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Yes, based on their modelling assumptions, that is what they found. I've written some papers where universal coverage is the most efficient healthcare delivery system, and that the U.S. is highly inefficient in providing care. But these estimates (especially calling them a lower bound) always are a bit fishy. Many "socialized" countries have created systems, over time, to increase payments/competition/open up alternative avenues to access care.
Since it hasn't gone through peer review yet, I'm not sure how much the results will stand up to scrutiny, but reading the paper, here are some questions I would bring up to the authors if providing a referee report.
The US healthcare system, as it currently stands, is untenable. So assessing alternatives needs to be done correctly.
How did their estimates more than double since the original publication in 2020? Improving the prognosis of health care in the USA - The Lancet. What's notable is that, in the 2020 paper, 37 million do not have HI coverage, while 41 million are underinsured. The figures in the recent paper are 27.5 million and "tens of millions"; in the discussion, they call it 45 million. They anticipate an additional 5 million uninsured from end of subsidies, and more underinsured. They estimated $450 billion (2017 dollars) with 68,000 lives in 2020. Now, it's $1.04 trillion and 114,000 lives annually? They try to explain it on pages 9 and 10, but there's nothing evidence based.
There is the potential for induced demand from lower reimbursement rates (Physician responses to Medicare reimbursement rates - ScienceDirect), which would work OPPOSITE of #2, and yet nothing is said about this. This would increase costs. In fact, the only increase in usage comes from under- and uninsured, rather than previously privately insured.
Asserting that this result is a "lower bound" is bold. And unlikely. Especially, as they keep pointing out, in a static model. We know that induced demand in healthcare is a thing; we know that physicians respond to incentives; we know that consumer choice is valued. Don't downplay this.
Also, if this affects physician income (hard to see how it wouldn’t tbh), you’d see a lot of physicians who are on the cusp of retirement leave medicine.
The mid career physicians would probably gut it out, but add on multiple years of extra work until they can retire.
Early career physicians and those in medical school currently would be screwed, and you’d have a lot fewer people apply for med school. Probably enough to still fill the classes, but you would lose most of the best and brightest applicants who would pivot to more lucrative private sector careers.
The current medical education system in the US works because of massive delayed gratification - tons of money up front and generally terrible work-life balance for 7+ years (15+ years if you include undergrad and the longer residencies) while making a fraction of a fair market rate, all in the expectation of making the real money when you’re an attending physician.
In the countries with socialized medicine, they make less but have shorter training and super cheap med school. The government would have to figure that out before making the switch unless they want to gut US healthcare.
The two-pronged approach here is to recognize that medical education, like medical care itself, is a public good. We can make sure that new medical graduates aren't looking down the barrel of half a million dollars in debt. Remember free college wasn't affordable at $70 billion for ten years? Somehow spending the same or even more over a few months to attempt a regime change that predictably ended up closing the Strait of Hormuz wasn't a problem.
The massive front-loading of education costs causes a decades-long delay of savings compound interest for those in medical careers who spend the first decade of their careers paying off loans, which then has to be paid back in the form of inflated salary expectations, especially late career. This issue is entirely preventable without damaging doctor lifestyle one bit.
Please educate me, with citations, how eliminating medical debt but also creating significant income inequality for new physicians versus established ones will work?
The incomes are still so high this is a non issue. Youd have to cut income by more than 50% before it would begin to be an issue. Not to mention that many try to do it as helping people is its own reward which would replace people only in it for the money for a good while.
You forget that since residency is capped that the output is capped otherwise it would have reach equilibrium with lower wages already.
CBO grading
Who wins and who loses within physician pay specifically — this is the CBO's own language, not a paraphrase of intent: providers whose all-payer weighted-average rate under current law is higher than Medicare's average rates are more likely to face a decrease in their average payment rate under the single-payer system, while providers whose rate is lower than Medicare's average are more likely to see an increase.
Translated to specialty terms:
>Losers: specialists with heavy private-insurance patient mixes and rates well above Medicare — orthopedics, dermatology, plastics, cardiology, radiology, anesthesiology, gastroenterology
>Winners (or flat): primary care, pediatrics, family medicine, and any provider whose current patient mix already leans Medicare/Medicaid-heavy (since their blended current rate is already close to or below Medicare)
so residency where supply > demand get a pay cut and where demand > supply get a pay raise. Looks like a big economic win
Its just basic economics. You dont know where youre supply constrained because we have 51K people apply for 43K residency positions every single year. So already an 8K over supply of people applying. Every single year.
This is a weaker worry than it sounds, for a few reasons:
Residency spots are capped by GME funding (mostly Medicare-funded) and hospital capacity, not by market income signals in the short run — so a rate cut doesn't directly shrink spots.
Applicant demand for residency slots is already vastly oversupplied relative to spots (especially from IMGs and a growing number of US MD/DO grads), so even a meaningful drop in specialty attractiveness wouldn't likely leave positions unfilled overall.
Where you'd see effects is in specialty mix, not fill rate: fewer top students chasing the highest-paying specialties (ortho, derm, plastics) if the pay premium shrinks, and relatively more interest in primary care if it becomes financially competitive. That's arguably a stated goal of M4A advocates, not a bug.
Countries with single-payer systems (Canada, UK, etc.) don't have trouble filling residency/training positions — the U.S. concern is more about total physician supply and geographic maldistribution than a training-pipeline collapse.
> The incomes are still so high this is a non issue. Youd have to cut income by more than 50% before it would begin to be an issue.
Completely false. Incomes are high because the opportunity cost for these people (90+ percentile performers) is high. If you drop it, you lower the flow of doctors coming in.
Incomes are also high because doctors are taking on the risk of failure with medical education debt. That risk has to be priced or people won't do it.
> Not to mention that many try to do it as helping people is its own reward which would replace people only in it for the money for a good while.
Economics does not work this way. Those effects exist but they are tiny and a rounding error at these scales.
> You forget that since residency is capped that the output is capped otherwise it would have reach equilibrium with lower wages already.
Residency caps the inflow of new doctors. Nothing caps the outflow of retiring or out-migrating doctors.
/u/EconomistWithaD is 100% correct here. Medicare4all unchanged would be a classic monopsony condition and wages would fall and many hospitals would close. If not done very carefully, wait times become the gatekeeper. Currently Medicare can get away with this to a degree because EMTALA + private insurers forces the rest of the economy to subsidize Medicare/Medicaid costs, to the tune around 100-200 billion dollars a year.
> Completely false. Incomes are high because the opportunity cost for these people (90+ percentile performers) is high. If you drop it, you lower the flow of doctors coming in.
>
>
Believe me the 90% percentile performers are not becoming doctors lol. Those people in the last gen became software engineers getting the same salary on 4 years education with way better hours and way less debt.
>Incomes are also high because doctors are taking on the risk of failure with medical education debt. That risk has to be priced or people won't do it.
Its more along the lines of people deciding whether its worth it on the debt vs increase in income. As you see higher income families go for it because of prestige rather than incme.
>Economics does not work this way. Those effects exist but they are tiny and a rounding error at these scales.
Actually it does as you would see even less teachers if this wasnt the case.
>Residency caps the inflow of new doctors. Nothing caps the outflow of retiring or out-migrating doctors.
And where are they going eh? Some other country with 50% of the income?
>/u/EconomistWithaD is 100% correct here. Medicare4all unchanged would be a classic monopsony condition and wages would fall and many hospitals would close. If not done very carefully, wait times become the gatekeeper. Currently Medicare can get away with this to a degree because EMTALA + private insurers forces the rest of the economy to subsidize Medicare/Medicaid costs, to the tune around 100-200 billion dollars a year.
You mean what we have now with a physician shortage and hospitals closing?
Medicare rates would increase 10-20% and would handle all of those things quite easily. Without the 600 billion profit piggy backing the private insurer does.
Who wins and who loses within physician pay specifically — this is the CBO's own language, not a paraphrase of intent: providers whose all-payer weighted-average rate under current law is higher than Medicare's average rates are more likely to face a decrease in their average payment rate under the single-payer system, while providers whose rate is lower than Medicare's average are more likely to see an increase.
Translated to specialty terms:
Losers: specialists with heavy private-insurance patient mixes and rates well above Medicare — orthopedics, dermatology, plastics, cardiology, radiology, anesthesiology, gastroenterology
Winners (or flat): primary care, pediatrics, family medicine, and any provider whose current patient mix already leans Medicare/Medicaid-heavy (since their blended current rate is already close to or below Medicare)
so the losers already have supply > demand residency. The winners dont. So then it evens out fufilling all needs.
Any M4A program would have to solve for the wild medical debt that we saddle doctors with to start their career in practicing medicine. I have friends who left medical school with ~300k in loans, and they spent basically a decade making nothing. They are super skeptical of any system that’s going to cut their earnings.
My wife had over $500k. $300k isn't even that crazy. Plenty of my college roommates got over half a million as well but they all get paid 7 figures now or close to it to compensate.
As others have pointed out, for a lot of them it’s more like $500k, and the problem is we’re talking about reducing that compensation. It starts to be a much more risky career path.
> In the countries with socialized medicine, they make less but have shorter training and super cheap med school.
No Medicare for All solution is complete without this. There needs to be an option for people to enlist in the National Health Service, where they receive a state-sponsored medical education, and in-return contract to serve a number of years in the public health delivery service.
This would function similar to the GI Bill, only with the education coming first and the service coming afterward. Millions of people with the aptitude for medicine would now be available to enter the profession, not just those who can afford the education. And this could drastically increase the number of available General Practitioners, who could afford to practice in lower income and rural areas because they would not be required to become specialists charging more as required to pay off a million dollar education bill.
(Edit: And nowhere do I hear anyone talking about how nationalized medicine would be the biggest business stimulus program in history - because that massive cost of employer-sponsored healthcare benefits would now be eliminated - but should also be replaced with new business taxes to fund public healthcare otherwise corporations will just take the windfall and add it to executive pay and shareholder returns which they should not be allowed to do)
> No Medicare for All solution is complete without this. There needs to be an option for people to enlist in the National Health Service, where they receive a state-sponsored medical education, and in-return contract to serve a number of years in the public health delivery service.
This is one approach, but having looked into it, I don't think it's the best solution. You have to look at where the gatekeepers move to and who bears the risk of failures as well as the evasion channels. Foreign systems have major problems currently where their doctors get their degree, paid for by the state, then work the minimum required and leap to a higher paying career in the next easiest location. Australia and NZ pick up doctors from the UK/Nordics/Canada due to recognizing their licensing. In the US, we pick up doctors from India and other developing countries because they have to repeat residency, which is worth it when the pay gap is big enough.
The better design is Australia's: income-contingent loans. The student owes the government, repayment comes out of future income above a threshold, all on a per-account/per-person basis, and if income never materializes the government eats the loss. This splits completion risk correctly - the student bears it when training pays off, the state bears it when it doesn't - and it changes the politics of capacity: seats are easier to expand when students co-finance than when every seat costs the government the full amount with full risks of failure.
> This would function similar to the GI Bill, only with the education coming first and the service coming afterward.
This doesn't work because people can move and leave and you cannot force them to stay. Similarly, the gatekeeper still exists - UHC governments with free education have immensely difficult testing to qualify for the channel (remember, government has the risk of failure so they must). This testing is more difficult and strenuous than necessary and likely deters some people who otherwise would successfully complete the programs (I.e., you can't ever predict perfectly, and whoever is taking the risk has to set the parameters to minimize losses).
