For The Cost Of Obamacare Bills Congress Could Build And Run Free Clinics

[Tijuana]

If we insist on spending this staggering amount of money, we could spend it in a way that actually provides health care for the many Americans who supposedly desperately need it.

Scott Ehrlich By Scott Ehrlich
APRIL 13, 2017

The Affordable Care Act, or Obamacare, was advertised as costing $854 billion. This figure is based on “gaming” the Congressional Budget Office, disguising the true cost in the ten-year budget window. The latest CBO score reinforces that claim, now projecting the ACA will cost around $2 trillion for the next ten-year budget window while providing health care for no Americans since merely having an insurance card doesn’t ensure any doctor will take it as payment.

The Republicans then touted their ACA replacement as saving $337 billion in this huge new ACA expense, rather than savings from public health spending pre-Obamacare. If we are going to waste tax dollars while not providing health care to anyone, I’d rather waste $1.6 trillion than $2 trillion. But if we insist on spending this staggering amount of money, we could hypothetically spend it in a way that actually provides health care for the many Americans who supposedly desperately need it.

How About Providing Actual Health Care
Let’s use the $854 billion Obamacare was originally projected to cost, since that was the retail sales price for the proposal that, although through dubious methods, actually passed both houses of Congress. What can that buy? According to my research, the current cost of building a hospital is about $1 to $1.5 million per bed. The average cost to run a hospital is about $2,200 per bed per day, or around $800,000 per bed per year. Those numbers are the best I can find and a useful starting point for this discussion even if they aren’t perfect.

So, for reference, let’s use the Atlanta Veterans Affairs hospital as an example. The Atlanta VA has 466 beds and claims to “serve the healthcare needs of more than 130,000 enrolled Veterans living in 50 counties across northeast Georgia”. If we were to build another hospital of that size, let’s use $1 million per bed as the cost, since it’s a public hospital and we can get rid of some of the frills of some of the state-of-the-art, private research hospitals.

Let’s make it 500 beds to make the math easier, giving us a construction cost of roughly $500 million. And let’s say we want to reduce wait times and staff it really well, so let’s raise our costs to $1 million per bed per year. This would make the approximate 10-year cost of a new federally funded, 500-bed hospital $5.5 billion.

Spending $5.5 billion on a taxpayer-funded hospital would be a lot of money but, unlike changing the insurance system, would provide actual health care for approximately 150,000 people. For $550 billion, the government could build two new 500-bed hospitals in each state and run them for a decade, providing actual health care to approximately 15 million people.

But not every person needs hospital care. For the vast majority of treatments, an outpatient clinic will do. The cost on those, according to the numbers I have found, is significantly lower. This article pegs the cost of building an outpatient clinic at about $500 per square foot. This one puts the cost of running it at about $1 to $2 million per year.

Let use the average estimate for building and the high end estimate for running it for the same reasons we did with the hospital. A 20,000-square-foot outpatient clinic could be built for $10 million and run for about $2 million a year, giving it a ten-year cost of $30 million.

That means for $300 billion, the government could build 10,000 outpatient clinics, or 20 clinics for every congressional district in the country and Washington DC, and still be able to build another 1,200 or so clinics in poorer or underserved areas. Since this clinic serves 3,500 people in 10,000 square feet, we can assume we can serve 7,000 people in each of our government clinics. That means the outpatient clinics could serve 70 million people.

Add the hospital numbers to that and the government would be providing actual health care for a whopping 85 million people. Remember, now, much of the ACA debate has concerned the uninsured, who number about 29 million. This would serve almost three times that figure.

So What Does This Mean?
So for a cost of $850 billion—a huge number, to be sure, but equal to the original Obamacare estimate—the government can hypothetically provide actual health care for 85 million people for the next decade, without accounting for a single cent of potential revenue to offset it.

While these facilities may not bring in revenue, they would bring in significant cost savings. According to the Centers for Medicaid Services, Medicaid spending in 2015 alone was $545 billion and had an enrollment of 70 million people. So, assuming that both of those numbers stay flat (which they won’t), Medicaid spending would cost approximately $5.5 trillion in the same time period. The government could transfer our entire U.S. Medicaid population into these new federal hospitals and clinics and, on net, save more than $4.5 trillion over a decade.

