Universal health coverage could save $1T and 114k lives a year: study

There are a lot of people making a lot of money on the inefficiencies of the US system. They won’t give up their revenue streams without a fight, and they are filthy rich on the backs of sick people. You better believe they will play dirty.

Switzerland has the system closest to the US in my experience, but with universal coverage.

As individual, you buy basic insurance costing roughly $500/month with a $2500 yearly deductible (LAMal/KVG). Applicants must be accepted even with pre-existing conditions. Post-deductible, you pay 10% co-insurance capped at roughly $800/year (no medical bankruptcy). Insurers operate basic plans as non-profit. They make their profit on optional supplemental insurance (private hospital rooms, extra benefits...) The state subsidizes basic premiums for low-income individuals. A doctor's visit is a $150 minimum, similar to the US.

What was most surprising compared to here in the US is employers pay $0 toward premiums. Funding is entirely decoupled from employment. You don't lose coverage or change plans when changing jobs.

On the negative, basic insurance does not have dental, so dental stuff is out-of-pocket and expensive.

In terms of stats, the US spends 18% of GDP on healthcare vs. 12% for Switzerland and the gain is lower stress too. Not perfect but maybe the best of both worlds.

I'd like to believe this, but the study makes a bunch of really hasty assumptions.

The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewer avoidable emergency department visits and hospitalizations.

The buckets themselves don't necessarily survive much scrutiny.

Take "Medicare-level payments to providers". Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch.

The line item of "fewer avoidable emergency department visits and hospitalizations" assumes greater insurance coverage leads to greater access to primary care. It's true that great primary care prevents hospitalizations, and can be a net cost saving under certain assumptions [1]. But, we're actually in a primary care shortage. Existing insurance payments for primary care are low enough that private practices are going out of business and fewer residents are going into family medicine. Cutting rates (the paragraph above) would make this worse.

For "less fraudulent billing," a lot of people in the industry believe that Medicare has a large amount of undetected fraud. That's unfortunately the flip-side of reduced administrative overhead. The authors assume an 8% savings here, but the 2003 paper they cite uses the word "fraud" only twice and doesn't give a number.

Healthcare reform is hard.

[1] Reasonable breakdown on the economics of advanced primary care models: https://olearykm.medium.com/the-cost-equation-for-new-primar...

Legislate transparent pricing for all medications and procedures first.

Paying 40 dollars for lozenges in the ER is insane.

Right now the system has an opaque pricing structure which makes no sense.

Force hospitals to expose API's with transparent pricing.

We've been down this road. ACA was predicated on studies like this, to no avail (it turns out that intense opposition chips away at it over time regardless of these studies).

I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan.

I'm not saying that this is what is happening now, but I am saying that calls for universal health coverage, no matter how correct and well supported, are going to probably face the same obstacles they did last time, so we need new coalitions and implementation proposals if we're going to give it a go again. It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to.

Universal Health Coverage has a lot of other benefits:

1. It detaches health insurance from the employment market. This means those minimum wage walmart jobs just became more feasible, or any low end job really, since their is no pressure to provide "benefits" anymore. This would seriously lubricate the labor market, because the friction to providing, taking, and changing a job is reduced.

2. It ends a bias for group plans. If you are poor or are a trades worker and need to buy insurance outside of a group plan, you are going to be in an expensive high risk pool.

3. Its a benefit we can fund socially with taxes that will immediately have a positive impact on lower income workers, as well as poorer regions of the country (e.g. red states).

The US is far too broken for such a thing to ever come to be. Politicians are bought and paid for, and the impact on the insurance companies and their profits make this impossible.

US legislators will never, ever, ever put the needs of the people above the needs of corporations, not as long as corporations can wield their massive wealth as "free speech" in the form of lobbying and political donations.

Sounds nice, though.

In a more sane world the Republican Party would be in favor of universal health coverage. How many potential entrepreneurs stay working at BigCorp because they need the health benefits? How many small businesses are crushed by the cost of providing healthcare to their employees? It would be great for business to remove any involvement they have in personal healthcare.

But I suppose they are the party of big business, not the party of business in general.

>A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.