Also the very rigid structure of their education paths reduces innovation because the system can't reward anyone who breaks off the rails. So Bill Gates would never have dropped out of Harvard to start Microsoft, which is a small anecdotal example but a real measurable phenomenon. Here again the Australian system wins - it keeps both channels intact and optimizes the flow because individuals can judge their abilities and dedication themselves rather than test hurdles forcibly disqualifying anyone close to the bar.
Kinda ridiculous that healthcare worker pay is always the first thing to get attacked when hospital profit margins are hurt. There are so many pointless middlemen getting their fingers in the pie that have no reason to exist, but for some reason it’s physician salary that gets targeted when it’s time to save money and not the price-gouging corporations.
Insurance company profit margins, hospitals overcharging for procedures so they can “negotiate” with insurance companies, and the bureaucratic costs associated with having a handoff between healthcare providers and insurance companies account for way more than 4% of healthcare costs, and all of it is completely unnecessary spending. None of it benefits patients in any way.
You need to get informed before you go spewing stuff. Insurance company profit margins are small and are much smaller than most industries. They're on par with or lower than regulated utilities, but with far, far higher risk factors.
> hospitals overcharging for procedures so they can “negotiate” with insurance companies,
Hospital profit margins are also small, still not above what normal companies are able to return on investments.
> and the bureaucratic costs associated with having a handoff between healthcare providers and insurance companies account for way more than 4% of healthcare costs,
This cost is huge. It's not profits, and it's a result of us forcing insurance companies to be the gatekeeper. If you want to fix this, insurance companies can't be the gatekeeper of care, but that doesn't mean we don't need a gatekeeper of care (every system must have one or the system explodes).
> and all of it is completely unnecessary spending. None of it benefits patients in any way.
It's not unncessary. It's just inefficient because insurers are not good gatekeepers. The gatekeeper has to be moved, but it can't be ignored.
> There are so many pointless middlemen getting their fingers in the pie that have no reason to exist, but for some reason it’s physician salary that gets targeted when it’s time to save money and not the price-gouging corporations.
You only think they have no reason to exist because you don't understand how the system works.
Insurance companies are a bad gatekeeper. Yes, agreed. But having no gatekeeper is not an option in any system, so we have to move the gatekeeper role.
Physician salaries are very large and much larger than UHC systems, so it's still worth talking about, but it is not the primary source of the problem.
Not possible. This is a classic monopsony situation. Wages and returns to investment (and therefore future investment) will fall. However, what will happen is doctors will exit the markets and wait times will become the new gatekeeper, plus some losses in the quality channel.
Doctors in America make $500k, while they make around $200k in other western countries. Cry me a river if they have to take a small pay cut. They will still be handsomely paid.
People not super familiar with the healthcare system would be very confused why healthcare for all would SAVE us money.
But when you see how much extra every company charges us for services, it becomes obvious. The act of giving everyone healthcare isn't what saves the money. It's FINALLY regulating things to make sure a aspirin doesn't cost tax payers 83 dollars per pill.
I’m trying to think of how it can be sold to the American people to make it palatable because I don’t think Americans need to be convinced that the current system is bad, but they are reluctant to believe in the viability of an alternative. To your point: Perhaps if it was framed in terms of ending corruption and corporate waste? Then it doesn’t become about increasing costs, it ideally becomes about efficiency in their minds.
I think, though, in the same way that Republicans have successfully sold a segment of the American electorate on the idea that Government doesn’t solve problems, it is the problem, there would need to be an effort to sell people on the idea that unregulated capitalism isn’t a cure-all for all situations.
I think we should sell it as shoring up Medicare for the elderly by adding lots of young people who will pay in but not file claims. Medicare is massively popular among the elderly, so talking about it like it will fail unless we expand it is probably a decent line of attack.
> I’m trying to think of how it can be sold to the American people to make it palatable because I don’t think Americans need to be convinced that the current system is bad, but they are reluctant to believe in the viability of an alternative.
I've been trying to say this for months. The key part to sell to the american people is a better understanding of the problem.
The problem with the American healthcare system is the gatekeeper is in the wrong place. All healthcare systems, everywhere, have a gatekeeper, because otherwise the systems explode.
Insurers are our gatekeeper. They are a very bad gatekeeper because every claim becomes a dispute channel and loops through claim-deny-appeal until it routes through the system or the claimant gives up. All of that is bad, but it's not actually the insurers fault - they MUST do this because they are the only ones keeping the system demand from exploding.
The right thing to do is to let insurers remain as logistics solvers and pricing coordinators, with as much price passthrough pressure as possible, but not to make them the gatekeeper of care decisions. Doctors can't do that either because they don't pay the bills, the system would explode. It has to be at a higher level. I've worked a lot on a system design to solve this, but it's hard to get anyone informed to listen and I only have so much effort to throw at it.
Bernie just found it. Tax dollars saved. Right now the victory goes to whoever can cut spending. Republicans were specifically put in office to do that. They failed miserably.
Hmm, then why does Bernie also admit, taxes will go up. m4A will not be a huge money saver.
Seriously, UHC will not save much costs. Yes, will save on prescription drugs and admin costs. But now more patients to see and Medicare/Medicaid rates will have to go up. So savings will be taken by other increased costs.
Plus this report? Not even peer reviewed. And early reviews show inaccurate data and some mistruths…
> Hmm, then why does Bernie also admit, taxes will go up. m4A will not be a huge money saver.
It would be better than what we have now.
It's not a great system - wait times will explode and taxes will rise substantially - but the total costs of a single-payer system are less than what we pay today. It would only be better than our current system because our current system is so bad.
Then new payroll taxes at business/individual. Business tax replaces private insurance costs.
Next will be a VAT, typically 20%-25%. Of if no VAT, raise individual income tax rates instead.
*****
So for average income earners? Will see new taxes. And if they do not use much healthcare, they may be concerned about losing more income to taxes.
For families/individuals earning $200k? Yeah they will take a hit. And why they support status quo or German UHC model that keeps private insurance and starts UHC.
So what i am hearing is, tax the rich and tax the ungodly rich ??? No more tax havens. No more dumping our tax dollars into companies like tesla without a financial return back to the people. No more wars. No more funding bombs dropped on little girls.
We have the money. We always had the money.
I am tired of playing games trying to figure out how to get my patients what they need. It creates a moral injury there is no bandage to cover, or treatment to heal it. Its painful and crushing.
> So what i am hearing is, tax the rich and tax the ungodly rich ???
This isn't even remotely close to being able to close the gap, and comes with substantial deadweight losses affecting the median citizen in the end.
> We have the money. We always had the money.
We don't have anywhere near enough for this. We can raise it, but the system needs to be made efficient and the problems need to be understood and then solved.
> I am tired of playing games trying to figure out how to get my patients what they need. It creates a moral injury there is no bandage to cover, or treatment to heal it. Its painful and crushing.
You are 100% correct and I'm sorry. The problem is the system keeps shoving off the problems onto someone else instead of breaking down and actually piecing out the problems to be actually solved. That means insurers become the gatekeepers of care, and doctors become the pawn to fight against their gatekeeping. It's all wrong because the structure of it is wrong.
It’s also fundamental to how insurance works. Insurance pools risk in order to cover everyone and turn a profit. You balance the risky patients with less risky patients. The problem with our system is that the government takes on all of the most risky patients, and leaves the least risky to private insurers.
From the get-go it’s easy to understand that this system makes no sense at all, and eliminating the government’s role is not a sensible solution either.
But, since we’re on an economics forum, we have to reckon with what that looks like on a large scale: most of us not having health insurance because it’s too expensive. Then, correspondingly, many more providers shutting down completely because they don’t have paying customers. So a general degradation of our healthcare system.
Is that really better than pooling everyone in one big insurance program?
They dont even have medicaid or anything like it for old people, it's all private sector, but you're mandated to buy it.
So mandate people buy it and have insurance companies charge more for overweight/smoking/drinking. Politically its easier to allow insurance companies to charge the willfully unhealthy more than say taxing them.
If you tax unhealthy behavior and reward healthy behavior you'll get end up benefiting society as a whole.
> It’s also fundamental to how insurance works. Insurance pools risk in order to cover everyone and turn a profit. You balance the risky patients with less risky patients. The problem with our system is that the government takes on all of the most risky patients, and leaves the least risky to private insurers.
This is not actually the real problem. Yes it's an accurate description, but if what you were describing were actually the case then insurer profits would be much higher. Insurer profits ae less than typical regulated monopolies, even though they have substantially more risk.
What ends up happening is that Medicare (combined with the EMTALA channel requirements and some other pressures) must be accepted but underpays for procedures. The cost gaps end up dumped back onto the private insurers. So they're still paying, it's just indirect.
It's not a good system. A better system by far would be to understand the full problem and move the gatekeeper of care - Insurers are not a good choice for gatekeeping care.
The best idea I heard in the Obama Care debates was a federal charter system (based on the Fed model) that would allow private insurers to bypass the complicated state-by-state regulatory model and submit to a single national regulatory scheme. Something like that could give the regulatory body ample leverage to reign in the completely out of control pricing systems between insurers and providers that’s the real source of our completely whacky health costs.
If 100% of patient panels reimbursed at Medicare rates you would have a wave of hospital / practice bankruptcies and retirements on day 1.
Health providers that are well capitalized to survive this are likely PE backed and therefore highly incentivized and organized to milk every dollar of Medicare claims they can.
I don’t see how the amount of Medicare fraud bureaucracy that will need to be built will not rival current health insurer overhead.
They could implement some cost control internally, because institutions built on unknowable but unlimited costs are not sustainable under any circumstances.
Medicare is already absolutely enormous, and the current users of the program would continue to use the great majority of its resources, so very little additional investigative overhead would be needed. You can milk Medicare as much now as you could under M4A, because Medicare is making most of the payments already.
How would M4A not result in an enormous increase in claims and usage flowing through Medicare? Every claim flowing through commercial insurance currently would now be flowing through CMS. Plus there would be an obvious uptick in usage.
There would be an increase, but Medicare is gigantic already because all of the nation’s most expensive patients are already on it, and using it constantly. Adding a bunch of much healthier people to the program is going to make it more economical, not less.
Smoking and overeating and drinking all make you very unhealthy, but not as unhealthy as your average 65+ year-old.
Fair enough on overall costs. But I still think the increase in transaction volume will be substantial, which is what results in increased need for anti fraud bureaucracy.
I worked for a national primary care chain, and while Medicare patients had much higher usage on a n=1 level than commercial patients, it was offset by there being simply so many more people under 65 (around 70-80% of patients). Total usage when you factor in patients x volume per patient ended up being close to 50/50.
With then revenue being even more skewed to non Medicare due to commercial reimbursement rates.
> There would be an increase, but Medicare is gigantic already because all of the nation’s most expensive patients are already on it, and using it constantly. Adding a bunch of much healthier people to the program is going to make it more economical, not less.
The problem that /u/Wrenchinspokesby is getting at is that medicare is underpaying for procedure costs. Medicare can get away with that because of a combination of small regional pressures and EMTALA rules force providers that would normally drop Medicare to keep accepting it. The costs get subsidized by the private industry.
If you switch to M4A, you have created a monopsony condition and wages and ROI's would drop, which would drive a wave of retirement and outmigration from doctors and hospital closures. Wait times would become the new gatekeeper of care instead of insurance denials. The problem would be nearly unsolvable for medicare.
