Comment by hx8
2 days ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is
Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.
2 days ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is
Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.
The problem with models is that depending on your assumptions you can show just about anything. In general I think the foundation of a good argument, and good science, is assuming the minimum and seeing if your idea still works. They assume:
- hospital reimbursement drops to medicare rates ($296 billion)
- pharma prices decline 51% ($378 billion)
- administrative overhead way down ($286 billion)
- fraudulent billing way down ($286 billion)
- people stop going to the ER and stop being hospitalized as frequently, so the expanded use of services only costs $198 billion
Those seem like extremely optimistic assumptions, and the paper gives 0 consideration to most knock-on effects. For instance I don't think it's reasonable to cut hospital funding by $296 billion, increase the access to these hospitals, and assume everything will work out just fine. They at least acknowledge not acknowledging this, but that one factor alone already is likely to dramatically reshape things. And there are many others.
(1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything.
Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.
There's a multitude of evidence that points to the success of the ACA from a cost perspective (among other things).
Cost of healthcare for individuals is not a good metric to judge by. The ecosystem of hospitals, patients, doctors, insurers, health systems, and the federal government is complex and you're not going to get a clear picture of the overall impact of the ACA by looking as something as simple as cost savings.
One example, hospitals are required to treat patients whether or not they hold insurance. The hospital foots the bill for that care and it's a major reason why hospitals shut down (especially in underserved communities). Getting more people on insurance plans was a direct factor is keeping many struggling hospitals and health systems afloat.
https://www.statnews.com/2019/03/22/affordable-care-act-cont...
https://www.networkforphl.org/news-insights/the-affordable-c...
https://www.cbpp.org/research/health/chart-book-accomplishme...
If the ACA was so successful at reducing coats we wouldn't still be having discussions like this about the excessive costs of both care and insurance in the US.
We will never know how costs would have changed if we didn't implement the ACA, and cost is not the only metric of success. But it clearly hasn't led us to a place where people feel okay with what the industry costs.
1 reply →
1. Do any of the cost savings recommendations you address come close to $1T/yr impact? This is the scale we should be aiming for.
2. If you think this modeling is inaccurate or incomplete you can directly discuss that. That would be a much more interesting discussion than "it might be incorrect."
That's a great question, and one that should receive similar funding and attention to properly compare.
My hunch is that (a) this study over estimates on the cost reduction side and would not pan out, and (b) improving health should always be a better cost savings than reducing corporate overhead (especially given how piss poor our average health is today).