New York Single Payer. $91 Billion. (1 Viewer)

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I love it when @matttyl comes into these threads with logic bombs 

 

[NutterButter]

I love it when @matttyl comes into these threads with logic bombs 

I do like his style.  Very informative.   

 

[MarvinTScamper]

EOL care is a problem. Medicating and keeping alive essentially corpses with a pulse. 

Yes, and WILDLY expensive.   Like $2-5k per day.

 

[matttyl]

Why not or better yet what CAN we do to lower it?

1. Get healthy

2. Promote actual competition in the industry where possible.  Transparency and such.

3. Try to get Rx companies to justify their ridiculous costs (and ridiculous profits).   Same idea for many health groups. 

 

[NutterButter]

1. Get healthy

2. Promote actual competition in the industry where possible.  Transparency and such.

3. Try to get Rx companies to justify their ridiculous costs (and ridiculous profits).   Same idea for many health groups. 

#1 sounds nice and all, but can anything be done to influence that.   

Same goes for #3.  

 

[matttyl]

I wonder what the cost savings would be to a company that doesn't have to hire a bunch of people to buy and administer insurance benefits each year. Has to be significant in some cases especially as companies have scrambled in the last few years to keep cost to employer and employees under control. 

Whatever it is, though, it will have to at least partially be offset by someone at the state or federal level doing the very same thing (paid for by taxes).

 

[fantasycurse42]

Your employer probably pays at least that much for you, so you know. For pretty good coverage for my family of four it's over a grand. 

Just looked it up, they pay $1,615 a month.

 

[Ilov80s]

Yes, much less.  Some doctors and facilities get half or even a quarter for a service with a Medicare/Medicaid person than they do with someone with private insurance. 

What percent of dictators refuse Medicare/Medicaid?

 

[The Commish]

And it will do absolutely nothing to reduce costs, which is the main problem.

Why not or better yet what CAN we do to lower it?

Tell these companies that are making up their perceived "lost profits" overseas in our market to pound sand by putting limits on what they can charge.  The notion that this will stifle innovation is a myth at best or a fear mongering threat at worst.

 

[NutterButter]

Just looked it up, they pay $1,615 a month.

~2k per month for family total seems to be the norm that i've heard

 

[Doug B]

No, we can't.  We as a country spent about $4T on healthcare in 2014.

Or 20% less in 2015 ($3.2 trillion). Not cheap, to be sure, but it's clear there is no one firm, unassailable number. And that $3.2 trillion includes dental (normally separately insured today) and nursing home/retirement home expenditures -- knock that out and we get just below $3 trillion.

Still think something is broken and more than adequate care can be provided for sub-$5k/yr per person under 65 (note the goalpost shift). Don't all the 18-35 year-olds who never go to the doctor count for something? I get that our population is aging, but still.

I haven't spent $10,000 in a year on my own health as long as I've been in the work force (over 20 years). I might average $2,000-2,500 a year -- probably less (well less before age 35). And I am not a triathlete who lives on kelp and tofu. I guess I considered myself as a good example of the default healthcare consumer in America.

 

[Ilov80s]

#1 sounds nice and all, but can anything be done to influence that.   

Same goes for #3.  

We have tried with #1 but then people complain the government is taking away their rights. We have had a lot of successes though- just look at life now compared to 1960. Less smoking, more exercise, etc.

 

[matttyl]

Amazing that this mythical country (I'll call it "France") manages to have universal health care - which is not "socialized medicine" - and still operate as a functioning state.  Why, I hear that this "France" even still has doctors who didn't all leave for some physicians' paradise where they can charge patients anything they want to subsidize their high incomes!!  Wonder how they do it?  

Average French woman's BMI - 23.2.  Average American woman's BMI - 26.5.  Roughly a ~20 pound difference.  Setting up universal is one thing - funding it is something totally different.  The cost it would be for us here would be astronomical due to the fact that we simply aren't a healthy society.  That (as been mentioned here) should be at the top of the list of things to change. 

 

[kface]

But you wouldn't have health insurance coming out of your paycheck, so there is some kind of offset to the increase?  Insurance on paychecks goes down, taxes go up?

Costs to major employers go way down as well.