It's still a better system than what we have today, but that's because our system today is so bad. The Swiss system is much, much better than M4A for example, though it still has problems.
Not really. You're forgetting all the money spent generating that profit that also wouldn't have to be spent if there's no profit incentive. The money spent on advertising to tell people to go to your urgent care vs the closest one in an emergency for example.
> The money spent on advertising to tell people to go to your urgent care vs the closest one in an emergency for example.
This is smaller than a rounding error.
> Not really. You're forgetting all the money spent generating that profit that also wouldn't have to be spent if there's no profit incentive.
You just don't understand the system or the real problem.
The problem isn't that insurance companies make and spend money. The problem is that we require insurance companies the be the gatekeepers of care. Every system has a gatekeeper of care or the system explodes. For us that's the insurance companies.
But they're very bad at that role. We get stuck in the claim-denial-appeal loops and that's where the biggest waste of money goes. It's not going into profits or whatever you think they're losing money on, it's on the administrative costs of trying to gatekeep care. But you can't get rid of denials either - every system has a gatekeeper or the system explodes. We have to move the gatekeeper of care to fix the problem. /u/Substantial-Ad-8575 is correct - the profits are not the source of the problems, and if you slash the miniscule profit margins they have, you slash investment and competition, neither of which helps the problem in the long run.
We still have tons of non-profit insurers. They charge similar rates to for-profit insurers, generally less than an 8% difference. Insurer profit margins are small, less than what regulated utilities get, but with far higher risk.
> But when you see how much extra every company charges us for services, it becomes obvious. The act of giving everyone healthcare isn't what saves the money. It's FINALLY regulating things to make sure a aspirin doesn't cost tax payers 83 dollars per pill.
The way that Medicare4all saves money is by establishing a monopsony condition driving down doctors and Medical investment ROI's, and the limiter will be split between long wait times and the quality limitations established by Medicare's rules (which are nowhere near complete enough to run a whole healthcare system's gatekeeping).
Great comment. It seems like switching to M4A will save a chunk of change and improve healthcare outcomes on average. But claims about how much for either are much shakier. That kind of makes sense to me, since we’re talking about an enormously complex system, but it should be hard to make bold claims about it.
Sometimes you have to accept a little imprecision in the numbers to get forward movement politically.
Suppose it only ends up saving $871 billion a year. That’s not a trillion a year—but it’s more than close enough that the point being made still stands. Would we be willing to throw out the proposal and keep lighting $871 billion a year on fire just because it isn’t quite what one proponent promised?
There comes a point where your cost analysis has to be treated as having a degree of uncertainty to it and that you’re generally going to trend on the right direction strongly enough to justify the change in policy. But… good luck getting that through the noise of public debate if you don’t streamline the statements and promises somewhat.
Okay. Most people would characterize a policy that was originally estimated off the cuff in a public statement by a politician to save “a trillion dollars a year”, actually only saving $871 billion a year as “accurate enough,” I think.
Certainly not off by enough that most reasonable people would characterize that as a purposeful lie to misrepresent costs.
I’m aware that politicians will stretch the truth or outright lie to get elected. This discussion is about the actual cost analysis and how they got the numbers that politicians turn into slogans.
Sane risk-pooling in the health insurance system would also be a major cost-saver. It’s kind of ridiculous at this point to be calling health insurance “insurance” when it doesn’t behave like an insurance product in any way other than in its paperwork.
Since you seem to be an expert on the subject, can you tell us about wait times? That's my biggest issue. I was diagnosed and under the knife in 8 hrs in the US for a complex spine issue. $500k surgery, I paid nothing.
Under the Canadian or UK system, the wait time would have been 1.5 to 2.5 years and I would have killed myself long before getting the surgery. I was also at a high risk of permanent paralysis, but since it technically wouldn't kill me, I get put way behind in the queue.
What have you found in regards to that? Because I'd rather be in a system where I can at least pay and get the treatment than it not be an option entirely.
Thanks. For spine stuff, it seems like all the best doctors in the world come to the US so they can charge whatever they want, so you don't see as many neurosurgeons, especially top ones, in universal systems, and because these conditions technically don't usually kill you but are about the most painful experiences ever, the universal systems don't prioritize them.
If I was in another country I would have had to come to the US and pay God knows what out of pocket to get it done. My fear is that option goes away entirely if the US goes universal. There isn't much reason to be a neuro and go through that insane residency without large financial incentives. The best neurosurgeons in the world at Hospital for Special Surgery in NYC for example don't take any insurance at all.
Anyone with decent health insurance now, and who is even a 75th percentile earner will be worse off financially, and with access to care. There will be less novel treatments developed without the massive profit motive afforded to private investment. That’s the reality.
There will be some benefits too - decoupling insurance from employment, less risk of catastrophic financial impact from getting really sick.
And the moral imperative, is certainly fair enough. But it’s ridiculous how much this is glossed over.
These are tired points that have been refuted again and again.
The cost savings difference between then (14%) and now (~20%) isn’t much different. You choosing to focus on the aggregate number is just….not taking inflation into account. Things, as it turns out, are more expensive now than in 2020. Wild you think the researchers aren’t aware of their own study from 6 years ago. Like, OK.
The cost savings of using Medicare reimbursement rates and negotiated pharmaceutical savings are known. Idk why you feel the need to “scare quote” them. We can look at other countries to see how it impacts supply, and idk why you’re framing it as fewer procedures for private care when we’re talking about public insurance for all.
I’m not following here - induced demand will raise costs, but the only increase in usage comes from the uninsured and underinsured? This a) would be temporary, as now they are fully insured and can see a doctor for the first time in a long time (insert lives saved/preventable deaths) and b) shows our current system is only saving money by locking people out of the system. Following this through - any increase in access for the uninsured/underinsured will cost money. Seems like a shitty (read: deadly) way to save money. Offsetting this, however, is that millions of people are now paying into the system that previously weren’t, reducing the cost of the system as a whole because that’s how insurance works.
Hogwash. We can, again, look around the world at every other country and see how people respond to incentives, and consumers don’t care about choice when their arm is broken or have cancer - they want expertise, not choice.
Wait times in America already vary greatly on income and insurance. Depending on where you live and what insurance you carry, wait times can already exceed what they are in other countries. Put simply, wait times can increase because there are people added to the line who were previously excluded based on ability to pay. Is that acceptable that people are jumping the line, not because of severity, but because they have money to do so
?
Your own paper does not list the US has having the shortest wait times (3-8 weeks) compared to other European countries (4-6 weeks).
Still no links. That's what you stupids do. Lots of talking, no evidence.
You know...you can adjust it, right? It's not hard to use a different base year? Since this one uses 2024 dollars, it's incredibly easy. It would be $820 billion. Or $570 billion if the 2020 paper used 2024 dollars. So, the real dollar amount, with FEWER uninsured is an 82.2% higher? Sure.
If you're going to be purposefully simple, you can stub a toe.
Even if you belive their math it would save 1 trillion meaning that is 1 trillion less going to companies that lobby/bribe politicians. And as such it won't happen.
It also doesnt account for the sure backlog that will be caused by everyone using it. Not saying it's ideal, but the number of people with anxiety or a nagging injury who normally just wait and see (to avoid thousands of dollars in diagnostic costs) will flood the hospitals since it's not on their finances. I'm honestly guilty of it myself; before I knew what anxiety was I thought I was having a heart attack and went through weeks of expensive testing (maxed out my deductible).
medicare and Medicaid currently cost the government 9 percent of GDP while only covering half of the population. most european countries spend less than this to covered everyone. you would need massive changes to the entire system to make it work, bolting on Medicare for all by itself is not enough .
Medicare and Medicaid cost a lot because they take on all of the riskiest patients from the population and leave private insurers with only the most profitable. It stands to reason that they would be extremely expensive. Healthcare for only really, really sick and old people is expensive.
the issue is full coverage in Europe is still cheaper than covering half in the usa. im not against Medicare for all, im just saying you need massive changes to entire health care system top to bottom. The USA cannot afford a medicare for all bolt on without massive tax raises, it has 2 trillion in debt added every year. social security will need reform by 2031 as well.
I just don’t know how this would be accomplished. If you suddenly laid off all of the people that work for health insurance companies , you would have high unemployment. Also , you can’t just say to shareholders of these companies.. your stock is worthless. Many employee probably have it in their 401ks . Plus doctors/hospitals wouldn’t know how much they woukd get reimbursed.
Listen I am in favor of universal care . The time to have done it was during the 50-60s when the healthcare industry was relatively small. I just don’t see how fhey could possibly do it practically at this point.
Give me a concrete plan. Details mattered. Who wouldn’t want to save lives and money? But you need to propose a concrete plan so we can get an idea how it will work. I’m on board directionally but I can’t go along with some vague declaration of intent and zero detail.
So if we just had a big and powerful enough government bureaucracy everything would be orders of magnitude better? Step one would need to be some sort of institution that Congress is in no way responsible for, since they are only interested in sound bites, not leadership and certainly not accountability. So I guess it could be modeled on Fannie Mae, because wow that has an ironclad history where everybody wins all of the time.
One of the arguments in favor of Medicare for All is that we already have the bureaucracy—it’s Medicare. Medicare is already enormously popular, especially with the people who are on it now. And as for costs and sustainability, Medicare already handles all of the most expensive and risky patients in the nation. Adding the rest of us to Medicare would just make the system more economical and sustainable, because it would add mostly young and healthy people who pay in and rarely file claims.
At least with the government there can be oversight. With the private sector, which is currently robbing us blind on healthcare, there’s practically nothing we can do
Obamacare was supposed to do that too... instead creating huge windfalls for insurance companies and healthcare companies at Americans' expense longterm. I think we need to look at government policies creating price-insensitive pockets of corruption as a real threat to actual economic outcomes
I’ve argued that M4A would be one of the worst ways to implement healthcare reform in the US. This isn’t an argument in favor of keeping the current system intact, rather that there are better options to be explored and M4A is a low effort attempt. I have theories on why it’s the leading proposal, but there are alternative models there that would be more workable for our distinctives.
First, fraud is absolutely a problem with the system so giving the current infrastructure what amounts to a blank check isn’t going to save money. If you don’t know, costs have spiraled because of what Medicare doesn’t pay to providers and hospitals. So for many of them with elderly populations, the balance of payments to stay open come from private insurance, hence the higher market cost.
Next, without pointing to a small subset of healthcare outcomes to criticize M4A, one does have to recognize the difference in care between urban and rural areas. Admittedly, M4A might produce better outcomes in urbanized areas with higher population density, but in rural ones the costs will be much higher to reach the same number of people. I don’t like the basis of the argument to be that, but there must be an answer given for the situation for proposed reforms. The Canadian system is absolutely horrible at accomplishing this goal despite effectively full funding from the federal acting as a backstop for the provincial. It’s great in the GTA or Vancouver, but 200km outside of those cities is a much different reality.
Excluding the argument of waitlists, it is demonstrated fact that the Canadian system doesn’t provide for all needs in every “less than urban” community, resulting in much worse outcomes despite the lack of financial burden. If you are the subset of the local population with a condition that lacks a specialist in your area, it can be life altering to receive care from the nearest provider. One case in mind is an administrator in a hospital relating to me that there was no cardiac specialist in their area despite world class orthopedics because of their proximity to a ski area. The nearest one for heart patients was a 200km drive.