Unlike Medicaid, which provides questionable to no health benefits and increasingly fewer doctors will take, these clinics would all be designed to take and treat Medicaid patients and anyone else who did not have the means to pay for care, or who decided their level of treatment wasn’t worth paying for. If a young invincible who didn’t buy insurance breaks his leg, he can get that fixed at a federal clinic. If someone is unemployed in middle age and comes down with pneumonia, now there is a place within driving distance she can be treated for free.

There are also the tangential benefits for everyone else. Moving this population, which tends to be the sickest in the country and a huge driver of health-care costs, to these federally funded facilities would free private hospitals to take payers. The costs to hospitals of people who receive care but don’t pay would be diminished, reducing the cost of patients they would have to pass on to paying patients. Emergency room waits would also be shorter and surgeries could be scheduled quicker, as patient populations are better spread out, leading to better health outcomes as well.

Let’s Get Some Perspective on Health Care
Of course, nothing like this would ever pass Congress and, even if it did, it’s questionable the federal government would be up to the task. It has proven fairly inept at handling a patient population of 9 million, so adding another 70 million or more would certainly strain the bureaucracy. Finding enough competent physicians to staff and run all these facilities would also be an issue.

Finally, as these would be funded solely with tax dollars, the quality of care would likely be lower than that from privately run facilities. But I’d have to imagine the health outcomes would still be much better when providing people with average doctors and facilities instead of great doctors but little actual access to care from subsidized insurance with unaffordable co-pays and hard-to-use facilities. After all, if Cubans can live to 79 despite the older facilities their broke government provides (regardless of what Michael Moore tells you), simply having access to doctors would be a big boon for these populations.

So, if lawmakers are determined to spend a trillion dollars on health care, this a hypothetical way to provide Americans with health care, while being cheaper than any health plan Congress has actually voted on. Also, under this plan if people like their insurance, they can keep it; if they like their doctor, they can keep her. And if they like having actual access to care, rather than a laminated card no one takes and $5,000 minimum to pay until their insurance kicks in, this will help with that.

I’m not saying that we should go this route or that the federal government should be spending a fortune on health care, or even make a comprehensive health plan. But if both parties are nevertheless intent to spend a trillion dollars on health care and enact a comprehensive health plan, this route could provide better health outcomes and massive savings by keeping government out of the insurance market.

Scott Ehrlich is the COO of DTC Perspectives, an independent health-care marketing and event company. He lives just outside of Atlanta with his wife, son, and 3 pugs.

http://thefederalist.com/2017/04/13/...ywhere-decade/

I found this to be an interesting article, to say the least.

The writer is making the case that simply providing healthcare for free would cost no more than the estimated costs of Obamacare, much less the actual costs. As a conservative in favor of single provider (possibly the only in the world), I have long maintained that the current US system is so devoid of the beneficial aspects of capitalism, that it makes more sense to simply handle it single provider, like we do police and fire departments.

The obvious counter argument is the VA. However, I say that if the entire public were subjected to the VA, the bad PR would clean things up dramatically, and quickly. Sure, we all have concern for veterans. But, we care more for ourselves.

I provided the original link, so that people can see his hotlinks that name his sources for his claims as they go along. He is simply using publicly available news articles and studies. He has not done his own study. This is basically napkin math.

[Poopymonster]

http://thefederalist.com/2017/04/13/...ywhere-decade/

I found this to be an interesting article, to say the least.

The writer is making the case that simply providing healthcare for free would cost no more than the estimated costs of Obamacare, much less the actual costs. As a conservative in favor of single provider (possibly the only in the world), I have long maintained that the current US system is so devoid of the beneficial aspects of capitalism, that it makes more sense to simply handle it single provider, like we do police and fire departments.

The obvious counter argument is the VA. However, I say that if the entire public were subjected to the VA, the bad PR would clean things up dramatically, and quickly. Sure, we all have concern for veterans. But, we care more for ourselves.

*cough*

SOSHALISM.

/thread

[Tijuana]

*cough*

SOSHALISM.

/thread

Yep, it's Socialism. Do you not find it interesting that this napkin math seems to cover 85 million people, while the current Obamacare rolls total merely 9 million?

