in fraud detection since Taiwan's transition, we conservatively assume that the improved fraud detection would garner savings amounting to half that observed in Taiwan, corresponding to 4% of total health-care expenditure."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Aside from decreased executive pay and decreased fraud, many jobs will be eliminated.

From the paper: "Improvements in system efficiency, such as reductions in billing tasks, will involve a contraction of the workforce. Although the country will benefit from lower costs, 936 000 administrative positions and 746 600 positions in the health-care insurance industry are estimated to become redundant. However, detailed transition plans have suggested either funding for early retirement options, extensive severance, retraining programmes, and relocation expenses for all workers in these sectors. Implementation of such a plan is estimated to cost $61·5 billion annually over 2 years, a sum which would be recouped within the first year by the health-care savings estimated here."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

> Decrease in administrative overhead, calculated by extrapolating the overhead in medicare to the entire US healthcare economy.

That doesn't strike me as unlikely at all. Maybe their extrapolation is aggressive, but there are people at nearly every practice who spend a large portion of their day just managing the billing of cases to insurance companies.

The amount of work that goes into billing a case to insurance companies is really insane. It tends to be a very manual process, because every insurance company is different.

Teams eliminated or dramatically reduced:

* VOB, verification of benefits, they fight with the insurance company just to determine what coverage the patient has, and it is purposefully not automated. If it were automated, it would be easier for us to know what they'll pay. By making it a manual process (or at least only partially automated) we have a greater chance of making a mistake they can reject a claim over. We also have a greater chance of simply getting someone on a bad day and refusing to cover things preemptively, required it to be elevated to our Appeals department.

* Coding, people whose jobs it is to make sure the notes left in the record by medical staff (doctors, nurses, techs, etc) is properly translated to ICD10 codes.

* Billers, people whose job it is to bundle up claims and records, make sure they're properly sorted for each insurance company, and submit the claims.

* UR, utilization review, the group that reviews how accurately we're tracking the treatment guidelines of the INSURER so they don't deny the claim for missing a comma. Our UR group missed a small technicality on some claims and we had to submit paper copies of every claim for 6 months to the insurer, in addition to the electronic requests as a "remediation and verification step", aka, punishment. We would literally print out the electronic claim, and mail it, so it's going to be identical to the electronic claim, but we had to do it for 6 months for one facility to one insurer.

* Collections, the people who call up the insurance company to demand payment for claims they approved but haven't paid on. This is a much larger group than you'd think, as most insurers will happily make you wait for payment until you complain.

* Appeals. They address complains made by insurers over rejected claims, either fixing the issue with the charge, or going to the insurers appeals department to tell them why it's correct. They also talk to insurers over patients that are rejected at the VOB stage.

* Out Of Network, these folks do nothing but deal with insurers we're not in-network with, collecting payments, negotiating Single Case Agreements, etc.

VOB and OON would be gone completely. Coders, UR, Bilelrs would have a lot less to do because there would be one insurer to deal with, so we could have fewer people. Medicare pays promptly and without hassle on approved claims, so does Tricare, so we'd need a lot fewer people in collections. We'd need fewer appeals people too due to one set of rules for everyone.

Healthcare in the USA is REALLY messed up, it's the worst sausage I've ever seen being made.

I have a family friend who lost his job, lost his insurance and couldn't afford to take his meds which would have prevented the massive stroke that paralyzed him 3 weeks later.

This was 10 years ago and his rehabilitation is still ongoing. His wife can't work and is his full-time caretaker. Multiple lives destroyed because we as a society can't get a system together where it makes rational sense to provide this man with the couple cents worth of pills that would have prevented this calamity.

It's the same story with every other chronic disease and health care issue - just massive amounts of human suffering that could be avoided.

Likewise, total billing and insurance related (BIR) administrative costs are ~$500 billion.[2] (Year unknown.) Or roughly 15% of total healthcare expenditures. And that's up from $471 billion in 2012[3], even though the ACA capped insurance provider administrative overhead and instituted many other reforms intended to address these costs.

Plus, it's odd that people on both the left and the right who are convinced that lobbyists control Washington will simultaneously hold the notion in their head that either a public option or single-payer would be able to consistently cap reimbursements and contain costs. If they're right then it's a miracle Medicare and Medicaid do as it as much as they do, and impossible for it to do so once the Federal government is directly reimbursing the majority of healthcare expenditures. Indeed, if it were possible then defense expenditures would be more efficient and a fraction of what they currently are.