You might be tempted to say nationalization would solve much of that, like the NHS in the UK, but id point you to the late John Pilger’s work in exposing the privatization measures amounting to bids going to cronies. The result of which was a move towards telemedicine run by a lowest bidder company focused on delivering the cheapest care possible. The NHS also provides no private method for people needing care to escape the system if they wish to seek treatment outside of leaving the country.
Out of all the systems I worked in / around, the Australian and NZ system was the closest I believe to being workable in the US. A safety net with public and private hospitals.
BIG asterisk on the claim that Medicare “underpayment” is why we have ballooning healthcare costs: this is a CLAIM made by lobbyists for healthcare providers, and is not actually a proven fact.
I’m all for it, but how do we manage cost overruns when the average American is obese and doesn’t care to change? Lots of people subsist off of Mountain Dew, Little Debbies, and sedentary lifestyles. Culturally, America is so fucked up. Debt, obesity, and functionally illiterate.
Obese and smokers die early and cost less in the long run as a result. We actually rely on them to keep our costs down. By far the most expensive part of treatment are your later years and these people all die early. There have been a few studies on this.
That old saw about an ounce of prevention ... if we had provided adequate healthcare to begin, we wouldn't have the obesity epidemic we do now. The average American doesn't have adequate physician guidance to safely reduce that weight. It's one thing to have a bunch of social media posts calling you fat vs. your doctor having a personalized discussion with you and then monitoring your progress as you safely lose weight.
>if we had provided adequate healthcare to begin, we wouldn’t have the obesity epidemic we do now
This is a supposition, and one not based on anything. No one is coming away from their doctor having just learned “huh, being fat is unhealthy? I had thought it was the opposite.” Obesity is an issue in every western country, nearly all of which have some form of UHC. It’s not a lack of healthcare availability, it’s a combination of easily available junk food, sedentary lifestyles enabled by driving everywhere, and a lack of willpower to stop yourself from consistently eating more than you should.
I trust physicians vs. Redditors but hey - that's just me. The medical community has long moved on from the "willpower" business.
>Dr. Tirissa J. Reid
>You're absolutely right. It's just now–even in the medical community–that people are becoming more and more aware that losing weight is not just a matter of willpower. It was only actually in 2013 that the American Medical Association first put out a statement saying that obesity is indeed a disease.
Every for-profit corporation involved in American healthcare would try to maintain infinitely increasing profits and lobby for bureaucratic regulations that would justify their existence and enable them to continue price gouging. For every well-intentioned government program, there is a company willing to operate as inefficiently as possible to collect taxpayer dollars.
Our system in America is very broken and unfortunately simply switching our system to Medicare for all won’t eliminate much of the underlying issues that caused prices to get so out of control in the first place.
So you would rather take the chance of dying or a family member over medical bills lol the only people that want this are the same people that want free everything else and bleach off the taxpayer
This argument falls apart when you remember that we still have terrible outcomes despite also having enormously expensive healthcare that doesn’t cover everyone.
Republicans won’t allow this “communism,” like they have in Western European democratic countries that are also capitalist. If anything, they want to reduce Social Security.
We are going to have to do something about Social Security soon. Reserve funds are projected to run out in 6 years. It's not an infinitely sustainable program.
Well, if an under reviewed study asserts it, it must be true.
How about start smaller a city, county or state offering healthcare to its residents? Like actually prove a model rather than a study that took shortcuts and didn’t look at record or third order problems.
And I can see why a white cishet male would think government deciding what and who gets coverage is a good idea. But, for the rest of us, lived experience tells us to be cautious when dealing with a sovereign immune from liability.
the term "medicare for all" is not a good one, because i think many people don't really understand what medicare is. my dad just had to pay $1800 out of pocket for a procedure on his back because medicare didn't cover it. many medicare recipients also have private insurance to supplement their medicare coverage because it's generally not enough.
i'm not sure that's what the "medicare for all" people actually want.
Any time there’s a picture of Bernie and it involves math and dollars, I always laugh. Great guy but I don’t think he knows what to do with money. He’s been a Senator for 4 decades and has sold books and is only worth 2 mil? He’s 84… a middle class person who saves for retirement would be worth more at 84. He can’t budget his own money, why am I going to take economics advice from him?
I don't even want it for all. I want a graduated approach that starts at anyone under 18 and anyone above 65, then every year from there it increases to 18+$n and 65-$n since inception. It takes 24 years for the entire population to be covered and it only fucks millennials, which I figure it's best we keep doing that.
I can only laugh at a self-proclaimed "greatest nation" being unable to provide something invented 200 years ago - and one of the strongest foundations for a functioning society. You cannot credibly call yourself the greatest while abandoning your most vulnerable citizens; at that point, you are a failed state. And when you then gaslight those same people about their reality, the hypocrisy becomes complete.
We are the ONLY developed nation that does not have some form of Universal Health care.
Because we have a for-profit system, where 95% of healthcare net income goes to shareholder payouts, we also spend far more than any other wealthy nation (18% of GDP), while ranking lower in key health outcomes like life expectancy and infant mortality.
Here is a look at preventable deaths, the us is about 2/3 higher than Canada
Not to mention, what's it like specifically for healthcare in the US? There's been reports circulating around that 92% of US adults have delayed or foregone healthcare due to worry about the costs. How many specifically didn't get treatment in the US from that, in addition to being on a waitlist in addition to those who couldn't even afford to try to get healthcare in the first place? Cuz there absolutely is plenty of places with very long waitlists in the US. When I was working in Boston a couple years ago at a hospital, the wait time to see a a pcp as a new patient for two of our new colleagues was over a year long
Decreasing population in developed countries is the quickest way to dismantle social programs such as this or Social Security banking on growing population.
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EconomistWithaD | 3 hours ago
Yes, based on their modelling assumptions, that is what they found. I've written some papers where universal coverage is the most efficient healthcare delivery system, and that the U.S. is highly inefficient in providing care. But these estimates (especially calling them a lower bound) always are a bit fishy. Many "socialized" countries have created systems, over time, to increase payments/competition/open up alternative avenues to access care.
Since it hasn't gone through peer review yet, I'm not sure how much the results will stand up to scrutiny, but reading the paper, here are some questions I would bring up to the authors if providing a referee report.
The US healthcare system, as it currently stands, is untenable. So assessing alternatives needs to be done correctly.
MixtureSpecial8951 | 2 hours ago
This is what the sub should have more of
Thanks!
rad_slut | 2 hours ago
Also, if this affects physician income (hard to see how it wouldn’t tbh), you’d see a lot of physicians who are on the cusp of retirement leave medicine.
The mid career physicians would probably gut it out, but add on multiple years of extra work until they can retire.
Early career physicians and those in medical school currently would be screwed, and you’d have a lot fewer people apply for med school. Probably enough to still fill the classes, but you would lose most of the best and brightest applicants who would pivot to more lucrative private sector careers.
The current medical education system in the US works because of massive delayed gratification - tons of money up front and generally terrible work-life balance for 7+ years (15+ years if you include undergrad and the longer residencies) while making a fraction of a fair market rate, all in the expectation of making the real money when you’re an attending physician.
In the countries with socialized medicine, they make less but have shorter training and super cheap med school. The government would have to figure that out before making the switch unless they want to gut US healthcare.
EconomistWithaD | 2 hours ago
Oh, it will. Dropping to Medicare reimbursement means an increase in volume, but you’ll still see income losses.
And yes, that induces retirements, fewer med school entrants, and reduced hours.
CrayonUpMyNose | 2 hours ago
The two-pronged approach here is to recognize that medical education, like medical care itself, is a public good. We can make sure that new medical graduates aren't looking down the barrel of half a million dollars in debt. Remember free college wasn't affordable at $70 billion for ten years? Somehow spending the same or even more over a few months to attempt a regime change that predictably ended up closing the Strait of Hormuz wasn't a problem.
The massive front-loading of education costs causes a decades-long delay of savings compound interest for those in medical careers who spend the first decade of their careers paying off loans, which then has to be paid back in the form of inflated salary expectations, especially late career. This issue is entirely preventable without damaging doctor lifestyle one bit.
EconomistWithaD | 2 hours ago
Please educate me, with citations, how eliminating medical debt but also creating significant income inequality for new physicians versus established ones will work?
DadBod_DadBike | 2 hours ago
The classic progressive “we just need more” solution on display
SATX_Citizen | an hour ago
You said nothing to challenge the assertion parent comment made.
HumorAccomplished611 | 2 hours ago
> , fewer med school entrants
This seems unlikely. Its pretty much capped all the time. Need to open way more residency spots before that happens
EconomistWithaD | 2 hours ago
Yes, because of the income opportunities. Drop private insurance doctors to Medicare rates, and there are fewer.
HumorAccomplished611 | 2 hours ago
The incomes are still so high this is a non issue. Youd have to cut income by more than 50% before it would begin to be an issue. Not to mention that many try to do it as helping people is its own reward which would replace people only in it for the money for a good while.
You forget that since residency is capped that the output is capped otherwise it would have reach equilibrium with lower wages already.
CBO grading
Who wins and who loses within physician pay specifically — this is the CBO's own language, not a paraphrase of intent: providers whose all-payer weighted-average rate under current law is higher than Medicare's average rates are more likely to face a decrease in their average payment rate under the single-payer system, while providers whose rate is lower than Medicare's average are more likely to see an increase.
Translated to specialty terms:
>Losers: specialists with heavy private-insurance patient mixes and rates well above Medicare — orthopedics, dermatology, plastics, cardiology, radiology, anesthesiology, gastroenterology
>Winners (or flat): primary care, pediatrics, family medicine, and any provider whose current patient mix already leans Medicare/Medicaid-heavy (since their blended current rate is already close to or below Medicare)
so residency where supply > demand get a pay cut and where demand > supply get a pay raise. Looks like a big economic win
EconomistWithaD | 2 hours ago
Yeah. Like I did in my OP, you’re going to need to provide proof.
HumorAccomplished611 | 2 hours ago
Its just basic economics. You dont know where youre supply constrained because we have 51K people apply for 43K residency positions every single year. So already an 8K over supply of people applying. Every single year.
This is a weaker worry than it sounds, for a few reasons:
Residency spots are capped by GME funding (mostly Medicare-funded) and hospital capacity, not by market income signals in the short run — so a rate cut doesn't directly shrink spots.
Applicant demand for residency slots is already vastly oversupplied relative to spots (especially from IMGs and a growing number of US MD/DO grads), so even a meaningful drop in specialty attractiveness wouldn't likely leave positions unfilled overall.
Where you'd see effects is in specialty mix, not fill rate: fewer top students chasing the highest-paying specialties (ortho, derm, plastics) if the pay premium shrinks, and relatively more interest in primary care if it becomes financially competitive. That's arguably a stated goal of M4A advocates, not a bug.
Countries with single-payer systems (Canada, UK, etc.) don't have trouble filling residency/training positions — the U.S. concern is more about total physician supply and geographic maldistribution than a training-pipeline collapse.
EconomistWithaD | 2 hours ago
Thanks. But this Economist, who has done work in the sphere, would like to see the evidence of such "basic economics".
HumorAccomplished611 | 2 hours ago
Go ahead and show it. We are currently in a physician shortage. Not because of salary eh dumbass?