Most of the problems of the US system aren't really a matter of who pays, but the fact that so much is paid for services, at every level. Any really significant savings, cutting bureaucracy and pressuring providers to make costs resemble those of other developed countries, are taking money out of someone's pocket. Many hundreds of thousands of them, if not millions. This makes any significant reform very difficult, as those people vote, and will know exactly who made them worse off, even if the country in general was made much better off.

Read The Logic of Collective Action by Mancur Olsen. It wasn't written thinking of healthcare. but anyone looking at the US healthcare system will see that what is going on is stacks upon stacks of collective action beating overall societal efficiency, over and over and over again, in such a way that it's basically in none of the decision makers best interest to actually increase overall efficiency.

What about quality of care tradeoffs? In Canada, for example, you are forced to use the government system, and if it doesn't deem you important enough, there is no private option.

As a person living in Germany I find it insane that this hasn't been solved by the US of A. What the actual hell is going on?

There have been studies like this for decades, going back to at least the Clinton administration.

And nothing will come of it. Too many entrenched interests, regulatory capture, and lobbying + political donations.

Of course it does, but only one country has to keep commissioning and ignoring studies to work out a group of 300million people can get better prices for everything if the incentive for the government is to decrease the price rather than increase it for their buddies

As I understand it - ~30% of US federal spending is on health care.

In the UK it's about 20%.

Yet apparently the UK is mostly nationalised under the NHS, while in the US there is huge additional spending on private insurance.

Can somebody from the US explain to me how that's the case and why American's still put up with it?

It's crazy that universal health is the political third rail in most modern countries but for the opposite reasons

In most of the world it's the policy that cannot be touched, just in Europe, Canada and Australia its _existance_ is invoilable, in the US the _introduction_ seems to be the unwinnable war

As a Canadian ex-pat I've seen the following:

1) 2 friends had to wait over a year for gallbladder surgery.

2) A friend with autistic child had to wait 2 years for any type of therapy. He couldn't afford the $80k/yr for private care. Ontario has 70,000 autistic children on the waiting list for treatment.

3) Another friend had to wait several years to find a PCP in Ottawa, the capital city of Canada. He has a golf ball sized lump on his head and he can't see anyone without a referral from his PCP but he has none and no one was taking new patients. He put himself on a list to get the first PCP available anywhere in the city. After that he has to wait a year for a consult and who knows when surgery is.

4) Another friend had to wait 9 months to get an MRI for a pain in his neck. After that it was another 4 months to see a neurologist.

You don't pay in money but you pay in time and suffering.

The mortality numbers in this paper appear to be extrapolated from an observational study of 9,000 cases from 1988-1994. That paper distinguished between "privately insured" and "not privately insured". This paper distinguishes "adequately insured", "underinsured", and "uninsured", and applies the original paper's hazard numbers to everybody but the "adequately insured", with a coefficient modifier for the "underinsured" that they came up with themselves.

Cuba achieves similar life expectancy and infant mortality rates to the U.S. despite spending a fraction of the cost, focusing heavily on free community prevention.

Cuba has one of the highest doctor-to-population ratios in the world—roughly 6 to 8 physicians per 1,000 people: https://www.reddit.com/r/dataisbeautiful/comments/r468au/oc_...

That $1T that it might save is currently hitting lots of quarterly or annual reports as profits. With that much on the table I think the chances of seeing Universal Health Care here in the US are not great. The ones banking that money now will fight hard to keep it flowing into their pockets.

Real lives don't factor into their decisions, even if there are more than enough to fill a large city in this country - every year.

I think the evidence is quite clear that universal health care reduces aggregate costs, but the public cost in aggregate is enormous.

1. This means large new taxes for everyone. For those on lower incomes, they might end up better off. For those on middle-upper+ incomes, they will unequivocally end up paying more.

2. The U.S. already has unbelievably high deficits and debt. This would make that worse without significant spending cuts elsewhere, and without very large new taxes. And before someone says "just tax the rich!", even if every billionaire in the U.S. had all their wealthy confiscated today, it would barely cover U.S. federal spending for *one year.* Then the party's over and the government collapses. "Just tax the rich" is an absurdly superficial position. European taxation is broad and deep. Everyone pays high tax - even those who do not earn much.