I have already that about Canada.  While taxes are higher and the wages are higher for car manufacturers, what levels the playing field is there are no health care costs

 

[Toe Cutter]

We have tried with #1 but then people complain the government is taking away their rights. We have had a lot of successes though- just look at life now compared to 1960. Less smoking, more exercise, etc.

Aren't people getting fatter compared to the 60's?

 

[Ilov80s]

Don't we need to destroy the lobbying/campaign funding system to actually do anything with healthcare?

 

[NutterButter]

We have tried with #1 but then people complain the government is taking away their rights. We have had a lot of successes though- just look at life now compared to 1960. Less smoking, more exercise, etc.

but aren't we as unhealthy as ever?  

 

[Ilov80s]

Aren't people getting fatter compared to the 60's?

I would assume and that's an area in need of improvement. 

 

[kface]

Don't we need to destroy the lobbying/campaign funding system to actually do anything with healthcare?

That's the beauty of single payer...it destroys that in one gigantic swoop.  And that industrial complex is a cesspool

 

[Ilov80s]

but aren't we as unhealthy as ever?  

I don't know, are we? Life expectancy is up fwiw. Just anecdotal but growing up everyone I knew ate fast food and drank pop all the time. My parents never exercised. Now, I don't know anyone that eats fast food more than once or twice a year. None of my family or friends really drink pop. We all exercise. Just anecdotal but if you told me 20 years ago my mom wouldn't drink Coke, wouldn't eat pizza or McDonalds and had a gym membership, I would have laughed at you.

 

[Doug B]

but aren't we as unhealthy as ever?  

Depends on the metric. "Unhealthy" is an extremely vague term. As is "healthy". Is it average life span? Infant mortality? Average BMI (and if so, BMI at different stages of life)? Athletic metrics (ability to run a mile, do X situps in a minute)? What does "healthy" mean? Common sense doesn't get us very far.

 

[NutterButter]

I don't know, are we? Life expectancy is up fwiw. 

70% of the country is considered overweight.  I would consider that pretty unhealthy.   I wouldn't necessarily equate living longer to being healthy.   It could be that we've just gotten better at keeping people alive with expensive prescription drugs.   

 

[Aerial Assault]

Average French woman's BMI - 23.2.  Average American woman's BMI - 26.5.  Roughly a ~20 pound difference.  Setting up universal is one thing - funding it is something totally different.  The cost it would be for us here would be astronomical due to the fact that we simply aren't a healthy society.  That (as been mentioned here) should be at the top of the list of things to change. 

French health care costs are dramatically less than here and that's not because of a difference in female BMI.  It is, however, largely due to a large population who can't afford proper care, leading to explosive costs for everyone, making for a nice feedback loop, especially for the profiteers.  What's lacking in France are entitled greedy providers, vast for-profit hospital chains raking in outrageous sums, a rapacious pharma industry, and oh yes, the health insurance carriers also raking it in.  I firmly believe in a bit of shock economics here.  Introduce some sort of universal health care and these problems will start to go away, after which we'll see improvements in people's health.  

 

[Doug B]

but aren't we as unhealthy as ever?  

Something else -- there are things that American healthcare treats now that practically didn't exist (or was virtually unknown) in 1960.

For instance -- how much is spent on ADHD/ADD care these days? How much was spent on the same in 1960? Or on neurological disorders and mental health in general? Number of people on prescribed depression meds in 1960? And how much is spent on those meds today nationwide?

Gluten intolerance? And allergies ... barely a thing except for hay fever and pet dander in 1960 (right?). Various digestive disorders -- anyone walking around with diagnosed Crohn's or IBS in 1960? The more medical science learns and matures, the more things that need treatment seem to get identified. It's a complicated issue, but one that's not much discussed when comparing healthcare costs to years gone by.

(Did a whole lot of people just suffer in silence back then? I guess so.)

 

[Ilov80s]

70% of the country is considered overweight.  I would consider that pretty unhealthy.   I wouldn't necessarily equate living longer to being healthy.   It could be that we've just gotten better at keeping people alive with expensive prescription drugs.   

As posted earlier, it's complicated. The weight issue is serious, but we've also done a decent job making food healthier. Smoking has been a huge victory. Teen alcohol, drug and pregnancy is down. It's complicated. 

 

[matttyl]

#1 sounds nice and all, but can anything be done to influence that.   

Same goes for #3.  