EconEchoes5678 | an hour ago
> The incomes are still so high this is a non issue. Youd have to cut income by more than 50% before it would begin to be an issue.
Completely false. Incomes are high because the opportunity cost for these people (90+ percentile performers) is high. If you drop it, you lower the flow of doctors coming in.
Incomes are also high because doctors are taking on the risk of failure with medical education debt. That risk has to be priced or people won't do it.
> Not to mention that many try to do it as helping people is its own reward which would replace people only in it for the money for a good while.
Economics does not work this way. Those effects exist but they are tiny and a rounding error at these scales.
> You forget that since residency is capped that the output is capped otherwise it would have reach equilibrium with lower wages already.
Residency caps the inflow of new doctors. Nothing caps the outflow of retiring or out-migrating doctors.
/u/EconomistWithaD is 100% correct here. Medicare4all unchanged would be a classic monopsony condition and wages would fall and many hospitals would close. If not done very carefully, wait times become the gatekeeper. Currently Medicare can get away with this to a degree because EMTALA + private insurers forces the rest of the economy to subsidize Medicare/Medicaid costs, to the tune around 100-200 billion dollars a year.
HumorAccomplished611 | an hour ago
> Completely false. Incomes are high because the opportunity cost for these people (90+ percentile performers) is high. If you drop it, you lower the flow of doctors coming in. > >
Believe me the 90% percentile performers are not becoming doctors lol. Those people in the last gen became software engineers getting the same salary on 4 years education with way better hours and way less debt.
>Incomes are also high because doctors are taking on the risk of failure with medical education debt. That risk has to be priced or people won't do it.
Its more along the lines of people deciding whether its worth it on the debt vs increase in income. As you see higher income families go for it because of prestige rather than incme.
>Economics does not work this way. Those effects exist but they are tiny and a rounding error at these scales.
Actually it does as you would see even less teachers if this wasnt the case.
>Residency caps the inflow of new doctors. Nothing caps the outflow of retiring or out-migrating doctors.
And where are they going eh? Some other country with 50% of the income?
>/u/EconomistWithaD is 100% correct here. Medicare4all unchanged would be a classic monopsony condition and wages would fall and many hospitals would close. If not done very carefully, wait times become the gatekeeper. Currently Medicare can get away with this to a degree because EMTALA + private insurers forces the rest of the economy to subsidize Medicare/Medicaid costs, to the tune around 100-200 billion dollars a year.
You mean what we have now with a physician shortage and hospitals closing?
Medicare rates would increase 10-20% and would handle all of those things quite easily. Without the 600 billion profit piggy backing the private insurer does.
https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf
Who wins and who loses within physician pay specifically — this is the CBO's own language, not a paraphrase of intent: providers whose all-payer weighted-average rate under current law is higher than Medicare's average rates are more likely to face a decrease in their average payment rate under the single-payer system, while providers whose rate is lower than Medicare's average are more likely to see an increase.
Translated to specialty terms:
Losers: specialists with heavy private-insurance patient mixes and rates well above Medicare — orthopedics, dermatology, plastics, cardiology, radiology, anesthesiology, gastroenterology
Winners (or flat): primary care, pediatrics, family medicine, and any provider whose current patient mix already leans Medicare/Medicaid-heavy (since their blended current rate is already close to or below Medicare)
so the losers already have supply > demand residency. The winners dont. So then it evens out fufilling all needs.
EconomistWithaD | an hour ago
From your link. Again.
"Furthermore, in this paper, the reduction in payments made to providers..."
i_am_bromega | 2 hours ago
Any M4A program would have to solve for the wild medical debt that we saddle doctors with to start their career in practicing medicine. I have friends who left medical school with ~300k in loans, and they spent basically a decade making nothing. They are super skeptical of any system that’s going to cut their earnings.
Fletch71011 | 2 hours ago
My wife had over $500k. $300k isn't even that crazy. Plenty of my college roommates got over half a million as well but they all get paid 7 figures now or close to it to compensate.
Ambitious_Pilot_205 | an hour ago
It’s not just physicians. Think of pharmacists, PA/NP, PT who also are saddled with 100-200k or even more debt but have 1/4-1/2 of a physician salary
HumorAccomplished611 | 2 hours ago
And 300K is basically 1 years salary. Pretty easily doable.
i_am_bromega | an hour ago
As others have pointed out, for a lot of them it’s more like $500k, and the problem is we’re talking about reducing that compensation. It starts to be a much more risky career path.
Constant-Plant-9378 | 2 hours ago
> In the countries with socialized medicine, they make less but have shorter training and super cheap med school.
No Medicare for All solution is complete without this. There needs to be an option for people to enlist in the National Health Service, where they receive a state-sponsored medical education, and in-return contract to serve a number of years in the public health delivery service.
This would function similar to the GI Bill, only with the education coming first and the service coming afterward. Millions of people with the aptitude for medicine would now be available to enter the profession, not just those who can afford the education. And this could drastically increase the number of available General Practitioners, who could afford to practice in lower income and rural areas because they would not be required to become specialists charging more as required to pay off a million dollar education bill.
(Edit: And nowhere do I hear anyone talking about how nationalized medicine would be the biggest business stimulus program in history - because that massive cost of employer-sponsored healthcare benefits would now be eliminated - but should also be replaced with new business taxes to fund public healthcare otherwise corporations will just take the windfall and add it to executive pay and shareholder returns which they should not be allowed to do)
EconEchoes5678 | an hour ago
> No Medicare for All solution is complete without this. There needs to be an option for people to enlist in the National Health Service, where they receive a state-sponsored medical education, and in-return contract to serve a number of years in the public health delivery service.
This is one approach, but having looked into it, I don't think it's the best solution. You have to look at where the gatekeepers move to and who bears the risk of failures as well as the evasion channels. Foreign systems have major problems currently where their doctors get their degree, paid for by the state, then work the minimum required and leap to a higher paying career in the next easiest location. Australia and NZ pick up doctors from the UK/Nordics/Canada due to recognizing their licensing. In the US, we pick up doctors from India and other developing countries because they have to repeat residency, which is worth it when the pay gap is big enough.
The better design is Australia's: income-contingent loans. The student owes the government, repayment comes out of future income above a threshold, all on a per-account/per-person basis, and if income never materializes the government eats the loss. This splits completion risk correctly - the student bears it when training pays off, the state bears it when it doesn't - and it changes the politics of capacity: seats are easier to expand when students co-finance than when every seat costs the government the full amount with full risks of failure.
> This would function similar to the GI Bill, only with the education coming first and the service coming afterward.
This doesn't work because people can move and leave and you cannot force them to stay. Similarly, the gatekeeper still exists - UHC governments with free education have immensely difficult testing to qualify for the channel (remember, government has the risk of failure so they must). This testing is more difficult and strenuous than necessary and likely deters some people who otherwise would successfully complete the programs (I.e., you can't ever predict perfectly, and whoever is taking the risk has to set the parameters to minimize losses).
Also the very rigid structure of their education paths reduces innovation because the system can't reward anyone who breaks off the rails. So Bill Gates would never have dropped out of Harvard to start Microsoft, which is a small anecdotal example but a real measurable phenomenon. Here again the Australian system wins - it keeps both channels intact and optimizes the flow because individuals can judge their abilities and dedication themselves rather than test hurdles forcibly disqualifying anyone close to the bar.
Constant-Plant-9378 | 14 minutes ago
Good comment!
Swoly_Deadlift | 2 hours ago
Kinda ridiculous that healthcare worker pay is always the first thing to get attacked when hospital profit margins are hurt. There are so many pointless middlemen getting their fingers in the pie that have no reason to exist, but for some reason it’s physician salary that gets targeted when it’s time to save money and not the price-gouging corporations.
Substantial-Ad-8575 | 2 hours ago
Middle man account for less than 4% of overall private insurance spending. That’s why there is not more concern. Yeah, that little.
Swoly_Deadlift | 2 hours ago
Insurance company profit margins, hospitals overcharging for procedures so they can “negotiate” with insurance companies, and the bureaucratic costs associated with having a handoff between healthcare providers and insurance companies account for way more than 4% of healthcare costs, and all of it is completely unnecessary spending. None of it benefits patients in any way.
EconEchoes5678 | 54 minutes ago
> Insurance company profit margins,
You need to get informed before you go spewing stuff. Insurance company profit margins are small and are much smaller than most industries. They're on par with or lower than regulated utilities, but with far, far higher risk factors.
> hospitals overcharging for procedures so they can “negotiate” with insurance companies,
Hospital profit margins are also small, still not above what normal companies are able to return on investments.
> and the bureaucratic costs associated with having a handoff between healthcare providers and insurance companies account for way more than 4% of healthcare costs,
This cost is huge. It's not profits, and it's a result of us forcing insurance companies to be the gatekeeper. If you want to fix this, insurance companies can't be the gatekeeper of care, but that doesn't mean we don't need a gatekeeper of care (every system must have one or the system explodes).
> and all of it is completely unnecessary spending. None of it benefits patients in any way.
It's not unncessary. It's just inefficient because insurers are not good gatekeepers. The gatekeeper has to be moved, but it can't be ignored.
EconEchoes5678 | 52 minutes ago
> There are so many pointless middlemen getting their fingers in the pie that have no reason to exist, but for some reason it’s physician salary that gets targeted when it’s time to save money and not the price-gouging corporations.
You only think they have no reason to exist because you don't understand how the system works.
Insurance companies are a bad gatekeeper. Yes, agreed. But having no gatekeeper is not an option in any system, so we have to move the gatekeeper role.
Physician salaries are very large and much larger than UHC systems, so it's still worth talking about, but it is not the primary source of the problem.
Substantial-Ad-8575 | 2 hours ago
All of our doctors will opt out of UHC. So would need to find new GP, Mental Health, Cancer and Joint Specialists. Ouch.
EconEchoes5678 | an hour ago
Not possible. This is a classic monopsony situation. Wages and returns to investment (and therefore future investment) will fall. However, what will happen is doctors will exit the markets and wait times will become the new gatekeeper, plus some losses in the quality channel.
_THEWATERB0Y_ | 2 hours ago
Doctors in America make $500k, while they make around $200k in other western countries. Cry me a river if they have to take a small pay cut. They will still be handsomely paid.
imasleuth4truth2 | an hour ago
Cardiologists make 500K. Pediatricians make less than 200k.
dfsw | 2 hours ago
Sweet mother an actual economic driven post in economics, bless you.
ShdwWzrdMnyGngg | 3 hours ago
People not super familiar with the healthcare system would be very confused why healthcare for all would SAVE us money.
But when you see how much extra every company charges us for services, it becomes obvious. The act of giving everyone healthcare isn't what saves the money. It's FINALLY regulating things to make sure a aspirin doesn't cost tax payers 83 dollars per pill.
Sanhen | 3 hours ago
I’m trying to think of how it can be sold to the American people to make it palatable because I don’t think Americans need to be convinced that the current system is bad, but they are reluctant to believe in the viability of an alternative. To your point: Perhaps if it was framed in terms of ending corruption and corporate waste? Then it doesn’t become about increasing costs, it ideally becomes about efficiency in their minds.
I think, though, in the same way that Republicans have successfully sold a segment of the American electorate on the idea that Government doesn’t solve problems, it is the problem, there would need to be an effort to sell people on the idea that unregulated capitalism isn’t a cure-all for all situations.
