So lets have an honest discussion about what the US healthcare system is. It is a hybrid of both social and private healthcare. The problem with that isn't that hybrid systems aren't good, the problem is the American solution was to take the worst part of private healthcare, the worst part of socialized healthcare and then combine them.
I have long been a vehement Libertarian and I say what is considered heresy in my political sphere. I would rather have a single payer healthcare system than what we have right now if I had to make a choice. I think single payer is not great, but it's a hell of a lot better than the hybrid mess we have right now.
What is the point of insurance? They are supposed to cover you if you have an issue, yet their entire business model, to quote United, "Delay, Deny, and Defend" <--- edited for correction
What exactly does the US health insurance industry add to the process? My impression is that they are 100% parasitic; costing trillions in additional expense & contributing nothing to the process for patients or hospitals (unless you're a shareholder).
That’s not true, they add a ton of headache for literally everyone else involved in the process (care providers, pharmacies, and of course the patient themselves), all while collecting premiums for absolutely no services rendered. They are the only industry in the US whose entire business model is entirely based on NOT delivering the service they’re notionally being paid to deliver (hell, even their property & casualty siblings manage that and still turn a tidy profit).
In reality, they provide legal compliance to our employers who are required by law to provide “health insurance” once they reach a certain headcount. That’s it. They don’t actually provide the health insurance part to you the employee. That would cost money!
Ah, see, the problem is you’re expecting those dollars to go to actually providing healthcare, instead of lining the pockets of Wall Street investors. That’s simply not how this country works!
The stupid thing is that a Single Payer Healthcare System absolutely would be cheaper than forking over several hundred to several thousand dollars to a useless corporation every month for nothing in return, simply because there’d be fewer bureaucrats involved (which, if you think about it, that level of inefficiency is kind of impressive).
It's not so much like a weight strapped onto our economy dragging down progress. It's more like you put on a second engine on a car and hooked it up so it tried to drive in the opposite direction of where you're trying to go while someone yells "look how much gas we're using, we must be going so fast!"
And then also the car kills you by denying you medical care.
The primary benefit is *theoretically* efficiency. Having an insurance company rewards effective price negotiation with providers and balancing health outcomes against cost of treatment with profit while achieving a positive, cost effective outcome for consumers.
Competition should keep costs down while keeping quality high, again, *theoretically*. The problem is that our rats nest approach to rules and regulations around healthcare has created a lot of inefficiencies. The existence of insurance to begin with has also obfuscated the actual cost of care so people don't see it. The fact that a lot of employers provide health insurance even hides the bulk of that cost from consumers.
We either need to scrap the insurance model entirely and switch to a government-backed catastrophic plan/HSA system with enforced price transparency to optimize efficiency or take a single payer approach. The medical bankruptcy rate in this country clearly indicates that our current system isn't working.
It doesn't help that Healthcare has a cash price and an insurance price that is anywhere from 2 to 10 times the price of the cash price. A $3,000 insurance billed procedure could be billed at $500 for a cash paying patient. Anyone insurance wouldn't opt for that because it completely bypasses the insurance for deductible and out of pocket maximums. A family member was trying to get Zepbound, it was going to cost them $1200 a month through insurance but $450 cash pay direct through EliLilly.
Different costs between OOP and insurance should also be illegal. Why should a person without insurance get to pay less than thousands of people paying collectively through insurance? Also, what on Earth accounts for that delta other than provider greed? You might say admin costs for dealing with an insurance company, but with those price differentials, you shouldn’t be saying it with a straight face.
> The primary benefit is theoretically efficiency. Having an insurance company rewards effective price negotiation with providers and balancing health outcomes against cost of treatment with profit while achieving a positive, cost effective outcome for consumers.
And that might even be true in a world like auto insurance, where the consumer pays the full cost, and there are 15 different insurance companies and numerous repair shops to choose from.
But in medical care, your prices are generally set by one to five medical systems serving your area, and there are only a handful of insurers. The Obamacare exchange for my ZIP code has three insurers, and there are two medical systems within 25 miles of my address.
I think it is fair to say that any system which has so few sellers of a service is a broken market. Simply because what should happen is collusion between hospitals and the insurers to raise prices.
Nothing, it's a greed game. China a power house for making the ingredients pretty much every major country uses to make medicine and mostly all European countries for top medical help, with Japan and South Korea. US not shown in top 10
You have this thing where the US is essentially subsidizing the drug development of the whole world because the vast majority of profit is found within the US.
Like: GLP-1s from Novo literally doubled Denmark’s GDP growth because 70% of the revenue is found from the US. Countries get to implement stringent price controls because of the US Market.
so what’s the fix to this really? If you remove the profit motive there will be far less drugs developed, but you’ll probably have cheaper drugs. MFN clauses? Then either countries that cant afford them get priced out or they just dupe drugs (and then if they are violating your IP and getting away with it, there’s pressure to fix it… so trade conflicts). Honestly I don’t know if there is a good solution.
The high current prices mean more drugs are pursued than their otherwise would be. A company with a drug with 20% probability of success in clinical trials facing potential profit of 1 billion vs 500 million (200mm NPV vs 100mm NPV) may not pursue that drug in the lower priced scenario when trial and development costs cost 100mm.
Its a bureaucracy of malignant middle men. Each one exists only to extract their share of profit from the whole endeavor, and is completely unconcerned with the final product(access to healthcare) being of reasonable quality or affordable.
Same oversight and monetary management as NICE in the UK, Medicare in "single payer" countries, and insurance insurance companies in multipayer countries (France, Germany, Switzerland, Netherlands, Israel, Medicare Advantage).
The only benefit I’ve seen is they can flag truly unnecessary and expensive tests and procedures coming from corrupt doctors / dentists trying to squeeze as much money out of their patients as possible.
While that can be helpful in some cases, I’m not sure it’s worth all the extra money Americans pay into the healthcare system. Not to mention, insurance companies flag legitimate tests / procedures constantly, and for no other reason than they just don’t want to pay for it.
I had a doctor literally tell me “We are just ordering all these extra tests so everyone gets more money” I was a medical record reviewer, so I was livid.
Yeah, that's the part everyone forgets about the medical insurance industry. At some point in the system, someone has to prevent this kind of abuse. It's done in Europe far more upstream. It's on the health insurers in the US to prevent this abuse, and it creates problems where procedures and tests are denied that should be allowed.
There are bad actors, in the from of doctors and other clinicians, who would love to get rich by just ordering every test and procedure under the Sun.
And if you don't think they'll do that, remember there were a bunch of doctors ostensibly running opioid pill mills from the country club golf course.