These rosy estimates are ridiculous. We have over 10 years of direct experience with substantial and serious healthcare reform. Obamacare attempted and does enact a variant of almost every concrete reform imaginable. Whatever you think of Obamacare, you can't deny that it has provided mountains of empirical data about the difficulties and promises of containing costs. And yet Obamacare opponents on both sides--those who want to return to the pre-Obamacare system, and those who want a public option or single-payer--willfully ignore the evidence, unchastened by reality.

A California congressional committee looked at the potential costs for single-payer in the state and it would have required an additional $200 billion/year in tax revenue even after accounting for diverting existing private and Federal expenditures. That's what a cold, hard, realistic examination of the facts looks like even by those predisposed to enacting it. Maybe that $200 billion would be worth it; from a moral perspective it certainly seems so. But to deny the costs is to invite failure and financial ruin as not even a majority of Californians, let alone Americans, are willing to make that sacrifice.

We need to figure out how to better solve the cost problems before we continue to wade further into the waters. Otherwise we're just going to drown. If you look at all the other healthcare systems around the world with both better outcomes and lesser costs, neither single-payer nor a public option are defining characteristics. Rather, they run the gamut from mostly private to mostly public. It we can't lower costs with Obamacare, which has both substantial public and private components (and thus opportunities for exploring structural efficiencies across the spectrum), switching to single-payer or a public option won't move the needle.

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[2] https://www.americanprogress.org/issues/healthcare/reports/2...

[3] https://www.ncbi.nlm.nih.gov/pubmed/25540104

With a universal system, those costs (and jobs) would evaporate to the tune of millions per year in salaries alone.

For the employees, each of them could quickly retrain or just shift into other departments as needed as most staff did when the company was acquired and IT admins moved to PM or lead roles in other departments.

#2 exists and would have a huge impact not only on the industry but your time and mine. I've spent maybe 8 hours this year already just working with medical billing groups to pay up and already spent close to $2000 between my partner and I with an estimate $4-6000 before the end of the year without doing a sleep study which I greatly need.

Universal is definitely cheaper. All we have to do is compare ourselves to just about every other western democracy to see ow.

Many friends in healthcare have pointed out (correctly it seems) that medicare has lower overhead because medicare shifted that cost onto the existing admin, and many places lose money on medicare, but are forced to take it. So it's simply not possible to extrapolate that to all hospitals without bankrupting many.

Here's a WaPo article with ample links to peer reviewed papers on the issue. (Note the part WaPo rates as false is that ALL hospitals would close; WaPo does admit with cited sources that there is ample evidence Medicare pricing would cause less service and less capacity from many fronts).

https://www.washingtonpost.com/politics/2019/07/03/would-med...

I don't think that's more likely to explain the cost saving than the sheer scale advantages of having a unified bureaucracy rather than countless of small insurance agents.

I will dig the source out when I'm home but (I think it was Paul Krugman) who went over the administrative overhead in one of his blog posts. Medicare and Medicaid both have administrative costs of less than 1% of their budget, the private industry clocks in at more than 15-18% IIRC. I have trouble believing that this is mainly fraud detection considering that it's consistent across other countries with consolidated healthcare sectors.

A single large administration can simply streamline these processes better than thousands of individual companies. To be frank the insurance industry seems mostly like an employment program for the middle class white collar sector.

Rather, I'd like to point out something that I haven't seen discussed. Maybe someone here can knock it down.

Health care spending increases drastically and nonlinearly after age 55. Medicare's admin overhead is in part a consequence of the cohort of patients it serves: they receive more medical services than everyone else, and so more of their medical spending goes to services relative to administrative costs.

Conversely, younger patients receive relatively few medical services, and the services they receive are much less expensive. Compared to that lower amount, fixed administrative costs are a higher percentage of their medical spending. Some admin costs scale directly with the costs of services rendered, but others don't.

As a result, it seems pretty clear that Medicare's admin overhead ratio would necessarily be higher if it covered everyone, and that any result taken by extrapolating current administrative overhead to the whole population would be dubious.

I wonder why this paper didn't contemplate effect of Medicare for all on hospital and provider spend?

Source? The linked study gives it at $3.034 trillion/year. That's on the lower end, but consistent with all other studies for single-payer healthcare I've seen, which price it in the $3-$5 trillion/year range.

Note that the US is already spending $3.5 trillion/year on healthcare.

Scottish NHS has no deductibles or copays in general, dentist has an fee for some people though. English system has a flat prescription fee of £9 or so for a minority of the population up to £100ish a year. It's very close to free at the point of use, however.

