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Comment by legitster | Hacker News Reader

The net savings would be $450B, but the total cost would still be in the 10s of trillions of dollars (Edit: 30-50 over 10 years), bigger than all of our federal spending combined. It's one thing to have as an objective, and another as a plan for getting there. The proposal they cite would make federal healthcare expenditures 69%(!!!) of the GDP (Edit: total federal expenditures). It's simply not realistic to convert our entire economy into a government and healthcare first system within only 4 years.

These calculations also ignore any affects of changed consumer preferences if you eliminate copays and deductibles, something no other universal healthcare system has done.

This is one of those calculations that is entirely accurate, but also entirely misleading.

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The "10s of trillions of dollars" estimates you see are for 10 years of projected spending, not for one year.

Thanks. Good correction.

> but the total cost would still be in the 10s of trillions of dollars

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.

> The proposal they cite would make federal healthcare expenditures 69%(!!!) of the GDP

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

"eliminate copays and deductibles, something no other universal healthcare system has done."

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.

Canada has no co-pays. The topic of payments never even comes up, unless you're not a resident. Prescription drugs and dental care are generally not covered, however.

In fact, I still struggle to understand the concept of a co-pay. Is it like a deductible for automobile insurance?

it's not really like a deductible. it's a small fixed cost you pay every time you see a doctor or fill a prescription. it creates a small amount of friction, presumably to prevent frivolous use of resources.

There is also "co-insurance", which can be in the range of 20 to 50 percent of the billed amount, depending on one's plan. It should go without saying that 20 to 50 percent of the bill on almost any substantive medical problem can be a financial extinction-level event for many American families.

Let me give an example of the billing issues American's face.

Last employer I paid around $9,100 annual ($350 every 2 weeks). This plan had a $6k deductible with no coverage until that was met, then a $6500 OOP (out-of-pocket) max. So the insurance company was guaranteed to get $15,600 before they paid anything outside of "preventative care".

Now, unfortunately, the insurance company had me under a totally different plan, with a 7300 OOP max. Since I don't pay them, I pay my employer, I have to deal with my incompetent HR dept to get this fixed. They not only don't fix it, they somehow split my family so the member with the majority of expenditures is now on the correct plan, but everyone else is on a different plan. This causes the insurance company to claw back payments to doctors and bill me for old services, around $400.

If the doctor bill is $100 and your co-pay is $20 then you pay the doctor $20 and the insurance pays the doctor $80. Co-pay because there are two payers.

Ignoring the math error (it's not 69% of GDP), I don't understand this argument.

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

Because public is only OK if it's done by Republicans. I know this sounds flippant and partisan, but what's the serious counterpoint? Spend publically on war, on tax cuts (1), on anything favored by conservatives: it's a natural function of government. Spend on anything else: it's usurping taxpayers rights to make their own choices, and reducing efficiency because everybody knows that individual Americans spend their money more wisely than the government.

(1) yes, i know that the riposte: "tax cuts are not expenditure, they are giving money back to tax payers, where it originally came from".

"The net savings would be $450B, but the total cost would still be in the 10s of trillions of dollars"

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.

This is the issue. The assumption that it’s somehow better for this to be handled as a consumer expenditure versus a tax is the actual debate.

That’s a very simplistic view. There’s also the question of how those numbers will change over time in each system, and how both care and cost will be distributed.

There’s also the political factor: how would we actually enable this? How do you get it passed? How do you ensure the SC doesn’t strike it down? How do you ensure it’s not just rolled back in 4 years when the presidency flips after the inevitable backlash?

"any affects of changed consumer preferences if you eliminate copays and deductibles"

I am curious on what you think are the effects.

More people will get the care they need than currently. Right now, there's a real dis-incentive to going to the doctor or to hospital for non-critical care/injuries.

And that's a good thing I would say.

Definitely.

The costs are already in the trillions!

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.

The 69% figure doesn’t sound right.

It wasn't. Fixed.

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