[Edge-]

I provided the original link, so that people can see his hotlinks that name his sources for his claims as they go along. He is simply using publicly available news articles and studies. He has not done his own study. This is basically napkin math.

Because the VA isn't a single payer system. Single payer systems, like what you advocate for, is just the government handling all the billing/payment for health care, not actually providing the health care. You still go to private doctors who are employees of their respective practices/care groups, the government just handles paying. That's what Medicare is.

The VA is actually government run healthcare, the doctors are employees of the government.

They're two very different things that people should not confuse.

Yep, it's Socialism. Do you not find it interesting that this napkin math seems to cover 85 million people, while the current Obamacare rolls total merely 9 million?

Not really. The ACA was a step in the right direction, but it was always a deeply flawed step in that direction. Eliminating insurance companies, while it will impact a large number of folks who work in that industry, eliminates a huge amount of the excess costs that are what makes health care in the US much more expensive than other countries with similar (or better) quality of care.

[Kaleredar]

It's almost as if Obamacare was gutted and confounded before it went into place because a certain political party was morally opposed to giving people free healthcare.

[May90]

It is not exactly a secret that ACA is extremely cost-ineffective. The claim in the article may very well be true. But, let's be realistic... Free clinics aren't going to happen any time soon.

[Tijuana]

Because the VA isn't a single payer system. Single payer systems, like what you advocate for, is just the government handling all the billing/payment for health care, not actually providing the health care. You still go to private doctors who are employees of their respective practices/care groups, the government just handles paying. That's what Medicare is.

The VA is actually government run healthcare, the doctors are employees of the government.

They're two very different things that people should not confuse.

No offense, but it is you who is confused about my point.

This is not single payer for all, it's single provider for the poor. This is an alternative to Obamacare, not a re-work of the entire system.

- - - Updated - - -

It's little surprise that it would be cheaper, given that building two hospitals per state would provide nowhere near the services of insuring every person in that state.

This is an alternative to Obamacare and Medicaid only.

[Shadowmelded]

Good luck with it. Just try and keep some of the worst aspects of capitalism out of it. Market forces introduced into the NHS have been wreaking havoc and profit motives (PFI for example) have lead to ballooning costs (compounded by the natural ballooning costs due to an aging population).

[Tijuana]

It's almost as if Obamacare was gutted and confounded before it went into place because a certain political party was morally opposed to giving people free healthcare.

Many states were going to be unable to bear the burden of the cost of Medicaid expansion, since the federal funding was temporary. Not every state is California, with it's Hollywood riches.

- - - Updated - - -

Good luck with it. Just try and keep some of the worst aspects of capitalism out of it. Market forces introduced into the NHS have been wreaking havoc and profit motives (PFI for example) have lead to ballooning costs (compounded by the natural ballooning costs due to an aging population).

Interesting take. My stance is that this is good, because the market forces are ABSENT from the current US system. And again, this is just for the poor, not for all.

[Edge-]

Many states were going to be unable to bear the burden of the cost of Medicaid expansion, since the federal funding was temporary. Not every state is California, with it's Hollywood riches.

California relies on the federal subsidies with its Medicaid expansion as well.

And there's a push for single-payer in California now, we'll see what happens with it but it seems like there's a chance something may come about as a result of it.

Has nothing to do with "Hollywood riches" as far as I know, I don't even know how much that area contributes to the overall state economy compared to areas North of it like Silicon Valley.

[Sunseeker]

http://thefederalist.com/2017/04/13/...ywhere-decade/

I found this to be an interesting article, to say the least.

The writer is making the case that simply providing healthcare for free would cost no more than the estimated costs of Obamacare, much less the actual costs. As a conservative in favor of single provider (possibly the only in the world), I have long maintained that the current US system is so devoid of the beneficial aspects of capitalism, that it makes more sense to simply handle it single provider, like we do police and fire departments.

The obvious counter argument is the VA. However, I say that if the entire public were subjected to the VA, the bad PR would clean things up dramatically, and quickly. Sure, we all have concern for veterans. But, we care more for ourselves.

I provided the original link, so that people can see his hotlinks that name his sources for his claims as they go along. He is simply using publicly available news articles and studies. He has not done his own study. This is basically napkin math.

Yes. We on the left have made this argument for literally decades.