It’s both. More CYA though. In most cases the doctor ordering all those tests is either a family practice doc or an ER doc. As major hospital systems take over we’re seeing more and more physician employees who get paid the same whether they’re asleep or coding someone. Yes, it’s more complicated than that and they are always being judged on various productivity measures, but your doctor is almost certainly ordering a frivolous CT angiogram because there’s a 1% chance they find something and avoid a lawsuit, not because it puts an extra few bucks in their pocket.
Actually lawsuits are very difficult to win against a doctor. You have to basically die to sue or have something catastrophic happen. Other “smaller” cases (less than $500k of damages) are very difficult to pursue.
Sure, but hospitals operate from a risk management perspective more than anything outside of possibly airlines. Even a lawsuit that is ultimately settled or dismissed can still be bad PR.
No I’ve worked in medicine for almost 20 years. It’s more like “I will order extra tests from my friend A, then my friend A orders extra tests from friend B. Then friend B orders extra tests from me.”
For one, it’s great for global biopharma/medtech development since potential payouts for success are so much higher (e.g., for a given drug, a pharma company will model ~60-70% of revenue from US, ~20-30% from Europe, and ~10% from RoW).
This is an important point that doesn’t get discussed enough. See figure 9, https://researchonline.lse.ac.uk/id/eprint/87362/2/jama_Papanicolas_2018_sc_180001_3_.pdf
Because the profit comes from the peripheral costs. Medications, devices, wages, etc etc. and because everyone of those jobs are wasted costs to the system
4% profit margin doesn't mean 4% return for the investor. If I have 10 customers paying me $100/yr in insurance, that's $1k with $40 profit. Next year, I have 20 customers, and my profit has doubled to $80. My profit margin remains the same but my earnings doubled.
The 4% is profit margin, not return on assets or return on equity.
Yeah, this is an important distinction I should have made. I think if the incumbent companies were making a healthier margin, there would be more of an opportunity to attract new capital/start-ups into the marketplace. But why would you at this point, with a 4% margin and a very real possibility that the system will be socialized in the coming years.
Lol, so not going to actually address anything and instead ask why investors behave the way they do? Well, Walmart has a 3% margin. Krogers has a sub-1% margin, why are investors so dedicated to continuing those industries?
I guess when you can’t defend your beliefs, one can always just change the subject instead of changing his or her mind.
ah, so clearly you're just a gaslighting troll who makes statements without support & resorts to insults & changing the goalposts when asked even the simplest question. I didn't change the subject - I asked you an extremely basic question *about* the subject. You failed.
Then why hasn’t it happened? Seriously, the public opinion is UNH is making money hand over fist. I get it would be a big hill to climb, but there’s money out there if the returns match the rhetoric.
It's a low margin (actually in reality if you gave the healthcare instead of denying it ZERO margin) business. That's one of the huge problems. There isn't profit in healthcare. It's one of those things like education that doesn't make money at it's core. It's there to make people better. Not make money, but we live in a society that is entirely driven by the profit motive and hell it's brought us some great things, but there are things that shouldn't be operated on the profit motive. Police, Firefighters, Education, and yes.. healthcare.
Not trying to start an argument, but you don’t think there is value in having companies like Medtronic and Boston Scientific competing with each other on price? If Earl Bakken can’t make a profit on pacemakers, do we get insulin pumps?
Oh I totally agree, the "free market" has inspired innovation in the medical field for sure. Like I said -- it's really complicated and I don't have the answers.
The incentives are completely fucked. They want healthcare costs as high in aggregate as possible because then they can charge higher premiums -> larger float -> more profits.
They’ve created an ideal situation for themselves. For example, a hospital charges $100k, the insurer negotiates it down to $10k, they tell the customer that they paid the full $100k and then ask for $5k more from them. All while charging more than $1k a month.
They act as a counterbalance to unchecked medical Care. unfortunately not all doctors are good at their jobs and not all doctors put their patients' interests first. so they can be an important check on medical quality but in reality it has become very predatory.
and they were supposed to be able to pool enough money together for people to afford care and they haven't been able to do that.
This is not the case. You are thinking about Medicare. Medicare collects and audits provider cost information to help establish its payment rates, which private insurers use as a benchmark when negotiating their own rates. Doctors assess what care patients need, and medical boards oversee professional standards.
All insurers do in the process is determine if they must pay, which they have an incentive to find ways not to (insurance paperwork is complex for a reason
)
In what world is "unchecked medical care" a serious problem? And what impact does "making it too expensive to get even basic or preventative healthcare" any kind of check on unskilled doctors?
Yep - and the fact that you’re paying out of pocket like 500-800 per month then have to shoulder 7500 in deductibles annually before they pay for anything is insane. Plus you have your copays when you visit too. System is nearly pointless
Which basically means most of us who have insurance really only have catastrophic coverage.
My wife and I have decent insurance through my employer but it’s only really good for emergencies.
If either of us got cancer or contracted a mysterious illness that required endless batteries of tests and specialist visits we’d be broke in less than a year.
Until you have a 7 figure procedure or require a 6 figure medicine annually to treat a condition. One of my best friends had both and ended up with his deductible as the price. It's great if you need it, for most healthy adults it's hard to see the point.
Fair point but we live in Asia and insurance and procedures are much less expensive. I fly to Singapore for my medical care and it’s still than I’d pay in the US
Okay but most other systems handle those procedures just fine, so we're talking about achieving the bare minimum, with a ton of other downsides as well.
> Until you have a 7 figure procedure or require a 6 figure medicine annually to treat a condition. One of my best friends had both and ended up with his deductible as the price. It's great if you need it, for most healthy adults it's hard to see the point.
EXCEPT, the entire rest of the world doesn't fuck you over completely, like the USA does.
Well not the entire rest of the world, but yeah of course lol. I was just pointing out why someone might really need healthcare in the US. Inversely, single payer systems have their drawbacks too, insulin pump use is exceptionally far behind in Europe compared to the states.
I'm not an advocate for the US healthcare system, but I think it's disingenuous to act like single payer is better in every way. At this point I think that's true economically, and I've become really disillusioned with our system and it's unnecessary complications.
Another element is the fundamental change in workforce participation should healthcare ever become a public option.
I fully expect to see a mass exodus of people leaving their jobs to do what they might love more rather than being chained to a job they hate to get benefits they can’t live without.
The current healthcare model is a mechanism of the slave owner mindset.
It would help but let’s not act like the lack of social safety nets to create significantly better small business participation aren’t still going to be a wall people run into.
A huge issue is many of the people leaving will be healthcare workers.
You’re going to hit them with lower wages, higher tax rates and more work all at the same time. It’s a recipe for a mass exodus.
So I’ve been working in healthcare IT for the past 10 years and I think this bit is interesting…
There will likely not be much change for the care side (doctors, nurses, etc), but the question will be what is to do with all of the corporate workers.