Yes, but not over night.  Tobacco use was over 40% in American adults in in the mid 1960s.  Last number I saw from the CDC was for 2015, and it was under 16%. 

#3 will be tough, but in the age of digital information and immediate outcry (see epipen doubling price and such), the public can greatly influence this. 

 

[matttyl]

Just looked it up, they pay $1,615 a month.

HEY, my guess of 1,500 a month in the above example wasn't too far off!  Maybe I do know what I'm talking about!

 

[NutterButter]

Something else -- there are things that American healthcare treats now that practically didn't exist (or was virtually unknown) in 1960.

For instance -- how much is spent on ADHD/ADD care these days? How much was spent on the same in 1960? Or on neurological disorders and mental health in general? Number of people on prescribed depression meds in 1960? And how much is spent on those meds today nationwide?

Gluten intolerance? And allergies ... barely a thing except for hay fever and pet dander in 1960 (right?). Various digestive disorders -- anyone walking around with diagnosed Crohn's or IBS in 1960? The more medical science learns and matures, the more things that need treatment seem to get identified. It's a complicated issue, but one that's not much discussed when comparing healthcare costs to years gone by.

(Did a whole lot of people just suffer in silence back then? I guess so.)

Oh absolutely.  But none of that has to do with my original question of how we make people live healthier lives; eating better and exercising more for instance.

 

[matttyl]

What percent of dictators refuse Medicare/Medicaid?

Well, "refuse" and "not taking on additional" are two different things.  Lots of docs choose to technically accept both due to certain stipulations, but they seem to always fill up their open spots with those who have private insurance - and why wouldn't they? 

I've even seen stories (and posted them in the ACA thread here) of doctors actually assisting people currently on Medicaid in purchasing private insurance (ACA individual) plans because the reimbursements for them are so much higher.  So it actually makes sense for the doctor to pay for the patients private plan and get that reimbursement back than it is to see the same patient with Medicaid. 

 

[matttyl]

Or 20% less in 2015 ($3.2 trillion). Not cheap, to be sure, but it's clear there is no one firm, unassailable number. And that $3.2 trillion includes dental (normally separately insured today) and nursing home/retirement home expenditures -- knock that out and we get just below $3 trillion.

Still think something is broken and more than adequate care can be provided for sub-$5k/yr per person under 65 (note the goalpost shift). Don't all the 18-35 year-olds who never go to the doctor count for something? I get that our population is aging, but still.

I haven't spent $10,000 in a year on my own health as long as I've been in the work force (over 20 years). I might average $2,000-2,500 a year -- probably less (well less before age 35). And I am not a triathlete who lives on kelp and tofu. I guess I considered myself as a good example of the default healthcare consumer in America.

I got my number from the first hit that came up on a bing search of "total US healthcare expenditure 2014", which was this.  My point is that it's a huge, huge, huge number - even when divided down to a per person amount.  Oh, and it's projected to be $5.6T in only 8 years. 

As for your last paragraph - so was my family member.  Picture of health, never a broken bone or surgery - until they were thrown for a horse who then stepped on their head and crushed part of their skull above their left eye.  Over $1m in heath expenses and over two years later, they are now fine.  Takes a lot of people like you (2,000 average expenses from a $5k "adequate care" figure you cite - leaving $3k a year leftover) to offset that one person.  Over 300 of them in fact....

 

[jonessed]

That's the beauty of single payer...it destroys that in one gigantic swoop.  And that industrial complex is a cesspool

No.  There would still be plenty of lobbying.

 

[kface]

No.  There would still be plenty of lobbying.

I don't think it's fair to compare the lobbying establishment now with the limited lobbying that would occur under single payer.  

 

[matttyl]

Depends on the metric. "Unhealthy" is an extremely vague term. As is "healthy". Is it average life span? Infant mortality? Average BMI (and if so, BMI at different stages of life)? Athletic metrics (ability to run a mile, do X situps in a minute)? What does "healthy" mean? Common sense doesn't get us very far.

Healthy vs unhealthy honestly shouldn't be measured by that, at least when looking over a long timeline. 

