They do not pay out per stream. They pay out a set % of their total revenue to rights holders. Spotify has to pay the exact same amount of money before and after that change.
The savings for Spotify is in not having the (not so insignificant) administrative overhead of trying to make hundreds of thousands of basically worthless payouts to different individuals that are worth <$5 or even <$1.
I think it's fairly reasonable to draw some sort of lower bound on the minimum you need to reach to get a payout, especially in a world where basically anyone can put music on their service.
Look: If you give a damn about what you're listening to, you can go over to Spotify and create your own playlists filled with music you care about (assuming they have the artists you like in their catalog). In that case, the artists will get paid accordingly.
But Spotify has realized that a lot of people use it for background noise and don't give two shits whether what they're listening to is a "real" band or music-like content squeezed out of sweatshop sessions in Sweden or whatever. I can't fault them overmuch for taking advantage of the actual listening preferences of its users. If you feel cheated by this, spend some time curating playlists on your own.
Tacking on the CEO-shooter's mantra to your message is shameful. This isn't healthcare. This isn't killing anyone. It's a fully optional service that happens to be popular. Trying to link it to anger over being denied healthcare is ridiculous.
I'm just rambling without much explanation sorry, but I'm gonna hit the reply button anyway!