If we for example expanded Medicare to all Americans, it would dramatically increase the number of folks needed on the backend to gather and process healthcare access requests etc.
Right now, the best company that does this is Kaiser - as they have a closed loop system. I’d imagine a dramatic expansion of Medicare would work similar.
So we would need a ton of workers to support the expanded demand of Medicare.
They won’t all get picked up, but I think a decent number of them would be.
Nursing turnover is already huge. It’s ballooned from 11% to 18% annual turnover in just the last 7-8 years.
By 50 most doctors who aren’t horrific with their money are in a position to retire outside of their own healthcare needs.
These are high earning W2 positions which will be where the tax increase will need to concentrate to cover the new system.
The only way to pencil out the math is to expect salary reductions from high earners in the healthcare sector.
It’s a perfect storm or end up with massive healthcare shortages. I know my spouse, myself and a number of people I’ve talked to would bail on clinical care tomorrow if we move to a system like those proposed here constantly. For us, we’re also dual nationals so we’d also consider bailing on the US without the better wages.
Fair. But whether we roll out Medicare for all, single payer or whatever, those issues will persist. Care providers and solving their quality of life and pay challenges would be a subset of the overall change to be addressed.
Maybe, because of the dumping of all the profit needs, those savings could go to the workers.
>For us, we’re also dual nationals so we’d also consider bailing on the US without the better wages.
Honestly curious where you would move that has lower taxes, and a not significantly worse standard of living. It's not like there are decent countries to move to that don't have single payer or significantly socialized healthcare systems
I think single payer isn’t politically feasible in our braindead political landscape so I would be fine with busting up the regulatory restrictions for consumers and the tax incentives for companies to buy expensive plans and instead give everyone HSAs and ram that money into there and force hospitals to publish prices, as a start.
Then monthly payments for catastrophic policies only if you want, as an option
Just rip the money the fuck away from these health insurance predators and let us go doctor shopping for PCPs ourselves and get insurance to just fuck off and have actual transparent pricing on drugs and standard procedures
>The administration sent warning letters to 519 hospitals for failing to provide transparent pricing information, according to a June Associated Press report. Hospitals in every state except Alaska received at least one letter.
...
>By contrast, CMS has fined one hospital in 2026. Pinnacle Hospital in Crown Point, Ind., was fined $51,615 on Feb. 4 for 155 days of noncompliance. The fewer-than-30-bed hospital was the 28th facility fined since the rules took effect Jan. 1, 2021. Pinnacle drew a second penalty of $40,356 in June for continued noncompliance, bringing its total to $91,971.
>That pace trails 2025, when CMS fined 10 hospitals, with penalties ranging from $32,301 to $309,738. CMS fined three hospitals in 2024.
No, it was the ACA, so Obama there, then Trump’s HHS/CMS released the rule under the ACA on Jan 1 2021 while Trump was doing his insurrection stuff.
And I have a bit of depth of knowledge on this because I started building an “uninsure-me” website with data scrapes of every hospital system in the United States in April 2026. The machine readable code is a fucking mess. Zero standards. It’s all over the place.
It needs to be less purposefully granular and instead abstracted up a bit, too. It’s just purposeful noise but the price differences between uninsured (cash pay) vs insured is often astounding.
Well we can’t do either because of the same root cause, propaganda
No one is building a space data center, and even if a genie got single payer up in the USA, shit would get sabotaged constantly, worse than Obamacare, by the right wing of this country.
and make more medications over the counter. statins asthma inhalers birth control pills HRT etc. you can require people to go through software education at the pharmacy before they buy them so there's at least some counseling on how to use things safely but get medicine out of the way.
and put labs in all the pharmacies and make most of the blood work direct access for consumers and let companies compete. there is no race to the bottom in medicine. there's a race to the top. we need to flip the dynamics.
If you just let women check their ferritin at will for like 10 bucks that will remove millions of dollars of expense from the medical care system frex.
Simply adding back the mandate would at least get you 90% of the way there from "completely broken, ass backwards incentives" that we are at now. I think that actually is feasible at least.
I don’t think we have the political landscape for that either. Both ways to fix would face major propaganda from the other side. I think the anti-regulatory fix is the less popular opinion too. Especially if there were no safety nets.
To corroborate your point... United States Domestic general government health expenditures per capita ranks 4th after Monaco, Norway, and Luxembourg according to OECD...
So even if you deduct all the private expenditures that come out of our pockets for health insurance, we still rank 4th in how much GOVERNMENT spending we do per American.
Before finding this, I had no idea how completely warped and broken our system is. Not to mention that DOES NOT include private expenditures and, on top of that, our healthcare outcomes rank just below Russia (in terms of Healthy Life Expectancy) and Croatia. (in terms of Overall Life Expectancy)
The US government expenditures per capita are $7,269.29, Russia's is $2,244.05, and Croatia's is $2,713.16.
That's under 1/4th and under a half the government spending on healthcare per capita to achieve BETTER results.
Two reasons for this often repeated claim from those our educations system has failed...
Our system allows for insured Americans that need surgery to be pushed to the back of the line by anyone willing to buy your spot from hospitals that face no risk of losing government funding from your taxes for doing so. Why wouldn't they let gullible chuds like you die when there's no risk of losing government funding for cancelling on you for some Australian billionaire or Middle Eastern dictator?
The reality, though, is that estimates of others coming to US specifically for Healthcare always falls under 500,000 per year, which is dwarfed by the over 1.1 million Americans that fly to other countries for the same purpose. This is especially pronounced when you consider that the only 4.2% of the world population is American while non-Americans number about 7.84 Billion non-Americans across the world.
So a MASSIVELY higher percentage of Americans travel outside of America to receive healthcare while an incredibly tiny fraction of non-Americans come to America for healthcare.
If you're not too busy indulging in Fox News and 8chan for the rest of your life, I strongly encourage you to look up what I'm saying. Don't respond to me with your results, either. Just do it for yourself this time and blame your sources for making a fool out of you instead of blaming me.
Government healthcare wait times are insane. Look at NHS, it can take 8+ years to see a psychiatrist for an autism or ADHD evaluation for kids. Do you think we would accept that in the US??
Eight years is outrageous! America’s fix? Price people off the waitlist entirely. In a 2024 survey, 57% of underinsured Americans skipped needed care because of cost. That’s not efficiency, it’s rationing by wealth. And our government alone outspends the UK’s entire system per person to deliver it. A waitlist you can’t afford to join isn’t shorter. It’s just invisible.
You do know that countries with universal healthcare also often have private healthcare sector as well? So you can pay to get to psychiatrist quick, or you can wait in line and eventually get there. And no, before you misunderstand, emergency procedures are not pay to get, private sector usually does not even do them where I'm from but directs customers to private sector. They are done quick.