Example - in 1963 John and Jackie Kennedy had a child, Patrick, who had infant respiratory distress syndrome and died two days later.  Roughly 20 years later matttyl was born and had a worse case of that same affliction (in fact my great uncle told my father "I wouldn't get too attached" after I was born - but obviously made it.  Medical advances have given us longer life expediencies, but they have also allowed us to be less healthy.  20-30 years ago breast cancer was a killer, today it has a ~90% survival rate if caught early enough.  Drugs can now literally cure Hep C, but it hasn't stopped people from getting Hep C in the first place. 

 

[Doug B]

Oh, and it's projected to be $5.6T in only 8 years. 

Looking at that link ... what's the difference between getting soaked by more taxes to go single payer versus getting soaked by just general healthcare expenditures? Something's gotta give ... the trendlines would suggest that nearly the entire U.S. GNP would get spent on healthcare after 35-40 years or so (did not actually do the math there).

Can healthcare costs rise like that in a vacuum? Does the rest of the economy stay the same? Do the people who make out handsomely from rising healthcare costs put enough back into the economy (due to spending, investments, etc.) to make it at least close to a wash? Or at least more palatable?

Just can't see the status quo being maintained for many decades into the future. Some kind of sea change is inevitable, is it not?

 

[matttyl]

French health care costs are dramatically less than here and that's not because of a difference in female BMI.  It is, however, largely due to a large population who can't afford proper care, leading to explosive costs for everyone, making for a nice feedback loop, especially for the profiteers.  What's lacking in France are entitled greedy providers, vast for-profit hospital chains raking in outrageous sums, a rapacious pharma industry, and oh yes, the health insurance carriers also raking it in.  I firmly believe in a bit of shock economics here.  Introduce some sort of universal health care and these problems will start to go away, after which we'll see improvements in people's health.  

Female BMI is just what came up when I searched average weight between the two countries.  My point is that we, on average, aren't as healthy as other counties.  We're fatter, lazier, have a much worse diet...on and on.  What may work for them may not work other places - or at least it would have to be much more expensive (hence the $91B number given in the title of this thread for just one state).  Lets break that $91B (which I think is far too low, another estimate put it at $226B) out a bit.  New York has 19.8m people in a country with 324m total.  That's 6.11%, meaning if you extrapolate that $91B/$226B over the entire country, it comes to $1.5T to $3.7T - and doesn't include anyone on Medicare or Medicaid. 

As for the bolded, and I've discussed this before, it's not nearly what people believe it is.  Average profit margin for health insurance carriers is about 3% these days (in fact I saw one study recently which had it at .6%) - compare that to just about any other industry (including RX which you pointed out and I agree with).  Most health insurance companies make less than $100 per enrollee each year in profit - and above we already discovered a family's premium can average over $20k a year. 

 

[culdeus]

Oh absolutely.  But none of that has to do with my original question of how we make people live healthier lives; eating better and exercising more for instance.

For the first time ever. Ever. 50% of this country is meeting cdc exercise guidelines. 

Now that number could be higher but there is no evidence to say this is getting worse. 

 

[matttyl]

Looking at that link ... what's the difference between getting soaked by more taxes to go single payer versus getting soaked by just general healthcare expenditures? S

There is none - if you're assuming the same average level of care and yada yada.  You're just changing who's paying for it - but you've also stumbled across the biggest problem.  It's not WHO pays for it (which is what your question here is), it's WHY IS IT SO MUCH? 

There is no difference if my family and I are paying $20k in premiums a year (more like $25k after deductibles and OOP) or $20k (really $25k) in taxes a year if we're getting the same health care.  The question, at least to me, is why is it $20k a year?!

 

[matttyl]

For the first time ever. Ever. 50% of this country is meeting cdc exercise guidelines. 

Now that number could be higher but there is no evidence to say this is getting worse. 

Considering those guidelines themselves are less than 10 years old, I'm not sure you can really say "ever".  Much less say it twice. 

 

[Aerial Assault]

Female BMI is just what came up when I searched average weight between the two countries.  My point is that we, on average, aren't as healthy as other counties.  We're fatter, lazier, have a much worse diet...on and on.  What may work for them may not work other places - or at least it would have to be much more expensive (hence the $91B number given in the title of this thread for just one state).  Lets break that $91B (which I think is far too low, another estimate put it at $226B) out a bit.  New York has 19.8m people in a country with 324m total.  That's 6.11%, meaning if you extrapolate that $91B/$226B over the entire country, it comes to $1.5T to $3.7T - and doesn't include anyone on Medicare or Medicaid. 