[Wyrt]

It wouldn't cost so much if the government would do something about the exploitation of consumers by healthcare providers and pharmaceutical companies.

[Redwyrm]

"could build two new 500-bed hospitals in each state"

You do know that states have populations ranging from 600,000 to 38.5 million?

[Tijuana]

Yes. We on the left have made this argument for literally decades.

Do you find it interesting that there would be 10x more people covered, if you just gave them the care for free, than for this convoluted scheme of Obamacare that was supposed to lower costs for all?

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"could build two new 500-bed hospitals in each state"

You do know that states have populations ranging from 600,000 to 38.5 million?

I don't think the writer was making the point that they all must go to the same place. Even if he did, it's unlikely it would ever work like that, obviously.

- - - Updated - - -

It wouldn't cost so much if the government would do something about the exploitation of consumers by healthcare providers and pharmaceutical companies.

I agree that the real issue is the cost of the care, not the cost of the insurance. The picture painted by politicians, in regards to the health insurers, doesn't really add up when you look at their stock performance.

[I Push Buttons]

This is silly, just casually seeing a doctor isn't the expensive part of healthcare spending... And this comparison of "you could make 10000 free clinics for the cost of the ACA" is stupid at best...

[Sunseeker]

Do you find it interesting that there would be 10x more people covered, if you just gave them the care for free, than for this convoluted scheme of Obamacare that was supposed to lower costs for all?

No. I don't find it "interesting". I find it logical. I find it the functional reality that has existed in numerous of our Western peers for again decades.

[Shadowmelded]

Interesting take. My stance is that this is good, because the market forces are ABSENT from the current US system. And again, this is just for the poor, not for all.

It'll lead to decreasing standards due to outsourcing of certain functions to the lowest bidder that eventually leads to problems down the road. Could be in any number of areas; procedures, even something as mundane as cleaners. Underpaid, overworked, perhaps lax training, no sense of belonging to the institution leads to a lot of work being done poorly. And that's how you get an MRSA outbreak.

[I Push Buttons]

Do you find it interesting that there would be 10x more people covered, if you just gave them the care for free, than for this convoluted scheme of Obamacare that was supposed to lower costs for all?

No, but I find it interesting that you think having questionable access to a free clinic is equivalent to being insured against most maladies.

Is a free clinic going to treat their cancer?

Is a free clinic going to perform their open heart surgery?

Is a free clinic going to be their destination in an emergency?

No?

Ok then we are back at square one... Because those people all still need to be insured to cover the cost of those things if and when they need them.

[Tijuana]

It's not even providing as much as insuring everyone who has subsidized health insurance. Two hospitals are not going to be able to distribute their services evenly throughout an entire state to hit all the people who need those free services.

Obamacare has 9 million people covered currently. This plan would theoretically cover 85 million people, at a cheaper cost. That is why I found it interesting, for various reasons.

- - - Updated - - -

No, but I find it interesting that you think having questionable access to a free clinic is equivalent to being insured against most maladies.

Is a free clinic going to treat their cancer?

Is a free clinic going to perform their open heart surgery?

Is a free clinic going to be their destination in an emergency?

No?

Ok then we are back at square one... Because those people all still need to be insured to cover the cost of those things if and when they need them.

The plan includes 100 hospitals as well. There is also nothing that says they could not do more. The point was to work backward from the estimated Obamacare costs figure.

[Barnabas]

http://thefederalist.com/2017/04/13/...ywhere-decade/

I found this to be an interesting article, to say the least.

The writer is making the case that simply providing healthcare for free would cost no more than the estimated costs of Obamacare, much less the actual costs. As a conservative in favor of single provider (possibly the only in the world), I have long maintained that the current US system is so devoid of the beneficial aspects of capitalism, that it makes more sense to simply handle it single provider, like we do police and fire departments.

The obvious counter argument is the VA. However, I say that if the entire public were subjected to the VA, the bad PR would clean things up dramatically, and quickly. Sure, we all have concern for veterans. But, we care more for ourselves.

I provided the original link, so that people can see his hotlinks that name his sources for his claims as they go along. He is simply using publicly available news articles and studies. He has not done his own study. This is basically napkin math.

A blast from the past and have state hospitals again?