I disagree. Given the death of fiscal conservatism, and the newfound need to appeal to the grass roots (tons of which on welfare/assisstance) will force their hand.
Still probably a decade away though. Rising health costs need to hit critical mass first
And far better outcomes…
Well, at least they don’t obsess every waking hour about their health insurance or lack of it 
Ya, who needs to think for themselves when the state does it for you.
I will fundamentally fight tooth and nail that current per capita Medicaid costs =/= UHC per capita costs. That’s why I was very specific by saying if the GOP buys in (the assumption being far less political sabotage and a more streamlined process)
I agree, they don’t. I even noted that at the bottom and in subsequent posts. However… per capita costs would need to come down a lot just to breakeven.
*It would basically need to be cut in half. I don’t think that’s realistic, do you?
Do you believe that you can achieve nearly $2T in savings when it goes from our current government healthcare system to UHC?
Because, we’ve heard stuff like that before.
why would you expect them to? They’re completely different populations - I’d assume, per capita, medicaid recipients are sicker and require more care and attention than an average “UHC patient” … that’s comparing a bushel of rotten apples to a reasonably typical apple orchard
Nope, that’s why I said above the realistic ones are 1.8-1.9 ish
Made up totals from current per capita =/= 2T in savings needed.
Honestly, and it’s pretty hilarious considering all of the back and forth I’ve had with our resident brain dead alt lefty, I would be fine, possibly even support, UHC IF the federal government didn’t already have its claws in so many things and IF we didn’t run a deficit for decades at a time and IF we weren’t so far in debt as a nation and IF people took steps to prevent disease/obesity/etc…
We simply cannot continue to just add huge social programs and hope the next generation finds a way to pay for their inevitable bloat.
We currently spend about 2.69T so you’d need a savings of $790B. Do you think that’s realistic?
*That’s about $2.4K per person.
1.8T shakes out to roughly 5600 per person. Not sure if that’s completely realistic given America’s obesity problems, but I’d be more than happy to make up the extra in increased copays at time of use
I agree I don’t think that’s very realistic. That’s about $900B less than we currently spend in total healthcare costs public and private. You would be removing profit (savings) sure, but you would also be removing R&D expenditures (additional cost) and profit driven efficiencies (minimal headcount for maximal output). You would probably save money switching from private sector to public bureaucracy I just don’t think it would be even close to $900B.
Of course, this doesn’t factor in the economic impact of eliminating the healthcare industry and displacing I don’t even know how many workers.
And, just so I’m understanding correctly, you want to basically just shift the cost from premiums to taxes (essentially breaking even so we save $0) and then make people pay more in co-pays. Correct? I don’t see the advantage other than the obvious, universal coverage.
*Said healthcare industry really meant health insurance industry.
So here’s a thing that is relevant:
A substantial cost savings in healthcare could be achieved if we took a harder stance against reimbursement for practices that are lacking sufficient evidence of efficacy. Don’t reimburse hospitals and/or physicians for things that are not proven to work. Don’t give FDA approval to things that are not proven to work. The only way that stuff gets paid for is if the patient enrolls in a research study to test whether it works.
I’m not just talking about “no pacemakers for 85 year olds with less than five years of life expectancy” stuff. The more time that I spend in cardiology research, the more often I see devices and/or imaging tests being used in questionable situations where the current body of evidence does NOT support that their use is beneficial; people just do it because they think it works, or because it makes sense that it would work, even if the product has been studied extensively and shown NOT to work in a specific setting and/or population. An excellent example is the use of an intra-aortic balloon pump (IABP) in patients with cardiogenic shock complicating an acute myocardial infarction (heart attack):
A well-conducted randomized controlled trial found minimal evidence of clinical benefit with the use of an IABP in patients with cardiogenic shock. Patients with cardiogenic shock that got an IABP before intervention had no better survival than patients that did not get an IABP.
When speaking with interventional cardiologists, they all believe that use of an IABP in the MI-with-shock setting makes the patient’s hemodynamic numbers LOOK better, but that there is no evidence that it improves survival or reduces any other clinically meaningful complications. And yet, this is still frequently used in practice in this patient population, despite several years’ worth of evidence that it does not improve outcomes. But it’s all about patient selection, they say. We just need to identify the right people, they say. Don’t take the IABP away just because it only works for SOME people. OK, then prove that it works with a trial!! Until there’s actually evidence that the IABP improves survival in a specific population that you can identify correctly, no reimbursement for this unless the patient is enrolling in a research study to assess whether it works.
I think universal coverage (while being a great benefit on it’s own) will also cause a snowball effect that has the power to change our horrible health culture.
Want lower taxes? Quit eating shitty food and start going for walks. Want lower taxes? Put some of your time in prevantative care.
Also, this is ABSOLUTELY be a pipe dream, and in no way achievable (because Americans don’t actually want to take responsibility for their actions), but I’d like to see certain aspects of UHC that dissuade people from making horrible choices.
TL;DR version of that long rant above - another way that UHC or something like it could be much more palatable from a cost standpoint would be that the UHC program refuses to reimburse the physician and/or hospital for any practice that cannot be justified with current medical evidence, with some sort of rare-case exceptions for diseases or conditions that have not been sufficiently studied to have that answer.
But there are absolutely a fair number of devices and/or procedures currently in use that have sufficient evidence to conclude they are NOT effective, and they remain in use anyway because they’ve just become ingrained in practice as a thing you’re supposed to do. This is why, while I defend the FDA in threads with our resident idiot as serving an important function, if anything I wish they were a lot HARDER on approving things. We’ve lowered the bar a little too much and allowed things to get traction or approval that work in theory, not practice, and it’s upsetting that money gets wasted on expensive-but-not-that-effective-devices when putting that money to work elsewhere in public health could have a greater impact for more people.
I wish I shared your optimism. I think it does the opposite.
But, half the country doesn’t even pay income tax. I love the idea, but it doesn’t incentive half the country.
Agreed, it’s lovely, but a pipe dream.
@ActivitiesGuy is that an issue in UHC’s too or just here?
Has there been a shift away from healthier lifestyles in EU since the implementation of UHC? Genuinely asking, I don’t know
Sure it does. If that portion of the country turns into the driving cost factor, it opens them up to have other social programs gutted to compensate. I’m absolutely not opposed to that
Not that I am aware of, but we aren’t the EU. We’re leading the way in obesity now. I don’t think how healthcare is paid for will change that mentality.
If anything, I think it places even less responsibility on personal accountability.
I don’t know why it seems to work in the EU, perhaps it’s just their outlook on health, how they live, etc…
When has a social program once implemented ever truly been gutted for any reason, let alone the cost driver isn’t doing what they should be doing to minimize costs?
We, generally speaking, can’t even bring up cutting social security, Medicare, Medicaid, etc…
The ACA I guess. Has it actually been gutted? I can’t think of anything else.
I can already see it now:
R: People’s personal choices are increasing healthcare costs. We should increase their share of the burden!
L: These are the poor, the sick, the weary. They can’t afford to pay taxes. They can’t afford to pay more in co-pays. The rich can foot the bill!
(on and on for eternity)
Right now, in our current system, you could save money on healthcare through preventative care, but people don’t.