As for the bolded, and I've discussed this before, it's not nearly what people believe it is.  Average profit margin for health insurance carriers is about 3% these days (in fact I saw one study recently which had it at .6%) - compare that to just about any other industry (including RX which you pointed out and I agree with).  Most health insurance companies make less than $100 per enrollee each year in profit - and above we already discovered a family's premium can average over $20k a year. 

Ugh, this again?  The key figure is return on equity, which is between 16 and 20%.  Lower than Big Pharma, but more than just about everyone else across sectors.  And that's ridiculous and a huge part of the problem.  

 

[NutterButter]

For the first time ever. Ever. 50% of this country is meeting cdc exercise guidelines. 

Now that number could be higher but there is no evidence to say this is getting worse. 

Is this just offset by having far greater sedentary jobs?

 

[Aerial Assault]

Considering those guidelines themselves are less than 10 years old, I'm not sure you can really say "ever".  Much less say it twice. 

They're much more current and relevant than the obsolete or at least obsolescent BMI, which you just cited.  

 

[matttyl]

Ugh, this again?  The key figure is return on equity, which is between 16 and 20%.  Lower than Big Pharma, but more than just about everyone else across sectors.  And that's ridiculous and a huge part of the problem.  

Well, it's not - so there's that.  Heck, this source has (general - both life and property and casualty broken out seperately) insurance at 3.39%.

 

[Steve Tasker]

Does anyone know how US-Canada handles this? 

This is a mildly complicated question.  The technical answer would be dependent on your visa status and your factual residence.  If you reside in Ontario and work in the US, I believe you would still be subject to OHIP contributions on your Ontario provincial tax return based on my limited knowledge (because you're presumably paid on a W-2 rather than a T4, meaning it wouldn't be deducted as a payroll tax expense - not 100% certain on the mechanic for this; I am not a Canadian accountant).  Assuming your US-based employer has US-resident employees and a US health insurance plan, you shouldn't be required to be on it.  Vice versa for a US-resident working in Ontario - I don't believe you would be covered by OHIP but would need US-based insurance.  Any company with the financial wherewithal to sponsor a cross-border visa has probably taken that into account, as it would be extremely difficult to recruit US-resident talent without having some mechanic for providing US-based insurance to its US-resident employees.  

From a tax residence standpoint, where a taxpayer maintains health insurance and other insurances is actually one of the major "tiebreaker" tests to determine where you are actually resident for tax purposes.  It's hard to argue that you're a Canadian resident rather than a US resident for tax purposes if you're on a US health insurance plan and not a Canadian provincial plan, for example.  And some visas restrict where you can actually claim residence, where you are required to pay Social Security (or the Canada Pension Plan equivalent) taxes, and so on.  

This is not tax advice and should not be construed as such.

 

[matttyl]

They're much more current and relevant than the obsolete or at least obsolescent BMI, which you just cited.  

My point wasn't the exact figures, but you knew that.  In fact the exact current figures are even worse as the average adult BMI in the states is now 28.8.

 

[Sabertooth]

I can't imagine this works well, but it'll at least serve as a petri dish to see how big of a disaster it would be, or if there's some feasibility to it. 

It isn't like the system now works well.  It's already a disaster unless you are an insurance company or a pharm company. 

 

[Arsenal of Doom]

What do you think the profit margin is for those private insurance companies....vs the companies these people work for?

Insurance Companies run pretty close to U.S. avg. profit margins, so... similar would probably be a good guess without knowing who they work for. 

 

[matttyl]

Insurance Companies run pretty close to U.S. avg. profit margins, so... similar would probably be a good guess without knowing who they work for. 

Since when??

 

[bigmarc27]

It isn't like the system now works well.  It's already a disaster unless you are an insurance company or a pharm company. 

It can always be worse. 

 

[culdeus]

Is this just offset by having far greater sedentary jobs?

Or the exercise may not be optimal. 

 

[Arsenal of Doom]

Since when??

That doesn't tell you anything about the avg. profit margin. It just lists a bunch of industries and cuts off at where health insurance comes in. Collectively corporate profits average about 6.5% historically. High margin industries like finance and high tech are typically in the high teens to low twenties, some industries are negative.

ETA: This appears to be a pretty good updated list of profit margin by industry