Gamer_Grease | 2 hours ago
I think we should sell it as shoring up Medicare for the elderly by adding lots of young people who will pay in but not file claims. Medicare is massively popular among the elderly, so talking about it like it will fail unless we expand it is probably a decent line of attack.
EconEchoes5678 | 46 minutes ago
> I’m trying to think of how it can be sold to the American people to make it palatable because I don’t think Americans need to be convinced that the current system is bad, but they are reluctant to believe in the viability of an alternative.
I've been trying to say this for months. The key part to sell to the american people is a better understanding of the problem.
The problem with the American healthcare system is the gatekeeper is in the wrong place. All healthcare systems, everywhere, have a gatekeeper, because otherwise the systems explode.
Insurers are our gatekeeper. They are a very bad gatekeeper because every claim becomes a dispute channel and loops through claim-deny-appeal until it routes through the system or the claimant gives up. All of that is bad, but it's not actually the insurers fault - they MUST do this because they are the only ones keeping the system demand from exploding.
The right thing to do is to let insurers remain as logistics solvers and pricing coordinators, with as much price passthrough pressure as possible, but not to make them the gatekeeper of care decisions. Doctors can't do that either because they don't pay the bills, the system would explode. It has to be at a higher level. I've worked a lot on a system design to solve this, but it's hard to get anyone informed to listen and I only have so much effort to throw at it.
ShdwWzrdMnyGngg | 2 hours ago
Bernie just found it. Tax dollars saved. Right now the victory goes to whoever can cut spending. Republicans were specifically put in office to do that. They failed miserably.
Substantial-Ad-8575 | 2 hours ago
Hmm, then why does Bernie also admit, taxes will go up. m4A will not be a huge money saver.
Seriously, UHC will not save much costs. Yes, will save on prescription drugs and admin costs. But now more patients to see and Medicare/Medicaid rates will have to go up. So savings will be taken by other increased costs.
Plus this report? Not even peer reviewed. And early reviews show inaccurate data and some mistruths…
EconEchoes5678 | 41 minutes ago
> Hmm, then why does Bernie also admit, taxes will go up. m4A will not be a huge money saver.
It would be better than what we have now.
It's not a great system - wait times will explode and taxes will rise substantially - but the total costs of a single-payer system are less than what we pay today. It would only be better than our current system because our current system is so bad.
Substantial-Ad-8575 | 2 hours ago
Biggest hurdle? Taxes.
So income tax rates, would need a jump up.
Then new payroll taxes at business/individual. Business tax replaces private insurance costs.
Next will be a VAT, typically 20%-25%. Of if no VAT, raise individual income tax rates instead.
*****
So for average income earners? Will see new taxes. And if they do not use much healthcare, they may be concerned about losing more income to taxes.
For families/individuals earning $200k? Yeah they will take a hit. And why they support status quo or German UHC model that keeps private insurance and starts UHC.
elleandbea | 2 hours ago
So what i am hearing is, tax the rich and tax the ungodly rich ??? No more tax havens. No more dumping our tax dollars into companies like tesla without a financial return back to the people. No more wars. No more funding bombs dropped on little girls.
We have the money. We always had the money.
I am tired of playing games trying to figure out how to get my patients what they need. It creates a moral injury there is no bandage to cover, or treatment to heal it. Its painful and crushing.
EconEchoes5678 | 42 minutes ago
> So what i am hearing is, tax the rich and tax the ungodly rich ???
This isn't even remotely close to being able to close the gap, and comes with substantial deadweight losses affecting the median citizen in the end.
> We have the money. We always had the money.
We don't have anywhere near enough for this. We can raise it, but the system needs to be made efficient and the problems need to be understood and then solved.
> I am tired of playing games trying to figure out how to get my patients what they need. It creates a moral injury there is no bandage to cover, or treatment to heal it. Its painful and crushing.
You are 100% correct and I'm sorry. The problem is the system keeps shoving off the problems onto someone else instead of breaking down and actually piecing out the problems to be actually solved. That means insurers become the gatekeepers of care, and doctors become the pawn to fight against their gatekeeping. It's all wrong because the structure of it is wrong.
Gamer_Grease | 2 hours ago
It’s also fundamental to how insurance works. Insurance pools risk in order to cover everyone and turn a profit. You balance the risky patients with less risky patients. The problem with our system is that the government takes on all of the most risky patients, and leaves the least risky to private insurers.
From the get-go it’s easy to understand that this system makes no sense at all, and eliminating the government’s role is not a sensible solution either.
Willing_Activity_855 | 2 hours ago
except in real insurance companies are allowed to hedge risk. Fat, smoke, drink companies would be allowed to 1 find out 2 charge you more.
Which is how it should work. If you're a dipshit you should pay more.
Gamer_Grease | 2 hours ago
But, since we’re on an economics forum, we have to reckon with what that looks like on a large scale: most of us not having health insurance because it’s too expensive. Then, correspondingly, many more providers shutting down completely because they don’t have paying customers. So a general degradation of our healthcare system.
Is that really better than pooling everyone in one big insurance program?
Willing_Activity_855 | 2 hours ago
in switzerland they manage it.
They dont even have medicaid or anything like it for old people, it's all private sector, but you're mandated to buy it.
So mandate people buy it and have insurance companies charge more for overweight/smoking/drinking. Politically its easier to allow insurance companies to charge the willfully unhealthy more than say taxing them.
If you tax unhealthy behavior and reward healthy behavior you'll get end up benefiting society as a whole.
i_am_bromega | 2 hours ago
Why not both? Everyone in one big program and those that smoke, etc. also pay more into said program since they will require more in services.
Gamer_Grease | 2 hours ago
I would be willing to consider it, so long as we first get M4A.
EconEchoes5678 | 30 minutes ago
> It’s also fundamental to how insurance works. Insurance pools risk in order to cover everyone and turn a profit. You balance the risky patients with less risky patients. The problem with our system is that the government takes on all of the most risky patients, and leaves the least risky to private insurers.
This is not actually the real problem. Yes it's an accurate description, but if what you were describing were actually the case then insurer profits would be much higher. Insurer profits ae less than typical regulated monopolies, even though they have substantially more risk.
What ends up happening is that Medicare (combined with the EMTALA channel requirements and some other pressures) must be accepted but underpays for procedures. The cost gaps end up dumped back onto the private insurers. So they're still paying, it's just indirect.
It's not a good system. A better system by far would be to understand the full problem and move the gatekeeper of care - Insurers are not a good choice for gatekeeping care.
Ok_Culture_3621 | 2 hours ago
The best idea I heard in the Obama Care debates was a federal charter system (based on the Fed model) that would allow private insurers to bypass the complicated state-by-state regulatory model and submit to a single national regulatory scheme. Something like that could give the regulatory body ample leverage to reign in the completely out of control pricing systems between insurers and providers that’s the real source of our completely whacky health costs.
Wrenchinspokesby | 2 hours ago
If 100% of patient panels reimbursed at Medicare rates you would have a wave of hospital / practice bankruptcies and retirements on day 1.
Health providers that are well capitalized to survive this are likely PE backed and therefore highly incentivized and organized to milk every dollar of Medicare claims they can.
I don’t see how the amount of Medicare fraud bureaucracy that will need to be built will not rival current health insurer overhead.
Gamer_Grease | 2 hours ago
They could implement some cost control internally, because institutions built on unknowable but unlimited costs are not sustainable under any circumstances.
Medicare is already absolutely enormous, and the current users of the program would continue to use the great majority of its resources, so very little additional investigative overhead would be needed. You can milk Medicare as much now as you could under M4A, because Medicare is making most of the payments already.
Wrenchinspokesby | 2 hours ago
How would M4A not result in an enormous increase in claims and usage flowing through Medicare? Every claim flowing through commercial insurance currently would now be flowing through CMS. Plus there would be an obvious uptick in usage.
Gamer_Grease | 2 hours ago
There would be an increase, but Medicare is gigantic already because all of the nation’s most expensive patients are already on it, and using it constantly. Adding a bunch of much healthier people to the program is going to make it more economical, not less.
Smoking and overeating and drinking all make you very unhealthy, but not as unhealthy as your average 65+ year-old.
Wrenchinspokesby | 2 hours ago
Fair enough on overall costs. But I still think the increase in transaction volume will be substantial, which is what results in increased need for anti fraud bureaucracy.
I worked for a national primary care chain, and while Medicare patients had much higher usage on a n=1 level than commercial patients, it was offset by there being simply so many more people under 65 (around 70-80% of patients). Total usage when you factor in patients x volume per patient ended up being close to 50/50.
With then revenue being even more skewed to non Medicare due to commercial reimbursement rates.
EconEchoes5678 | 13 minutes ago
> There would be an increase, but Medicare is gigantic already because all of the nation’s most expensive patients are already on it, and using it constantly. Adding a bunch of much healthier people to the program is going to make it more economical, not less.
The problem that /u/Wrenchinspokesby is getting at is that medicare is underpaying for procedure costs. Medicare can get away with that because of a combination of small regional pressures and EMTALA rules force providers that would normally drop Medicare to keep accepting it. The costs get subsidized by the private industry.
If you switch to M4A, you have created a monopsony condition and wages and ROI's would drop, which would drive a wave of retirement and outmigration from doctors and hospital closures. Wait times would become the new gatekeeper of care instead of insurance denials. The problem would be nearly unsolvable for medicare.
It's still a better system than what we have today, but that's because our system today is so bad. The Swiss system is much, much better than M4A for example, though it still has problems.
DasFunke | 3 hours ago
Just if you eliminate profit from insurance companies that’s hundreds of billions saved.
Substantial-Ad-8575 | 2 hours ago
No, it’s about 4-6% of overall healthcare spending. That’s it, 4-6%. Not a huge number.
Worth-Lead-5944 | 2 hours ago
Not really. You're forgetting all the money spent generating that profit that also wouldn't have to be spent if there's no profit incentive. The money spent on advertising to tell people to go to your urgent care vs the closest one in an emergency for example.
EconEchoes5678 | 17 minutes ago
> The money spent on advertising to tell people to go to your urgent care vs the closest one in an emergency for example.
This is smaller than a rounding error.
> Not really. You're forgetting all the money spent generating that profit that also wouldn't have to be spent if there's no profit incentive.
You just don't understand the system or the real problem.
The problem isn't that insurance companies make and spend money. The problem is that we require insurance companies the be the gatekeepers of care. Every system has a gatekeeper of care or the system explodes. For us that's the insurance companies.
But they're very bad at that role. We get stuck in the claim-denial-appeal loops and that's where the biggest waste of money goes. It's not going into profits or whatever you think they're losing money on, it's on the administrative costs of trying to gatekeep care. But you can't get rid of denials either - every system has a gatekeeper or the system explodes. We have to move the gatekeeper of care to fix the problem. /u/Substantial-Ad-8575 is correct - the profits are not the source of the problems, and if you slash the miniscule profit margins they have, you slash investment and competition, neither of which helps the problem in the long run.
mottledmussel | an hour ago
MLR is already capped for insurance in the US.
Willing_Activity_855 | 2 hours ago
that what switzerland does, universal healtcare but entirely through private sector non profit insurance.
Swoly_Deadlift | 2 hours ago
Non-profits in America hardly function like non-profits. MBA culture has caused corporate greed to leak into everything.
DeArgonaut | 2 hours ago
Didn't the US used to have non-profit insurance until reagan came along?