3. U.S. society is built on rugged individualism. Acceptance of immigrants under the premise that they will work hard and contribute. For this reason, U.S. success at integrating immigrants is better than anywhere else in the world, by a wide margin. Our issues re immigration in Europe are numerous and unbelievably contentious. Should the U.S. become a "welfare state," like European countries, it would no longer have a natural filter for immigrants. It would realise the type of immigration that we get in Europe, where for many groups, a majority refuse to work - for life. For this reason, it would require a MUCH tougher filter on immigrants - much more so than what the current administration is doing.

I do not see the U.S. materially reducing spending in other areas, including the military. I do not see general public support for large taxation increases across the board. I do not see public consensus on strict new immigration requirements and enforcement. For these reasons and more, I do not think public health care is a realistic prospect for the foreseeable future.

There aren't enough Physicians, they don't make much and they all seem to be working 12 hour days but being paid a salary that would equate to an 8 hour day.

Doctors see downsides of a universal coverage are mostly about loss of autonomy and increased demand because when care becomes free demand rises along with pressure to expand access without extra staff.

How much would it save if you account for the fact that half of congress would sabotage it in to oblivion?

Since when has a government projection of costs ever been in any way realistic? The estimates for the costs of Medicare when it was established were low by a factor of 10.

Last time I joined a discussion about US health care on HN (years ago), the picture looked bleak: secret chargemasters in every hospital, no realistic way for patients to compare options because the options are too complicated, and lots of people still falling through the cracks.

I can't help but think the picture looks very different now. There is growing awareness that chargemasters can not be secret. LLMs offer a way to overcome the complexity of choosing options, opening doors for real competition. I sincerely hope we can take advantage of this changed landscape to provide better care. Universal health care remains an interesting possible direction, but I now have hope that we can do a lot better within the existing laws.

Link to the preprint https://www.medrxiv.org/content/10.64898/2026.07.22.26358689...

I would like to know if anyone has a method or resource to cover rough calculations on things like:

1) how much cost comes from "friction" like middleman, administrative bloat, shitty digitalization/note sharing, all the time the nurses and doctors have to spend on paperwork... Etc.

2) how much drug development is subsidized by the US patient via higher domestic vs. foreign pricing. Or even how much of the cost total is drugs?

3) how much roughly every added year of life past some marker of "high quality of life" is spent just keeping people alive. And if there's any trends there, cost going up or down total and per person.

4) some basic accounting of where the spend is actually going. A lot of people in this thread are talking about hospital margins. There's much more to health care than that. Labs, hospice, mental health, labs/diagnostics, drugs, r&d, nursing facilities and many things I probably don't even know about.

Basically an equivalent of david mackays "without the hot air" but for health care.

Also if anyone has some good reading on ideas around kind of SEZs for drug/treatment development where people opt in to riskier care. Not quite the same thing but I know for example that lots of medical device development and proving is done in spain to gather evidence for the FDA since the FDA process for devices is legitimately insane.

Oh and if there has been any proposals or even adoption of better health record management, digitization. Especially access to your own health record. Im not a crypto guy but it seems like maybe it could be an application for it?

People talk about policies like they're something like can be picked up off the shelf at supermarket. If you could take the policies and Sweden copy-paste them to the US, then sure, we could save $1T and a hundred thousand lives. This would be a very difficult thing to replicate if you're a country without any existing healthcare system. It is impossible in a country with an extremely mature healthcare system, which accounts for nearly 20% of GDP.

No politician is going to want to deal with the fallout of massive layoffs or millions of people having their coverage changed (e.g. no free chiropractor appointments or GLP-1s for weight loss), especially since the Democrats suffered one of the worst Congressional losses in US history the year the ACA was passed. There are ways to make this transition less painful, but the only people interested in health policy are those who make money from healthcare, so you generally only see solutions that involve throwing money at the problem. We need regular people to develop an understanding of health policy or else we'll end up with a policy that merges the worst parts of a planned economy and capitalism even more than today.

This would be much easier to sell if everyone stopped referring to it in the context of “healthcare” and instead used “universal health insurance” or “universal health insurance rates”.

The number of politicians that conflate healthcare and health insurance (notwithstanding the actual convergence of the two through payers’ purchasing provider entities) is mind boggling.