That's not remotely true. I'm mystified how you could even type such a sentence without realizing its obvious falsity.

I am curious on what you think are the effects.

US health care spending for 2018 alone was $3.65 trillion.

10 years of that sort of spending would result in $36.5 trillion.

So we're already talking tens of trillions of dollars, even if nothing changes.

We would save money. Why does it matter if that money is spent publicly vs privately?

I absolutely see your point, though, this idea that we can give everyone in the United States access to health care is revolutionary! Exciting, compassionate, and revolutionary!

We have the opportunity to clear some of the institutional sclerosis that weighs at our society and economy. I really hope it happens.

From https://www.shrm.org/resourcesandtools/hr-topics/benefits/pa...:

>"Health benefit costs are still rising at two times the rate of wage increases and three times general inflation, "making this [cost] trend unaffordable and unsustainable over the long term," Brian Marcotte, NBGH president and CEO, said at an Aug. 7 press conference in Washington, D.C.

Medicare is one of the most efficient ways of delivering healthcare we have in this country. With overheads of 2-5% compared to the 10+% of the private industry[2]

2. https://www.americanprogress.org/issues/healthcare/reports/2...

Unless there's another equilibrium at the new demand which neither you nor I can state that there is or isn't.

There is a reason the income gap between different classes of the population is growing larger. That income gap is what should be funding these.

Policies of austerity are a direct result of the rich getting richer, not that it's not sustainable.

You think there are people out there who will smoke, knowing that it causes lung cancer, because they figure government will pick up the tab for the chemo? Bizarre, but ok, if so, why doesn't having insurance give them the same incentive?

> Is waste, fraud, and abuse taken into account at all in this study?

From the paper: "In addition to savings on overheads, a comprehensive database of health-care charges would facilitate detection of fraud, which extracts $85·7 billion every year. Following the transition to a single-payer system in Taiwan, an 8% reduction in overall national expenditure was attributed to the reduction in fraud. By moving from a fragmented health-care payment system to a unified system, irregularities in provider claims can be more easily detected. For example, under the fragmented system excessive claims for physician time can be spread across patients with several different insurance providers. However, acknowledging that improvements have been made in fraud detection since Taiwan's transition, we conservatively assume that the improved fraud detection would garner savings amounting to half that observed in Taiwan, corresponding to 4% of total health-care expenditure."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

> People who have a proclivity to go to the doctor too much will go even more when its 'free'. Younger people who eschew doctors because it interferes with their current lifestyle will feel even safer continuing bad health habits because free care will be there for them later in life.

Is this a significant problem in countries with single-payer systems?

> Why should I subsidize other people's bad decision making?

You already are? That's how health insurance works. What this study is showing is that you'll have to subsidize other people less, because the whole system will be less expensive.

[0] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

You already are through record high premiums, deductibles and what not to private insurance companies. The problem is that those companies are in it to make money which means everything is inflated and not to mention the bullshit of in-network/out of network and fighting with billing/administration to get bills corrected. No. I am sick of that and I would gladly pay to subsidize other people's decision making because we all already are.

If you really don't want to pay for other people, then no insurance should exist and everything should be out of pocket straight. Free market baby. But not gonna happen in the US when it comes to healthcare.

This is what you already do when you live in America. Other people made a bad decision to make healthcare a private industry, creating a billion dollar insurance business, and you are writing their paycheck out of yours.

Public option, it’s by far the best path forward.

[1] - https://www.congress.gov/bill/116th-congress/house-bill/1384

is that right? i mean, that seems like a really bad idea -- if you have money, why wouldn't you get better health care?

edit:

btw i live in a country with the largest public health care system in the world https://en.wikipedia.org/wiki/Sistema_%C3%9Anico_de_Sa%C3%BA... and we never banned private health care because... well, even with the best public health care system, you will still have to wait a lot to get any procedure done. so if you can afford, you can pay for private health care and get stuff done faster.

it doesn't mean that public health doesn't work -- it works quite well, it's just that you have to wait a lot sometimes for some procedures.

whether the insurance is coming from a single payer or a private company, access to health care does not mean unrestricted access to any medical procedure you want. Private insurers also deny treatments that aren't considered to be cost effective.

Right now, many procedures are made unavailable due to being considered "elective" or "cosmetic" or "out of network" by The Private Insurer.

The universal health care means that the extra insurance was not very expensive at all since it only covered the speedy access part. If you have money capitalism will always ensure you have speedy access to healthcare.