Willing_Activity_855 | 2 hours ago
by law? No
But yeah if you want to start one feel free, there's still some.
EconEchoes5678 | 16 minutes ago
We still have tons of non-profit insurers. They charge similar rates to for-profit insurers, generally less than an 8% difference. Insurer profit margins are small, less than what regulated utilities get, but with far higher risk.
Momoselfie | 2 hours ago
Saving companies millions in medical costs as well. They should advertise it like that for Republicans who only care about corporations.
DeArgonaut | 2 hours ago
Well it does also help to get everyone treated too. There's a lot of economic loss from people being unhealthy
Substantial-Ad-8575 | 2 hours ago
For private insurance? Middle man/Admin only accounts for 4% of overall spending. So it is a concern, just not a big money issue…
EconomistWithaD | 3 hours ago
Saves money in many areas, raises costs in others.
Net savings, however.
EconEchoes5678 | 50 minutes ago
> But when you see how much extra every company charges us for services, it becomes obvious. The act of giving everyone healthcare isn't what saves the money. It's FINALLY regulating things to make sure a aspirin doesn't cost tax payers 83 dollars per pill.
The way that Medicare4all saves money is by establishing a monopsony condition driving down doctors and Medical investment ROI's, and the limiter will be split between long wait times and the quality limitations established by Medicare's rules (which are nowhere near complete enough to run a whole healthcare system's gatekeeping).
Gamer_Grease | 2 hours ago
Great comment. It seems like switching to M4A will save a chunk of change and improve healthcare outcomes on average. But claims about how much for either are much shakier. That kind of makes sense to me, since we’re talking about an enormously complex system, but it should be hard to make bold claims about it.
Due_Satisfaction2167 | 2 hours ago
Sometimes you have to accept a little imprecision in the numbers to get forward movement politically.
Suppose it only ends up saving $871 billion a year. That’s not a trillion a year—but it’s more than close enough that the point being made still stands. Would we be willing to throw out the proposal and keep lighting $871 billion a year on fire just because it isn’t quite what one proponent promised?
There comes a point where your cost analysis has to be treated as having a degree of uncertainty to it and that you’re generally going to trend on the right direction strongly enough to justify the change in policy. But… good luck getting that through the noise of public debate if you don’t streamline the statements and promises somewhat.
i_am_bromega | 2 hours ago
No, the cost analysis should be accurate and honest.
Due_Satisfaction2167 | 2 hours ago
Okay. Most people would characterize a policy that was originally estimated off the cuff in a public statement by a politician to save “a trillion dollars a year”, actually only saving $871 billion a year as “accurate enough,” I think.
Certainly not off by enough that most reasonable people would characterize that as a purposeful lie to misrepresent costs.
i_am_bromega | 2 hours ago
I’m aware that politicians will stretch the truth or outright lie to get elected. This discussion is about the actual cost analysis and how they got the numbers that politicians turn into slogans.
EconomistWithaD | 2 hours ago
True universal coverage and a consolidated public option are going to be major savers.
Gamer_Grease | 2 hours ago
Sane risk-pooling in the health insurance system would also be a major cost-saver. It’s kind of ridiculous at this point to be calling health insurance “insurance” when it doesn’t behave like an insurance product in any way other than in its paperwork.
Fletch71011 | 2 hours ago
Since you seem to be an expert on the subject, can you tell us about wait times? That's my biggest issue. I was diagnosed and under the knife in 8 hrs in the US for a complex spine issue. $500k surgery, I paid nothing.
Under the Canadian or UK system, the wait time would have been 1.5 to 2.5 years and I would have killed myself long before getting the surgery. I was also at a high risk of permanent paralysis, but since it technically wouldn't kill me, I get put way behind in the queue.
What have you found in regards to that? Because I'd rather be in a system where I can at least pay and get the treatment than it not be an option entirely.
EconomistWithaD | 2 hours ago
So, because of differences and definitions across the OECD, it’s pretty hard to find wait times for anything but really broad-based stuff.
However, US patients see around mean/median for GP or RN, while below average/median for specialist.
Figure 5.13
https://www.oecd.org/en/publications/2025/11/health-at-a-glance-2025_a894f72e/full-report/waiting-times_3a1021fa.html
Fletch71011 | 2 hours ago
Thanks. For spine stuff, it seems like all the best doctors in the world come to the US so they can charge whatever they want, so you don't see as many neurosurgeons, especially top ones, in universal systems, and because these conditions technically don't usually kill you but are about the most painful experiences ever, the universal systems don't prioritize them.
If I was in another country I would have had to come to the US and pay God knows what out of pocket to get it done. My fear is that option goes away entirely if the US goes universal. There isn't much reason to be a neuro and go through that insane residency without large financial incentives. The best neurosurgeons in the world at Hospital for Special Surgery in NYC for example don't take any insurance at all.
EconomistWithaD | 2 hours ago
Medical tourism to the US for the rich is a thing.
Wrenchinspokesby | 2 hours ago
Anyone with decent health insurance now, and who is even a 75th percentile earner will be worse off financially, and with access to care. There will be less novel treatments developed without the massive profit motive afforded to private investment. That’s the reality.
There will be some benefits too - decoupling insurance from employment, less risk of catastrophic financial impact from getting really sick.
And the moral imperative, is certainly fair enough. But it’s ridiculous how much this is glossed over.
Xdddxddddddxxxdxd | an hour ago
I do not understand why people are “Medicare for all” or nothing. What’s wrong with a public option?
EconomistWithaD | an hour ago
People parrot what populists say, without critical thinking.
Most people championing M4A have never actually worked with (or been) a Medicare patient.
It exists, so it's "easier" to build off of, for some.
-JustJoel- | 2 hours ago
These are tired points that have been refuted again and again.
?
EconomistWithaD | 2 hours ago
Wrong. And bold to assert I am when you have provided no proof. None.
Most of this sounds like you didn’t read what I posted.
Certainly didn’t read all of the links.
Edit: point 1. You realize they use inflation adjusted dollars? Understand real versus nominal before you start to speak like an ass.
-JustJoel- | an hour ago
Please show where the 2026 study uses inflation adjusted 2017 dollars like the study did in 2020.
I read your bs - it’s the same talking points used for over a decade. They’re tired. And wrong. And you should be ashamed.
EconomistWithaD | an hour ago
If you're going to be purposefully simple, you can stub a toe.
psychmancer | 2 hours ago
Even if you belive their math it would save 1 trillion meaning that is 1 trillion less going to companies that lobby/bribe politicians. And as such it won't happen.
Datdawgydawg | 2 hours ago
It also doesnt account for the sure backlog that will be caused by everyone using it. Not saying it's ideal, but the number of people with anxiety or a nagging injury who normally just wait and see (to avoid thousands of dollars in diagnostic costs) will flood the hospitals since it's not on their finances. I'm honestly guilty of it myself; before I knew what anxiety was I thought I was having a heart attack and went through weeks of expensive testing (maxed out my deductible).
SpawningPoolsMinis | an hour ago
"we can't have affordable healthcare because people might use it and improve their life!"
fkn americans
schacks | 2 hours ago
As a Dane living in a social democracy with a very high degree of societal trust it hard to imagine anything remotely similar happening in the US.
Flamingturac | 2 hours ago
medicare and Medicaid currently cost the government 9 percent of GDP while only covering half of the population. most european countries spend less than this to covered everyone. you would need massive changes to the entire system to make it work, bolting on Medicare for all by itself is not enough .
Gamer_Grease | an hour ago
Medicare and Medicaid cost a lot because they take on all of the riskiest patients from the population and leave private insurers with only the most profitable. It stands to reason that they would be extremely expensive. Healthcare for only really, really sick and old people is expensive.
Flamingturac | an hour ago
the issue is full coverage in Europe is still cheaper than covering half in the usa. im not against Medicare for all, im just saying you need massive changes to entire health care system top to bottom. The USA cannot afford a medicare for all bolt on without massive tax raises, it has 2 trillion in debt added every year. social security will need reform by 2031 as well.
Gamer_Grease | an hour ago
It’s no “half” in the USA, it’s the great majority, because Medicare patients consume more care than anyone else in the nation.
We would definitely get a big tax hike. Most likely some portion of everyone’s premiums would shift over to taxes.
pittguy578 | an hour ago
I just don’t know how this would be accomplished. If you suddenly laid off all of the people that work for health insurance companies , you would have high unemployment. Also , you can’t just say to shareholders of these companies.. your stock is worthless. Many employee probably have it in their 401ks . Plus doctors/hospitals wouldn’t know how much they woukd get reimbursed.
Listen I am in favor of universal care . The time to have done it was during the 50-60s when the healthcare industry was relatively small. I just don’t see how fhey could possibly do it practically at this point.
_ii_ | 2 hours ago
Give me a concrete plan. Details mattered. Who wouldn’t want to save lives and money? But you need to propose a concrete plan so we can get an idea how it will work. I’m on board directionally but I can’t go along with some vague declaration of intent and zero detail.
Distinct-Response907 | 3 hours ago
So if we just had a big and powerful enough government bureaucracy everything would be orders of magnitude better? Step one would need to be some sort of institution that Congress is in no way responsible for, since they are only interested in sound bites, not leadership and certainly not accountability. So I guess it could be modeled on Fannie Mae, because wow that has an ironclad history where everybody wins all of the time.
Gamer_Grease | 2 hours ago
One of the arguments in favor of Medicare for All is that we already have the bureaucracy—it’s Medicare. Medicare is already enormously popular, especially with the people who are on it now. And as for costs and sustainability, Medicare already handles all of the most expensive and risky patients in the nation. Adding the rest of us to Medicare would just make the system more economical and sustainable, because it would add mostly young and healthy people who pay in and rarely file claims.
snowtax | 3 hours ago
Government is as good or bad as the people that we elect to office. If you don’t like government, vote better.
fredinNH | 2 hours ago
At least with the government there can be oversight. With the private sector, which is currently robbing us blind on healthcare, there’s practically nothing we can do
No_Presentation9490 | 2 hours ago
Obamacare was supposed to do that too... instead creating huge windfalls for insurance companies and healthcare companies at Americans' expense longterm. I think we need to look at government policies creating price-insensitive pockets of corruption as a real threat to actual economic outcomes
oldsmoBuick67 | 2 hours ago
I’ve argued that M4A would be one of the worst ways to implement healthcare reform in the US. This isn’t an argument in favor of keeping the current system intact, rather that there are better options to be explored and M4A is a low effort attempt. I have theories on why it’s the leading proposal, but there are alternative models there that would be more workable for our distinctives.
First, fraud is absolutely a problem with the system so giving the current infrastructure what amounts to a blank check isn’t going to save money. If you don’t know, costs have spiraled because of what Medicare doesn’t pay to providers and hospitals. So for many of them with elderly populations, the balance of payments to stay open come from private insurance, hence the higher market cost.
Next, without pointing to a small subset of healthcare outcomes to criticize M4A, one does have to recognize the difference in care between urban and rural areas. Admittedly, M4A might produce better outcomes in urbanized areas with higher population density, but in rural ones the costs will be much higher to reach the same number of people. I don’t like the basis of the argument to be that, but there must be an answer given for the situation for proposed reforms. The Canadian system is absolutely horrible at accomplishing this goal despite effectively full funding from the federal acting as a backstop for the provincial. It’s great in the GTA or Vancouver, but 200km outside of those cities is a much different reality.
