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.

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...

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

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.

1) U.S. healthcare spending subsidizes the rest of the world, much like U.S. defense spending. New drugs wouldn't be developed at the same rate if it wasn't profitable to do so, and it's profitable largely because it's profitable in the U.S.. Some proportion of the high U.S. spending relative to other countries is this. It's pretty stark. In revenue terms, for new drugs 2018-2023: 67.1% of total sales in the USA alone, 15.8% in Europe, 3.9% in Japan, and 13.2% for the entire rest of the world ( https://www.efpia.eu/media/2rxdkn43/the-pharmaceutical-indus... )

2) I believe the U.S. is willing to go to greater lengths to save people. So they will spend obscene amounts of resources keeping a cancer patient alive for an additional six months, or saving a borderline case of a premature baby, etc.

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.

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.

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.

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?

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...

impose universal health coverage & the jockeying will commence to see who is in charge of it. medical & diet fundamentalists will rejoice at the opportunity to seize control & force everyone to take certain drugs, eat or not eat certain foods or types of foods, exercise a particular way, surrender their organs at a particular age, or whatever else their hearts desire for everyone else. there have been so many rabbit trails taken, so much malfeasance, so much misinterpreting of data, etc., which has been uncovered just in the last decade or two to give anyone the ability to harm or control entire populations in this way. the increase in suffering will be great, & the long-term effects devastating.

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.

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.

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.

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?

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.

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.

Universal health coverage will asymptotically reach infinity costs (same as private health insurance).

This is the harsh reality. No system (private or public) can save all of the lives.

We are debating who will make the decision of who gets to get a chance to live longer.

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.

_could_

"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"

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

A perfect Communist economy could save even more money, eliminate most ads, duplication, and poverty. But they never figured out how to make it work.

I'm not opposed to a peaceful transition, but we'll need a big surplus and more idealism to make it happen.

Contrarian take, even with free healthcare, UNH is happy - https://s-1.vercel.app/posts/unh-value-trap-or-chronically-u...

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?

Very interesting reading the comments here from USAnians. You are really hurting, and your system is objectively very bad.

Inappropriate application of capitalism. A market failure of epic proportions.

Do something about it! You live in a democracy, act like it!!

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.

How many employees trapped in a job for health benefits for their families would universal health coverage free up?

Quantify the impact on productivity

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.

How on earth have administrative costs been soaring when there have been so many healthtech startups propped up in the past 10 years to bring down the cost of administration?

Also - given the rate of AI progress, shouldn't we see this cost go to zero essentially.

I've become so cynical that I think even if universal health coverage would be passed, since it almost certainly would be run by the executive branch, it would become just another political football to be fucked with every 4 to 8 years.

Just think, if we had universal health care in the US today, the MMR vaccine would not be covered by it!

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

It will never not be funny that whenever universal health coverage comes up, Americans will act as if it's some impossible task that wouldn't solve any problems when the rest of world seems to have sorted it out just fine.