The point of insurance in general is selling risk, with the insurance company as the buyer and individuals or companies as the sellers. It works pretty well for this with reasonable regulation (e.g. rules on what happens with catastrophic correlated risk realizations).
The US health insurance system is a hybrid between risk selling and just healthcare bundling. "There's a 1% chance I get cancer over time frame x and I'm willing to pay 0.011x the cost of cancer treatment for insurance per time frame" is an insurance market situation, "there's a 100% chance I want an annual checkup or age appropriate screening" is not really. The hybrid of these combined with a lot of regulation has lead to a fairly messy situation in the US now.
Most of the countries with single payer still have private insurance market too. It’s just that in the US the public healthcare sucks even though we pay the same for it as single payer would cost
The elephant in the room is also the pay for doctors, nurses, and specialists are insane and unsustainable.
Every other country that has socialized healthcare pay them a fraction of what they can get in the US.
In order to transition to this model in the US, you will need doctors and nurses to accept lower pay
Edit: every1 in comments disagreeing with me and bringing up arguments, except they can’t explain why every country with much better healthcare pay their doctors and nurses much less.
You all support socialized healthcare but won’t put your words where your mouth is.
Physician compensation accounts for roughly 7.5-10% of total U.S. health care expenditures
Edit because people seem to be misunderstanding me: What I am saying is that in the US physicians are compensated a SMALL fraction of the overall expenditure pie; and thus "paying them less" would do fuckall to improve things. Ditto for nurses and other hospital staff
Replace ALL the admin (in hospitals and insurance companies) with AI, and cut the price correspondingly.
Even replace some of the doctors - a lot of people get better results from AI than from a real person (sadly).
AI/tech assisted/remote surgeries.
Let Europe/China lead the way on research, and cut all of those expenses that the US currently subsidizes the rest of the world with. Instead, we can just steal their innovations for the fraction of the cost.
A lot of biotech and pharma innovation has moved to China including western companies who foolishly continue to either put research hubs there or do joint ventures.
You also have more Chinese grad students and early career scientists coming home vs staying in the U.S. like they did 10-15 years ago.
Replacing humans with Ai is a recipe for disaster particularly in healthcare. We need to get rid of insurance. They are leeches that have no reason to exist. The system is complex because of insurance because the business model is not health its profits over everything.
No it hasn’t. Using AI model results from MCAT or USMLE tests isn’t remotely the same thing as a physician making a general diagnosis and a treatment plan.
In the near term future, it is what I expect poor people will get before they are triaged to a physician for possible care.
That’s fine. That doesn’t mean Ai should take over everything. We also have shitty politicians and that’s where I think Ai would be more useful. CEOs don’t need em, Ai can do that. Humans, don’t need em, Ai can do it.
I could agree with the former, but I think it’s important to keep pharmaceutical research in America. It not only because removing our best minds from healthcare research would be depriving us and the world of life-changing healthcare, but because it brings tremendous value to our economy through private innovation and agglomeration effects.
The far far bigger elephant in the room is that the legal system gets to dip their beaks into the medical system. Currently working in a single payer system after having left the US and the lack of defensive medicine here is so refreshing, also no Press Gainey.
This is a complete red herring and it has made ZERO difference in medical costs in states that have hard cap tort limits.
It’s mostly red states because trial attorneys donate to Democrats to ensure those caps don’t come into effect. It’s a rounding error in terms of overall U.S. healthcare costs.
It’s not the cost of the lawsuits themselves, which is relatively low as you say. It’s the fear of lawsuits that leads to a much larger amount of unnecessary testing, treatment, and use of resources.
But again if it is capped to dramatically lower costs that you should evidence that there is a reduction in the practice of defensive medicine in those states. There is no clear definitive pattern like that on diagnostic and imaging services utilization.
GOP politicians can say whatever they want to but it doesn’t make it remotely true in actuality.
Even in tort reformed states, doctors don’t want to be sued because it’s still money, time, and possible license issues. On top of that, the culture is still defensive. It’s not necessarily rational to worry about lawsuits that much but it’s widespread.
To be sure, this isn’t the only or main thing driving up costs, but it’s a factor.
This is curious. I think it partly relates to the entire education->debt trap sort of design we see with these profession. Like yes, those countries pay their doctors way less, but they also don't levy 400k of debt onto their medical residents.
Which makes me more curious. If we want to address healthcare and therefore professional pay, we may also have to address student loans and the cost to become a doctor. The BS Biology/Premed alone is often several 10s of thousands. If we forgave student loans for those degress and made the tuition for those programs the same cost as other countries.. would healthcare professionals be able to accept less pay.
But it's all linked together. I dont see how any of it is honestly address without each being so.
The system to train them and put them into indebted servitude is broken too. The problem extends to academic training.
That said, these individuals are often overworked and it’s not exorbitant per the effort. Few clinicians make more or have a greater net worth in their 40s than they would had they chose a different path in college.
lol,
Good luck getting US healthcare workers to take less pay. That will not happen…
Ok, so main reasons why healthcare workers are paid less? Because they can and higher costs for each employee in those countries.
My company? I work in the US and earn 3.25x what the same job in France pays, 2.9x what the same worker in Germany pays. Because my company has higher taxes and costs, so there are less funds for worker wages. Higher corporate taxes, higher payroll taxes, and higher costs due to higher benefits/leave costs.
Some workers in those countries, recieve lower wages.
US? Low company taxes. Low payroll taxes. Less cost since there is no/little maternity leave or disability leave, and less regular PTO also.
So my company and others can offer workers higher wages.
US is indeed good for lower company and payroll taxes, which means companies can offer people more money, Also people can be fired a lot easier in the US then in most european countries. and less PTO in general. Sick leave as well, most european countries you can just call in sick for months and a company cant do anything about it.
How do you suppose that overpaid doctor is to pay for the $250,000+ student loan because god forbid the public proactively support education through taxation. Somebody is going to pay eventually. If it doesn’t come out from taxes, then they will take a bigger cut from your wallet.
Walk into any cardiac Operating Room in the U.S. and the combined education of student loan debt in that ONE room is ONE million dollars between anesthesia, the CRNA, the surgeon, the PA/NP, the perfusionist, and the nurses/surgical techs. Those professionals need to pay the loans by themselves that Americans feel shouldn’t be their burden despite wanting their services….they aren’t for free.
Maybe start looking at the real problem….why is the CEO of Banner making 20+ million/yr or the CEO of Jefferson making 5+ million/yr. These are not for profit healthcare networks. A salary like that is stealing from the community. The people doing the work (who you blame) are just trying to pay their fucking bills too.