Striking the word “healthcare” from the conversation would make this much more digestible for folks afraid of the “socialism boogeyman”…

Hard to believe, currently Medicare/Medicaid make up around 23% of the budget. If you opened that to all, there would have to be a huge tax increase to pay for it. I suppose if you are very poor then it would be good, but the middle class would be the ones having to foot the bill for this.

"You can have state of art Healthcare, or you can have Universal healthcare, you can't have both." -- Malcolm Gladwell

The way that universal health coverage saves money is by rationing care. You do not save lives when you ration care.

For the study, "which has not yet been peer reviewed"

It looks like this does not even include the current disincentive for insurers to treat chronic issues effectively early on. Since people switch insurers so often the odds you will be their “customer” in 5 or 10 years is low, so investing if your long term health won’t generate a return for them.

Even if the headline claim is true (other people have already critiqued it), this would dramatically increase the federal deficit without massive tax increases - and as far as I know, none of the advocates of a M4A-style program have ever explained how they would pay for it.

It boggles the mind when you hear people defend the US healthcare system in terms of efficiency (OK, granted, maybe people have long stopped doing that).

It has to be one of the most bureaucratic and paperwork overloaded systems of all time. It's hard to imagine somebody who've had an actual health crisis would think otherwise, unless they can afford people who can shield them from the BS.

Pretty obvious...

This is why almost every wealthy country and most middle income countries and many poor countries have universal health Canada,UK, Australia, almost every European country, Cuba, Costa Rica, Kyrgyzstan, Sri Lanka, and Rwanda.

There are a few minor weird oligarch run kleptocratic exceptions like America, but in the global context they are irrelevant.

Universal health care by country: https://en.wikipedia.org/wiki/Universal_health_care_by_count...

Won’t happen the big players make too much money the way things are, and that is more important than people’s lives or for our country

The thing studies like this never take into account is the degree to which all of these administrative jobs are corporate welfare. The inefficiency means a lot of people get a regular paycheck for work that is ultimately nonproductive. If you kill off those jobs by eliminating waste there will be millions of people looking for a new job.

But the bigger problem is the current system is really profitable for the millionaire and billionaire owners of those companies. They're well connected in Congress. Attempting to change the system is extremely difficult when it means so many rich people might lose their gravy train. These people go to expensive campaign dinners. Even when the ACA came out and the first versions had universal healthcare provisions those were quickly and quietly eliminated.

What about all the new unemployed lawyers and bureaucrats that feed on the broken American system?

Who's gonna tell the doctors and nurses that they get a 50% pay cut?

If this were at all true, now read it like the big wig or law maker holding the on/off lever who’s eyes see “Universal Health Coversge Could reduce $1T in available/taxable income”.

Did you notice the gorilla walk by? They sure didn’t.

For the most part, any time one person in the economy saves money, another person loses money. So, what about all the insurance company, private equity, and hospital system profits that would be eroded by a system that better serves individual humans?

/sarc

they're tryna convince the populace who don't like to read with useless studies.

get rid of medicare etc, then let it be handled on a city / state level. if some states wanna provide for public hospitals clinics - let them do so. even more if cities too wanna provide for public healthcare. then we can gladly reduce taxes too. the amount spent on medicare vs outcomes is already scam level.

trying to solve this at a national level won't work - too many middleman, too much politics and perverse incentives.

This doesnt need yet another study. Instead of narrating the problem we should figure out whats actually stopping it. And people saying the ACA was universal health coverage or even an attempt at it should stop intentionally derailing this discussion.

_could_

"You millennials and your obsession with public healthcare. Back in my day we just died."

What UHC proponents never honestly admit is that these headline figures require incredibly optimistic assumptions and also much more rationing of care than our current model. We spend a lot on healthcare because we consume a lot of services. To save money, you have to buy fewer services. Yes, you can squeeze providers a little bit ("Medicare-level payments to providers" -- which they will absolutely hate, by the way), and you get another little bit by disposing of insurance provider profit margins ("reduced administrative overhead"). But the vast majority is coming from rationing, which people hate. And it would also cost massively increased taxes on the middle class, which voters also hate.

"Fewer avoidable emergency department visits and hospitalizations" -- sheer optimism. "Less fraudulent billing" -- no reason to believe this would be true. There could be even more fraudulent billing! Medicare fraud has been a big problem, and solutions are largely reactionary.