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  brandonb
  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...
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  jvanderbot
  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.
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  greenpizza13
  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.
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  afavour
  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.
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  th0raway
  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.
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  karakoram
  >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.
• chermi
  I would like to know if anyone has a method to do 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?
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  ilamont
  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.
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  solaarphunk
  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.
• seanmcdirmid
  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).
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  DrScientist
  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?
• hathawsh
  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.
• ConceptJunkie
  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.
• myfavoritetings
  How much would it save if you account for the fact that half of congress would sabotage it in to oblivion?
• vondur
  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.
• tptacek
  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.
• anon
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• anon
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• lokar
  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.
• konaraddi
  Link to the preprint https://www.medrxiv.org/content/10.64898/2026.07.22.26358689...
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  davidfekke
  "You can have state of art Healthcare, or you can have Universal healthcare, you can't have both." -- Malcolm GladwellThe way that universal health coverage saves money is by rationing care. You do not save lives when you ration care.
• rlewkov
  For the study, "which has not yet been peer reviewed"
• dzonga
  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.
• jandrese
  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.
• ktzar
  What about all the new unemployed lawyers and bureaucrats that feed on the broken American system?
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  satnhak
  Come to a country with universal healthcare (England) and realise that if you work then you're paying 5x the market price for the worst healthcare imaginable. MRI scan - we don't know, one month wait, maybe two. Operation - are you going to die tomorrow with out it? No, ok then that could be years.You need to pay rock bottom wages to doctors to make it work, so guess what all the good doctors leave for private healthcare and you end up with the dregs from the third world.
• Aunche
  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.
• loeg
  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.
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  gryfft
  I wonder how many people would be on board for a program to make Medicare available for free for households making over $100,000 annually with 1-3 children.We're talking about families that are provably not lazy or sucking up handouts: taxpaying citizens with beautiful, healthy children. The job creators and professionals driving America, securing their future and their children's future.If the government were to focus on these first-class citizens, who knows what could be accomplished once the drag is taken off the system of the useless eaters and the welfare queens.
• anon
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• jsrozner
  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
• b3ing
  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
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  RajuChacha108
  Government provided healthcare ? NO.
• richwater
  There is already a healthcare program run by the US government and it's called Veteran Affairs. Veterans can't even access the care they need resulting in almost twice the risk of suicide.I'll pass on mandated, outlaw-private-insurance government healthcare, thanks.
• anon
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  ixtli
  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.
• Taikhoom10
  Bro nothing is free, if the goverment pays for all of us, then it is our own money being used for that, we have the most liberal tax code in the world, we spend the most in healthcare.
• westurner
  How many employees trapped in a job for health benefits for their families would universal health coverage free up?Quantify the impact on productivity
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  exabrial
  I don't want it. I don't want to pay for it either. anything the fed government does is utter crap.
• rohan_
  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.
• etchalon
  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.
• aidenn0
  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!
• calvinmorrison
  Baumol's cost disease is the simple answer. until healthcare stops improving outcomes and or we reduce labor cost will go up
• bpt3
  There are many studies from reputable sources (one being the CBO) that say it would result in almost no savings or potentially even higher costs, just like there are many studies like this one that say there will be massive savings with no reduction in quality of care.I support universal health care, but each side just lobs whatever data supports their position at the other without any real thought. Most people in support of a universal health care system seem to be completely unaware that the vast majority of households are happy with their current coverage (whether they should be or not isn't relevant really) and are not looking for someone who claims to know better to "improve their medical care" through a entity (the US federal government) that is generally not known for improving almost any situation it interacts with.I personally would like to see Medicare opened up to the public as an option. It's simple, doesn't require anything of anyone who doesn't want to participate, and should be a reasonable test for the claims of cost savings. If it's truly a better option, people will move to it. If not, then the conversion will not happen.Barring some sort of catastrophic financial or medical event, there is a 0% chance that anyone can make a radical change to the status quo.
• dboreham
  Ok but it doesn't save the donor class anything, so it won't happen.
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  jayess
  Who's gonna tell the doctors and nurses that they get a 50% pay cut?
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  whimsicalism
  I'm honestly curious how we square this with the only experimental evidence we have on cost-sharing in the US, like the Oregon Medicaid Study and the RAND study which showed no impact on mortality or really any physical health outcomes at all.
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  digitalsurgeonz
  Quite weird to see such a study from Yale, Yale is the heart of the capitalistic western empire, and it exists to serve the oligarchy and the capitalists. So then what gives ? perhaps the person working on this report is still an innocent person and has not yet seen the reality of his situation :)
• ck2
  let's imagine an impossible country where somehow Democrats pull this off in 2029 and the 2030s start with actual healthcare for all and not just "insurance"DOGE 2.0 will destroy it overnightbecause somehow funding is not exempt from executive manipulationlook at what they did to ACA (and everything else)all it takes another apathetic Congress and poof it will be gone so billionaires can get a few million off their taxesthere's absolutely no way to harden it against that
• lettergram
  Ah yes, the claim free money would save lives!The truth is once systems like this are implemented they change the dynamics of the study and as such could hurting lives.As a simple example, the biggest cost to the healthcare system in the US is dialysis. Many of those folks already have health issues, and by both dialysis and for all the issues that caused the need for dialysis in the first place is a massive strain. The direct cost of dialysis is $33B annually [1], but indirectly is probably at least another doubling.Further, the way the government has imposted monopolies in the space already has caused costs to balloon. While making it "universal" could mean the government gets control, and can limit the explosion. It can also could result in weird incentives like Canada, where they're promoting MAID.[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8729831/
• AlfredBarnes
  .....yeah
• CurbStomper
  [dead]
• jheriko
  [dead]
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  lapcat
  This is why it doesn't happen: politicians get bought."Jeffries co-sponsored Medicare for All legislation between 2013 and 2021, but in August 2026, he stated he shifted his stance and stated that he no longer supports or co-sponsors the proposal." https://en.wikipedia.org/wiki/Hakeem_Jeffries#Healthcare
• dotcoma
  Yeah, but how much would it cost in profits?That's the only thing that matters in Amerika.