Just like nobody cares about forgiving student loans for people that are obviously not making doctor wages, nobody cares if the overpaid doctor can pay his or not. The problem is health shouldn’t be a profit center. If we want to fund research stop fighting moronic wars. We have the money it’s just not going where it should.
Yeah we can and we should. If the only reason people become doctors is to make tons of money there’s is something completely wrong with our system. Pretty soon they won’t have that many people to treat anyway because nobody can afford them.
You think it fair to burden someone with 400k student loan debt + halving their salary?
After they have made the decision to go to med school. That's a 10 year+ journey, you can't pivot on a whim bc the government just randomly decided to fuck you before you graduate and make any money
Yeah and that’s a problem. Banks get bailed out for irresponsible financial decisions, they can help crash an economy and everything, but when it comes to the average folk and that could be a doctor a teacher or whatever, no they are expected to carry that debt forever regardless of the economic conditions of the country. And then we use that debt to justify higher healthcare costs including medical staff compensation yet the average person which is the bulk of who these people treat right because the billionaires go to Europe for that, the average person can’t even afford to see the doctor they have paid for 30times over…at what point can we all agree that the system is fucked and it’s not working for us???
What!? People call for cutting teachers salary and benefits constantly. All public sector workers. That's like a core part of republican policy. Doctors are going to have to buck up and start imagining salaries more like doctors are paid in Australia or Germany. A friend of my parents when I was growing up in Australia was an orthopedic surgeon who collected Ferraris. So you'll live. A lot of my family in Australia were/are doctors and they do fine. Not American doctor fine, but no one is crying for them.
You are proving my point. Why is working like this considered acceptable in the profession if these are people responsible for human lives? Why does becoming a doctor, which society really needs, why is it so astronomically expensive? Why does it require astronomical debt? You are defending your compensation for enduring a broken ass system that makes zero sense in the real world yet do not question why it operates that way. If medical professionals really put their foot down the system would be permanently changed. You are important not insurance. But they won’t do anything because in this country we prioritize profits over all. No doctor would want to go without pay because insurance companies are predatory monsters right? I don’t think medical professionals should be paid less, I think they need courage. I think insurance companies need to be banned and healthcare needs to go back to prioritizing patients and the people caring for them over profits. While you struggle with these crazy shifts and the stress that comes with that, and some patient dies because they afford to see you, some insurance shareholder is buying their 17th mansion in who knows where.
The "cuts" are to the amount we pay for healthcare right now. That's the current "spending". Is the required taxation lower or higher than what we pay for in premiums, deductibles, co-pays etc? The evidence seems to suggest it could be. Whenever people start going on about "well, where are you going to get the money" it's like they forgot we already pay for healthcare right now. We don't have to "find" some new source of revenue. It's us. Redirecting other current government spending would either help make the system better or lower costs by some amount.
Issue is new costs will eat into savings. Yes UHC can have some cost savings in 2-4 areas of spending. But that does not reflect more patients, more visits, higher pay rate needed, more subsidies, and higher malpractice costs. Which many proponents either gloss over or try to dismiss entirely.
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As for saving money? For me and my company? New payroll taxes will be more than I spend today. So yes, in my case and 14,800 workers. We’ll be paying more. My company especially, and workers will see less raises, less compensation as a result.
My wife’s small business? She Webber offered healthcare. Now would see a significant payroll tax. She will either lay off or try to raise prices. If raising prices does not bring in revenue to afford new tax, lay off or just close. If she closes, 30-40 employees looking for new jobs.
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So you are saying the govt can move funds from other social, defense, education, and transportation sectors. To make up needed funds to lower costs?
Of course they can do that. Would be prudent to also balance budget, cut spending in all areas to shift to UHC and raise normal income tax brackets at the same time. So a new individual payroll tax of 4.5-7% and increase of federal income tax of 5-10%. To align more with countries that offer UHC. Higher taxes at all levels…
>Every other country that has socialized healthcare pay them a fraction of what they can get in the US.
This is true for a lot of industries though. The US is just straight up rich enough to overpay. For example my wife and I looked into moving to Europe and we could expect to make about half of what we do now. Neither of us are in healthcare, and we are both in different industries
Yes, wife and I lived in London, Berlin, Madrid, Barcelona. Loved living in Europe. But with growing family, moved back to US.
We were able to leverage higher US wages/lower taxes. Allowed us to more easily retire at 48/43. Our coworkers still in Europe? 52-58 and still working, with less investments/retirement savings…
An, so levering higher wage potential in US. Accumulate larger funds for retirement. And then move to Europe.
Yes, that can be done easier. Why many coworkers at my comment come to US. Bank that extra income, let it earn more in investments. And retire back in their home country.
Best of luck. Make sure you have run the numbers, as US citizen still responsible for US taxes.
As for me and wife? We travel, 8-9 months a year. Typically spending 3-4 months in Europe. Just can’t see moving there permanently. We have 4 children and 3 grandchildren under 18 months. So staying in US.
People say this, but I have a couple close friends that are doctors. But not the rich kind. Most jobs in the US pay more than Europe. Software engineer pays like 40k in EU compared to an average of probably around 120k in the US. Lawyers in the US definitely make more than the UK or the EU. Regular white collar finance jobs definitely make more in the US than the UK or EU.
Also it’s only some kinds of doctors that make a lot. Pediatricians in the US make like 140-150k. Family medicine I’ve heard is like 180k-240k.
I don’t know where you live, but these aren’t astronomical numbers. Me and my wife have very middle of the road jobs, she is in supply chain, and I work in sales, and we each pull in around 130k each. We live in a sort of mid to HCOL on the east coast. In a good year, I know I’m probably making more than most pediatricians, and I work with dudes who pull in multiple hundreds of thousands a years, and I’m sure they make more than the “average” doctor. And there’s definitely more sales people making that money than there are doctors out there.
I don’t quite understand where the money in healthcare is going. There are some doctors out there that don’t take insurance and seemingly make millions. So it seems like you would make more by not taking insurance in the first place.
Thank you for this. I have patients complain to me constantly “you must be making a fortune off of me” and you must be rich…. I’m a physician assistant in FM who graduated with ~100k in loans. I make 140k a year with 1 week vacation if I hit all my production and quality bonuses. Unlike a lot of people I have no sick time and no PTO. I only get paid when I work. I take call 1 weekend a month and work some extra shifts on weekends throughout the year. I average 50-55hrs of work per week. Do I make a good living yes and I’m grateful for that but I also did 7 years of post high school education and had to take 2 years after undergrad to work/apply for PA school. I’d hardly say I’m the problem with health care being expensive. I see 20-22 pts per day 4 days per week and I have a wait list over a month long for a primary care appointment. I could go get a bunch of other jobs with way less stress and liability for similar pay (yes I know it would take me a few years but that’s not the point). My pay has not gone up in the past 3 yrs meanwhile your insurance premium (and mine) has shot way up. It ain’t me being the reason for the cost increase I literally get poorer by the year on the current system.