You want to contract with the world-class researcher to perform an experimental surgery that is unavailable through the public system? Sure, pay the money and we'll take care of you.

With a single payer, there would be a list - this is what we pay for, this is what we don’t pay for.

Because I'm a software developer and I make decent money, I didn't qualify for any tax credits or discounts. The cheapest health insurance plan that I could find cost twice as much as just paying both the ACA penalty and the Massachusetts state penalty. It made more financial sense to just go without insurance.

I can imagine that a lot of young software developers and other people who do contract work find themselves in similar situations.

See the bottom of this for a graphic: https://www.commonwealthfund.org/publications/issue-briefs/2... also the removal of the individual mandate probably contributed to the gap.

Thankfully the COBRA loophole meant I could avoid paying the costs if I ended up finding a job quickly, but during that period I was travelling with a check for the full amount of the insurance just in case.

Now imagine that but far worse for someone who couldn't actually afford any of those costs.

I'm only anecdotal, but by comparison, prior the ACA, my insurance for a family of 3 was $300/month with a $2500/year deductible. That $300/$5000 plan was considered predatory and high deductible.

The first plan offered to me under the ACA was something like $700/month with an $8000 deductible. Plans this year were ~$950/month with a ~$15,000 deductible. It's Cadillac pricing and one-star benefits.

Meanwhile, my "non-compliant, high deductible" plan from a private market is $400/month with a $5000/deductible.

I opted out of ACA - it made sense to opt out even when I had to pay the $2100/year penalty, because the premiums and the deductible were still less. I qualify as "underinsured", but that couldn't be farther from the truth. My plan can be irritating to use, but they have online self-service tools for providing healthcare, and I have never been questioned about paying for necessary treatments. I pay them, they pay the doc. Very simple.

For people who relied on private insurance and weren't destitute, the ACA has been a shit-show from day one.

The only highlight to the ACA for me is the hundreds of thousands in billables I've accrued helping institutions become "compliant" with the ACA.

1. 42% make too much to qualify for premium subsidies but elect not to purchase coverage, typically because it's unaffordable or just not worthwhile (the sibling commenters mentioning their expensive, crappy plans fall into this group).

2. 27% qualify for Medicaid, meaning that they could get coverage approximately free but they either don't know how or don't bother to sign up.

3. 22% qualify for partially subsidized coverage, but either they don't think the coverage is worth the money, they don't know how to sign up, or they just don't bother.

4. 9% are in the coverage gap - they live in states that didn't expand Medicaid and make too little to qualify for premium subsidies.

https://www.kff.org/uninsured/issue-brief/a-closer-look-at-t...

Employment sponsored healthcare will likely still exist in some form, perhaps to ensure speedier access to some care.

Which can easily be caused by a destructive and broken healthcare system leaving the ill unable to seek treatment and thus left to fend for themselves.

Even for those with insurance the costs - in time, in bureaucracy, in often money when your insurance provider refuses to cover - are unreasonable to consider seeing a doctor in a thousandfold situations that Europeans never even second guess. Because they don't need a waist deep paper trail to go to their physician, because they won't get a dozen different bill collectors harassing them in every legally gray way possible, because they don't need to break out the checkbook on the way out to pay the minimum barrier to entry extortion at the end.

There are differences through whether it should be single-payer or not.

Could you give me some examples of this? Living in a nation with universal healthcare, I've never seen this.

Aren't the electorate also the ones voting for tax structures (or for the politicians who'll implement them)?

Doesn't this cut both ways? Rich people voting for austerity is equivalent to the wealthy voting themselves benefits. You won't find the right balance if you always demonize welfare in favor of tax cuts.

I wonder about this in the same way I wonder about a world where we have professional window breakers, and what effects it would have on the window repair industry if we stopped having people go around breaking windows.

"Improvements in system efficiency, such as reductions in billing tasks, will involve a contraction of the workforce. Although the country will benefit from lower costs, 936 000 administrative positions and 746 600 positions in the health-care insurance industry are estimated to become redundant. However, detailed transition plans have suggested either funding for early retirement options, extensive severance, retraining programmes, and relocation expenses for all workers in these sectors. Implementation of such a plan is estimated to cost $61·5 billion annually over 2 years, a sum which would be recouped within the first year by the health-care savings estimated here."

If he wanted to make the argument that it would discourage people from seeking surgical degrees that is something worth discussing with current students, but that guy's costs are sunk. It's too late to change now.