Excluding the argument of waitlists, it is demonstrated fact that the Canadian system doesn’t provide for all needs in every “less than urban” community, resulting in much worse outcomes despite the lack of financial burden. If you are the subset of the local population with a condition that lacks a specialist in your area, it can be life altering to receive care from the nearest provider. One case in mind is an administrator in a hospital relating to me that there was no cardiac specialist in their area despite world class orthopedics because of their proximity to a ski area. The nearest one for heart patients was a 200km drive.
You might be tempted to say nationalization would solve much of that, like the NHS in the UK, but id point you to the late John Pilger’s work in exposing the privatization measures amounting to bids going to cronies. The result of which was a move towards telemedicine run by a lowest bidder company focused on delivering the cheapest care possible. The NHS also provides no private method for people needing care to escape the system if they wish to seek treatment outside of leaving the country.
Out of all the systems I worked in / around, the Australian and NZ system was the closest I believe to being workable in the US. A safety net with public and private hospitals.
Gamer_Grease | an hour ago
BIG asterisk on the claim that Medicare “underpayment” is why we have ballooning healthcare costs: this is a CLAIM made by lobbyists for healthcare providers, and is not actually a proven fact.
anonymousasu | 2 hours ago
I’m all for it, but how do we manage cost overruns when the average American is obese and doesn’t care to change? Lots of people subsist off of Mountain Dew, Little Debbies, and sedentary lifestyles. Culturally, America is so fucked up. Debt, obesity, and functionally illiterate.
Swoly_Deadlift | 2 hours ago
We tried to remove junk food from food stamps and lobbyists from Walmart and Coca Cola convinced Americans that it would be racist.
RoosterCogburn_1983 | 2 hours ago
No one is ever going to put a system into place that requires people to change their behavior or take personal responsibility.
Gamer_Grease | 2 hours ago
How does Medicare currently manage cost overruns when almost all of its customers are extremely unhealthy and high-risk?
Fletch71011 | 2 hours ago
Obese and smokers die early and cost less in the long run as a result. We actually rely on them to keep our costs down. By far the most expensive part of treatment are your later years and these people all die early. There have been a few studies on this.
strabosassistant | 2 hours ago
That old saw about an ounce of prevention ... if we had provided adequate healthcare to begin, we wouldn't have the obesity epidemic we do now. The average American doesn't have adequate physician guidance to safely reduce that weight. It's one thing to have a bunch of social media posts calling you fat vs. your doctor having a personalized discussion with you and then monitoring your progress as you safely lose weight.
BitingSatyr | 2 hours ago
>if we had provided adequate healthcare to begin, we wouldn’t have the obesity epidemic we do now
This is a supposition, and one not based on anything. No one is coming away from their doctor having just learned “huh, being fat is unhealthy? I had thought it was the opposite.” Obesity is an issue in every western country, nearly all of which have some form of UHC. It’s not a lack of healthcare availability, it’s a combination of easily available junk food, sedentary lifestyles enabled by driving everywhere, and a lack of willpower to stop yourself from consistently eating more than you should.
strabosassistant | 2 hours ago
I trust physicians vs. Redditors but hey - that's just me. The medical community has long moved on from the "willpower" business.
>Dr. Tirissa J. Reid
>You're absolutely right. It's just now–even in the medical community–that people are becoming more and more aware that losing weight is not just a matter of willpower. It was only actually in 2013 that the American Medical Association first put out a statement saying that obesity is indeed a disease.
>https://columbiasurgery.org/news/more-willpower-obesity-s-many-causes-factors
https://pmc.ncbi.nlm.nih.gov/articles/PMC4229150/
PineBNorth85 | 2 hours ago
Take it out of defence.
iL3nnox | 2 hours ago
Your taxes will be heat higher and your going to wait 9-12 to see a specialist. My aunt almost died waiting for a doctor in Canada. Nobody wants this
Swoly_Deadlift | 2 hours ago
Switzerland has universal healthcare that’s cheaper than America and has lower wait times.
angrysquirrel777 | an hour ago
What would you say would be the downsides if the US just straight up copied every single thing about Switzerlands set up?
Swoly_Deadlift | an hour ago
Every for-profit corporation involved in American healthcare would try to maintain infinitely increasing profits and lobby for bureaucratic regulations that would justify their existence and enable them to continue price gouging. For every well-intentioned government program, there is a company willing to operate as inefficiently as possible to collect taxpayer dollars.
Our system in America is very broken and unfortunately simply switching our system to Medicare for all won’t eliminate much of the underlying issues that caused prices to get so out of control in the first place.
cscholl20 | an hour ago
The wait to see a dermatologist is already several months under the current system, then we get screwed on billing for the privilege.
As far as taxes go, we're already paying premiums, so why not redirect those to an entity without a profit motive?
notfromhere23 | an hour ago
The higher taxes argument is a misnomer.
Most Americans spend crazy amounts on insurance policies that are far higher than any taxation would be.
Chipay | 2 hours ago
https://en.wikipedia.org/wiki/False_dilemma
PineBNorth85 | 2 hours ago
Ill take it over medical bankruptcy which is unheard of in the rest of the western world.
The US is trillions in debt. The taxes should go up either way. Sooner or later itll come due.
iL3nnox | 2 hours ago
So you would rather take the chance of dying or a family member over medical bills lol the only people that want this are the same people that want free everything else and bleach off the taxpayer
Mitherhobo | 2 hours ago
There's already a risk of dying in the American system due to waiting for care or being unable to afford it outright.
Gamer_Grease | an hour ago
This argument falls apart when you remember that we still have terrible outcomes despite also having enormously expensive healthcare that doesn’t cover everyone.
Ketaskooter | an hour ago
I have an uncle that lost a leg because of the wait to see a doctor, it already happens in the states.
KoseteBamse | 3 hours ago
Republicans won’t allow this “communism,” like they have in Western European democratic countries that are also capitalist. If anything, they want to reduce Social Security.
Willing_Activity_855 | 2 hours ago
most western europeans dont use single payer though.
Fletch71011 | 2 hours ago
We are going to have to do something about Social Security soon. Reserve funds are projected to run out in 6 years. It's not an infinitely sustainable program.
ericbythebay | an hour ago
Well, if an under reviewed study asserts it, it must be true.
How about start smaller a city, county or state offering healthcare to its residents? Like actually prove a model rather than a study that took shortcuts and didn’t look at record or third order problems.
And I can see why a white cishet male would think government deciding what and who gets coverage is a good idea. But, for the rest of us, lived experience tells us to be cautious when dealing with a sovereign immune from liability.
JackDostoevsky | an hour ago
the term "medicare for all" is not a good one, because i think many people don't really understand what medicare is. my dad just had to pay $1800 out of pocket for a procedure on his back because medicare didn't cover it. many medicare recipients also have private insurance to supplement their medicare coverage because it's generally not enough.
i'm not sure that's what the "medicare for all" people actually want.
Sweaty_Assignment_90 | 2 hours ago
Now is the time to talk about it, then get your butts to the polls and MAYBE it will happen.
But prob wont because less people get rich off of that system.
JackieDaytona77 | 3 hours ago
Any time there’s a picture of Bernie and it involves math and dollars, I always laugh. Great guy but I don’t think he knows what to do with money. He’s been a Senator for 4 decades and has sold books and is only worth 2 mil? He’s 84… a middle class person who saves for retirement would be worth more at 84. He can’t budget his own money, why am I going to take economics advice from him?
muskthecheeto | 3 hours ago
Serious ? 😂😂😂
JackieDaytona77 | 3 hours ago
Super Cereal
ThePensiveE | 3 hours ago
Perhaps he is motivated by something other than money? Doing good for society?
He's living a comfortable life without being awful to others which I guess is antithetical to some worldviews.
In the ideal MAGA world he would've had all his neighbors deported and just stolen their property.
cscholl20 | an hour ago
Congrats on the worst argument I've ever seen against single payer healthcare
PalatinusG1 | 2 hours ago
God you're stupid.
Easik | 2 hours ago
I don't even want it for all. I want a graduated approach that starts at anyone under 18 and anyone above 65, then every year from there it increases to 18+$n and 65-$n since inception. It takes 24 years for the entire population to be covered and it only fucks millennials, which I figure it's best we keep doing that.
Rich_Arm322 | an hour ago
I can only laugh at a self-proclaimed "greatest nation" being unable to provide something invented 200 years ago - and one of the strongest foundations for a functioning society. You cannot credibly call yourself the greatest while abandoning your most vulnerable citizens; at that point, you are a failed state. And when you then gaslight those same people about their reality, the hypocrisy becomes complete.
Geigengiger | an hour ago
Noone wants an army of senile care patients. Europe is stricken with demographic problems for the next three decades.
Unless people can afford it privately, it is not wished for Americans to live longer than necessary.
DiligentAd7956 | 2 hours ago
We are the ONLY developed nation that does not have some form of Universal Health care.
Because we have a for-profit system, where 95% of healthcare net income goes to shareholder payouts, we also spend far more than any other wealthy nation (18% of GDP), while ranking lower in key health outcomes like life expectancy and infant mortality.
Then-Ticket8896 | 2 hours ago
It is past time! Congress are dildos…crooks n thieves.
Term limits are needed. These old fucks care only about their ‘donations’ aka bribery money. Why are usa voters so damn stupid?!?
Gernaldo_Ribera | 3 hours ago
I support health care for all and saving money. But I can't help but feel like we have enough people in the world already.
Your comment body must contain at least 140 characters.
DeArgonaut | 3 hours ago
Sorry, not quite sure what you’re implying, that would should just let people die from treatable conditions?
Opening-Restaurant83 | 3 hours ago
https://www.ctvnews.ca/health/article/more-than-23000-canadians-died-on-medical-wait-lists-in-the-past-year-new-report-finds/
Just die waiting in line instead.
Buuuuut annnnnywayyyyyyyy
DeArgonaut | 2 hours ago
It's people on the wait list, which includes people who died because they didn't receive treatment, but also people who died for any other reason
DeArgonaut | 2 hours ago
https://www.oecd.org/en/publications/health-at-a-glance-2025_8f9e3f98-en/full-report/avoidable-mortality-preventable-and-treatable_e2e21c0b.html
Here is a look at preventable deaths, the us is about 2/3 higher than Canada
Not to mention, what's it like specifically for healthcare in the US? There's been reports circulating around that 92% of US adults have delayed or foregone healthcare due to worry about the costs. How many specifically didn't get treatment in the US from that, in addition to being on a waitlist in addition to those who couldn't even afford to try to get healthcare in the first place? Cuz there absolutely is plenty of places with very long waitlists in the US. When I was working in Boston a couple years ago at a hospital, the wait time to see a a pcp as a new patient for two of our new colleagues was over a year long
jcole4lsu | 3 hours ago
more death cult lunacy
DirtySanchez947 | 3 hours ago
My good sir, this is an economics forum, not a mass murder forum.
Gamer_Grease | 2 hours ago
To be fair, all the greatest mass-murderers have been economists.
Gamer_Grease | 2 hours ago
What does that have to do with anything?
in4life | 3 hours ago
Decreasing population in developed countries is the quickest way to dismantle social programs such as this or Social Security banking on growing population.
Opening-Restaurant83 | 3 hours ago
But that never works because third worlds just flow in like a river and the empathetic idiots just let it happen.