The vast majority of people want cheaper healthcare so they really don’t care to understand the economics behind it cos they have very fixed beliefs and mindsets and they do not want to change them.
Cheaper healthcare requires a lot of things that will be unpopular, e.g. a higher ratio of patients to healthcare workers so longer wait times. Also, the system must suppress wages for healthcare workers and impose price controls on drugs and expensive diagnostics but this also has the effect of making shortages more acute cos lower wages push people away from healthcare work, and price controls make drug and equipment vendors divert supply towards markets with higher pricing so there’s less for markets with price controls, etc. The right solution isn’t obvious at all, but some form of consumption control is almost certainly going to be necessary and none of it will be popular. e.g. docs won’t prescribe services that aren’t necessary or effective, long wait times will deter people who don’t need the treatment from using them, etc.
Also, I’m constantly surprised that alot of people have this misconception that if they pay annual premiums for health insurance, the cost of ALL treatments should be covered. No ifs, no buts. This mentality jacks up pricing for insurance and contributes to severe cost inflation. We live in a world of scarce resources, and especially so in healthcare, so no matter how much your annual premiums are, it’s not possible for any healthcare system to cover everything so the least necessary treatments must be curtailed in order for prices to remain affordable for others who truly need them more.
Health insurance isn’t meant to be a buffet for anyone to use limited healthcare resources in irresponsible ways. It exists to mainly protect you from catastrophic outcomes, e.g. a $200k brain surgery that will bankrupt you if you didn’t have health insurance. If everyone wants unnecessary MRIs, CT scans, etc “just in case” it shows something, then the cost will rise for everyone.
Finally, the cost of healthcare in a country isn’t just about how the healthcare system is designed (e.g. single payer, hybrid, how the insurance industry works, govt policies etc); it also has ALOT to do with how people choose to live and how their culture affects their healthiness, and Americans have perhaps the riskiest lifestyles due to the prevalence of highly processed foods, cities designed for driving not walking, guns, culture for binge drinking, insanely large portions at restaurants, etc.
I fucking hate arguments like yours. “The rest of the world figured it out but you’re all too dumb to understand that we’d have to make compromises, and therefore we’ll just stick with what we have”
So what’s the fucking solution then bud? Stick to the system we have so that I keep paying $700 bucks a paycheck to UHC so when I get cancer, I can pay another $10,000 out of pocket, to then get billed another $15,000 cause the janitor in the oncologist office wasn’t in network, to then get denied medicine cause it’s not covered, to then spend hours of my fucking life on the phone with these cretins explaining why I need medicine my doctor prescribed? Meanwhile, the leeches at the top get fat and rich off my money? And the same leeches get government handouts with my tax dollars on top of my premiums?!
On scarcity: this is artificial. We have all the money on the fucking planet for our war, Israel’s war, ukraines war but we don’t have money to help alleviate scarcity in medicine? First off, Is scarcity the reason an aspirin costs $1,500 bucks at the er? No it’s not. But we could found new medical schools to get more doctors, fund innovation in genetic drugs to get cheaper drugs, build new hospitals, etc. the scarcity here is artificial.
Our system is legal extortion. I’d happily make compromises so that all Americans have access to affordable healthcare. It’s honestly change the system or it’ll collapse.
Yupp. The only people who aren’t allowed socialized medicine (but are allowed to pay for everyone else’s) are regular working taxpaying citizens. Not sure why everyone else gets it but regular taxpayers get to be consistently fucked.
What compromises did they make? And if you're going to say wait times don't bother. My pcp is booked out 3-4 months. I had to wait months to get a colonoscopy, and a dermatology appointment needs to be booked out at least 6 months ahead of time.
They're talking about compromises made by some imaginary person with some imaginary health care plan who can waltz into their pcp's office (let alone a specialist...) for any old boo boo. Trying to scare us if we don't have long wait times right now! That bs might have worked in the 90s. But it's not going to work anymore. We live in the modern US private healthcare system. It sucks. There are no redeeming features that you can't get elsewhere for much less.
Depends where you are talking about. Combination of many things from wait times, availability of imaging, availability of procedures, and ability to drive your own care.
For wait times specifically it depends on what you are waiting for. But your unsourced wait times must be true.
Healthcare and most other services are not zero sum like most of your arguments imply. Good investments in supply side technologies could actually make cheaper healthcare, but hiring more people or giving more demand side subsidy (which is what the current US spending policy is all about) wont help.
Yup. People love to hate on insurance company denials but most of that utilization management is an attempt to keep costs down for everybody. The profits just aren't enough to explain all those denials.
It’s worse than that, they make them work more for less. It’s one of the reasons I can’t move to Canada. My wife is a nurse and the patient ratio is much higher in Canada and the pay is a fraction of what you can make here. No one wants to work more and be paid less. It’s why socialized medicine will always be much more expensive here. Cutting out insurance will save some money but it’s not gonna do anything crazy like reduce it by half or something. That said we should still do it. But it won’t be cheap.
The insurance and billing is about 30%. Exorbitant brand name drugs are a big chunk too. There's a lot e could cut before lowering pay for the people providing care.
Because according to this table the insurance overhead is less than 20% and that includes administration which absolutely would not vanish in a single payer system.
Actual insurance company profits are less than 2% of total annual US health spending.
Just remember that the doctor gets paid for treating a patient. Not curing a patient. I was “treated” in the United States for knee pain for 5 years and got progressively worse. I was treated in Europe for 1 week, had a small procedure and was cured. 60 visits in the US = $12,000 versus 2 visits in Europe for $15 after my insurance. Doctors don’t have an incentive to cure you quickly.
Doctors in the US make much more than their European counterparts. As do most US workers. Should we cut every worker’s pay too to equalize with Europe? Maybe go even further and peg it to Chinese salaries?
Their salaries are lower regardless of taxes, which are higher. Different issue. Interesting you’d like lower pay though. That’s not a popular sentiment.
While you're not wrong, it's probably worthwhile to compare liveable wage - aka the average healthcare workers' ability to pay for food and rent abroad where their minimum wage equivalent hasn't stagnated for the past 40 years.
The UK pays its healthcare workers meager wages, but it pays everyone meager wages compared to us. They can eat and have a roof over their head. We pay a whole lot of jobs so little that some work 80+ hrs/week and can't make ends meet, and it's not getting better.
Reddit will assure you that $600,000+ for a specialist is nothing more than a rounding error. We only mention "the developed world" when it's convenient
What should someone who goes to school for 12yrs, goes into massive high interest debt, gives up their 20s and early 30s, working and studying 60-80hrs/week get paid when it's all said an done? They are providing an actual measurable good to society. Plenty of other professions pay more without as concrete of a benefit to society.
These talking points come around like clockwork. How about I put the shoe on the other foot and use the lazy speaking point of "the developed world has figured it out!"
In reality, you already gave the answers on what we could fix. Instead, we will just continue to pay for everything at a premium price and pretend we have no solutions.
Artificially limiting the amount of doctors, absurdly high education costs, long training periods are nothing that need to be discussed at nauseum, complete with gotchas and talking points. If we increased the supply of specialists, they could make $400,000 instead of $600,000 and the world will be fine.
What a brain rot response. Thinking you can just use smoke and mirrors to make whatever point you want. If you want to use Anesthesia as your example, that is fine. They still make considerably more in the United States than they do anywhere else. That is the point. Period. Instead, I already know your response is talking points (shuffles papers) "well they deserve more because they do good and study good!"
No, my response is that doctors salaries don't move the needle on healthcare costs. At all. Canadian doctors have similar salaries and they have socialized medicine
It has nothing to do with "studying good" and everything to do with the exorbitant level of student loans MDs are saddled with.
There is no hope of paying off 400k on a 200k salary and affording any kind of life. NO ONE would become a doctor using that calculation
The actually expensive things doctors must carry is MALPRACTICE INSURANCE. If you made it impossible to sue doctors, then costs would actually go down
You could drop all physician pay to $0, and it would decrease overall healthcare spending by 8-10%. Imagine that. The people actually doing the diagnosing, testing, and treating, only get 8-10% of all the value they generate. If you want healthcare costs to decrease, there's bigger fish to fry than squeezing the people providing the service that enables this whole freaking machine. Look at the median length of careers, they're getting shorter. Burnout is already pushing people out of the field and you want to decrease their pay? Other countries have figured it out, and guess what, the US isnt the other countries. Public health and healthcare spending in the US are much more nuanced than just going after physician pay.
No one is talking about "fixing" US healthcare by just making physicians slaves to the government. But reducing their compensation is definitely part of the overall mix necessary to fix the system.
I don't think physicians would mind being government slaves if it meant fair compensation for value provided. A few things to consider when dialing in physician pay. There's already a shortage and people are also leaving the field sooner than before. Decreasing pay will only exacerbate the shortage problem. I personally think an easier solution would be to limit insurance company profits, so they focus on actually just serving their customers rather than their shareholders.
Medical Residents are ALREADY government slaves. They are legally barred from calling in sick, they cannot NOT show up to work and they can't get other jobs- they are legally indentured to the government for 65k a year with 80hr work weeks
If you told me that I would have to continue this career at 200k then I would quit tomorrow and go work as a medical advisor for Goldman or something
This is why I didn't care to engage. I already knew you were only going to bring disingenuous talking points. We have the highest salaries in the world. Fact. Higher salaries bring higher costs. Fact. Just because other things are broken, doesn't mean you act like a 5 year old and fix none of it.
Happy to engage in conversation in reducing healthcare costs and making it more efficient. I'm just also pointing out other facts that there's already a physician shortage. There's also a high rate of burnout with the way things are. Why spend all the resources it takes to train these professionals when you're not going to work on retaining them. Seems like an inefficiency that should be addressed. It's easier to retain someone than it is to send someone through the training pipeline, and the effects are immediate. Plenty of experienced docs who left because of burnout that could be reactivated given the right incentives. I agree that physicians in the US are the highest paid in the world. And that their salaries contribute to healthcare costs. Im also saying that US salary, in any profession, is also the highest paid when compared to other countries, so it's not really a fair argument to say because other countries pay less, so should we. A doc in France making 150k and a doc in the US making 150k are not living the same lives. I personally think limiting insurance company profits to refocus on serving patients rather than shareholders is a good start. Also having am honest conversation about preventative care and what it means to have robust public health would go a long way. And then also setting better expectations about end of life care, when care costs can blowup exponentially, when it doesn't extend quality of life. Those are alluch bigger potatoes in my opinion. Say you cut physician pay by 50%, their compensation makes up such a small portion of overall spending that the negative consequences would have worse repercussions on the system.
I also forgot to address your point about increasing supply earlier. Increasing supply without mainting pay would only help the shortage in the immediate term, but discourage next gen from entering the training path. It also doesn't decrease overall system cost. Going from 1 doc making 600k to 3 docs making 200k costs the same in the end, except you had to spend resources to train 2 more people and now the peeps that are 13 years younger will no longer enter the field. People think docs and their salaries should purely be based on free market supply demand, but they forget that healthcare services are inelastic and the supply takes a long time to come online. If you want people to go through it, the incentives have to be there. People who can become docs can also just as easily go into any other lucrative field. Once you force them to make that choice, you lose out on a potential doc.
Did you bother looking at the pay of the office workers? They are not important, nurses and doctors are and when you look at the medical debt to train a doctor and tell them there’s a massive pay cut coming you get no doctors. These people earn their pay, the white collar workers do not. Cut the real chaff first and the budget will magically fix itself.
Cut physician pay to 0 and healthcare costs decrease by only 8%-10%. The professionals trained and educated to deliver the care and push research are already feeling burnt out and you want to further decrease their compensation?
You need to look at as it relates to GDP and GDP per capita. Administrative costs associated with insurance and billing are about 30% of overall costs and that's about what separates our costs from Switzerland, which has a similar GDP per capita.
Who is going to authorize wiping out student loan debt for doctors then? You can’t have someone be 400k in medical debt and cut their salary in half
Also, no one would go through the medical training system in the US for only 200k a year. It’s too grueling and there are better things to do at that salary level
Canadian doctors are payed similar to the US and they have socialized medicine. They also have a very hard cap on the number of doctors that are allowed to graduate from medical schools in Canada so the state doesn't have to pay so many salaries
Which is why so many Canadian doctors immigrate to the states
First step would be to get rid of astronomical tuitions and nationwide tort reform. Then consolidate into a single payer and redistribute the market cap of the largest payers back into the pool.
One of the largest costs for healthcare in US? Malpractice Insurance. Which will skyrocket if US goes to UHC. With less patient time and more patients, will lead to more medical issues, turning into more lawsuits…
Estimates are under M4A under Sanders? That malpractice insurance would go up $175B-$225B, erasing any gains from
Prescription drug savings…
Tort reform usually means damages caps that limit the amount injured people can recover from negligent doctors. I'm not sure denying legitimate claims full compensation really accomplishes anything.
The pay is not even the issue. Money is not an issue. Do we have enough healthcare supply? No we don’t. What stands in our way? Time, space, and incentive structures.
I'm a party member, a delegate at both the state and national levels, and heavily involved in the party. To say you support a socialist policy of any kind is almost considered treason to a Libertarian.
One might argue that if you are pilloried for supporting reasonable policies because of how they are labeled, it may not be such a great party/economic philosophy.
Right the theory behind private healthcare is price transparency and choice which we have none of. In theory the competition should drive the price down but there is very little competition.
The theory behind socialized medicine is that everyone has access and doesn’t go bankrupt when provided care. Which we also don’t have.
Yes, and what we have is privatized healthcare with heavy government regulation and intervention, so it's literally the worst of both worlds. I mean think of this, it's illegal for many insurers to insure you if you don't live in a certain state. Most of them don't even compete with each other. They have "vertical" integration which means they own the hospital, the pharmacy, every doctor you see, and of course the insurance company.
As much as everyone likes to shit on Insurance and cherry pick talking points, there are people out there who consume millions in healthcare spending yearly that are covered. It’s how the entire system works.
25% of heath care spending is consumed by 1% of the population. 50% by the top 5% and the bottom 50% accounts for roughly 2-3% of total spending
The biggest issue with the US is there a ton of chronically un-heathy people here who consume an insane amount of drugs, services and procedures.
Yeah, we forget this. We are a very unhealthy population, or rather we have kept alive a subset of the population that is chronically unhealthy, for reasons their fault or not. Its the moral thing to do, in my opinion, but that also comes with a bill they will never be able to pay.
> The biggest issue with the US is there a ton of chronically un-heathy people here who consume an insane amount of drugs, services and procedures.
The chronically ill and people at end of life. Many people online love to advocate with medically-assisted suicide; having cared for (and continuing to do so) for some family at end of life and seeing the aggressive tactics that the hospice providers (which I see as a "soft" MAID) use in person, I'm very against it.
>Farmer was selling hospice, which, strictly speaking, is for the dying. To qualify, patients must agree to forgo curative care and be certified by doctors as having less than six months to live. But at AseraCare, a national chain where Farmer worked, she solicited recruits regardless of whether they were near death. She canvassed birthday parties at housing projects and went door to door promoting the program to loggers and textile workers. She sent colleagues to cadge rides on the Meals on Wheels van or to chat up veterans at the American Legion bar. “We’d find run-down places where people were more on the poverty line,” she told me. “You’re looking for uneducated people, if you will, because you’re able to provide something to them and meet a need.”
...
>Once a prospective patient expressed interest, a nurse would assess whether any of the person’s conditions fit — or could be made to fit — a fatal prognosis. The Black Belt, a swath of the Deep South that includes parts of Alabama, has some of the highest rates of heart disease, diabetes and emphysema in the country. On paper, Farmer knew, it was possible to finesse chronic symptoms, like shortness of breath, into proof of terminal decline.
One big problem is we have all different kinds of health insurance policies from hundreds of insurance companies, not to mention some government-run health insurance with byzantine regulations, and all of this greatly increases administrative costs, with hospital staff and physician staff arguing with the insurance companies over the phone whenever something gets denied (which happens often). The government regulations involving insurance, hospitals, etc., are also really complex, requiring expensive specialty lawyers, and our expensive legal system involving malpractice lawsuits and other legal problems further adds to the cost. These are all extra expenses that fall outside of actually providing health care to clients.
> I would rather have a single payer healthcare system
the counter argument would always be this.
Medicare for All is likely to increase federal costs by between $25 trillion and $35 trillion over ten years
To finance $30 trillion – a rough midpoint – policymakers would likely adopt a combination of approaches that are equivalent to a 32 percent payroll tax, 25 percent income surtax, 42 percent value-added tax (VAT), a $7,500 per capita mandatory public premium, doubling all income tax rates, reducing non-health spending by 80 percent, or increasing debt 105 percent of GDP. Taxes on high earners and corporations alone could not finance Medicare for All
Are you SURE "but no more premiums or co-pays or dedcutables ever!" will convince the American people to accept those costs?
Another issue with America's hybrid system is that many (most?) receive high quality care they can afford that they are happy with. 82% percent of Americans are satisfied with their personal healthcare.
Also what happends to Medicare (92% satisfied) and Medicaid (82% satisfied). Do those go away?
The American healthcare system is crazy and convoluted for sure by Western standards but we need to determine whether a majority want it radically changed or (as with so many things in American society/politics) a very very very very loud minority.
And those are all good counter arguments. I just know the current system is not great. Healthcare is primarily attached to either your employer or you being so destitute you cannot afford healthcare. I'm not sure what the best solution is, I know what we have right now isn't it. I personally know of two people who died of cancer because health insurers refused to run the tests to detect it when it would have been treatable. Sure they paid for their chemo when they had stage IV and were dying. Both would be alive right now if the tests had been run most likely. That's NOT an efficient use of resources.
It's not good counterarguments. Yes, the government will have to find new revenue, but that doesn't mean it will be hard because the money already exists. We already spend trillions every year on healthcare, it just goes to private insurers instead of one public insurer. On average, people will not be worse off trying to fund a single payer system, because people are already paying for healthcare.
If the total cost of the new system is less than current spending (and there are several estimates that suggest this is true), then the average person wins financially. The tax quotes are scary, but what that post omits is that by lifting the burden of healthcare away from business, wages will rise dramatically. That's where current healthcare spending largely comes from, wages that never get paid out to workers because they are diverted to healthcare spending.
> We already spend trillions every year on healthcare
We as in the government and individuals combined. 47% of Americans are on Medicare or Medicaid and aren't paying all that much out of pocket right now.
There's also a lot of people who are paying their fairly low premiums and staying healthy and therefore not paying much for healthcare. Universal healthcare advocates sometimes seem to suggest that most Americans have expensive catastrophic medical issues yearly (or often) and that's just not the case. Those people will be very unhappy paying the added taxes while staying healthy.
Point is it's a democracy and even if what you're saying makes sense there will be a big backlash at the ballot box from people paying into a system they don't use. In a lot of cases private insurance is there to keep your personal spending on healthcare low while you are healthy (most people most of the time) and the help you out when the rare out of the blue expensive emergency occurs.
medicare and medicaid spending is already on the government books, there will be no tax increase for this.
It's the private spending that will be new, but the funds for that private spending already exist, it's just a matter of how are we going to redirect this to the government's health plan? This is where tax increases come in. For people who are paying out of pocket, the average person will pay no more in tax than what they're already spending out of pocket. For people in a group plan, wage increases will offset tax increases for the average person.
>Those people will be very unhappy paying the added taxes while staying healthy.
These people are already paying for health insurance while staying healthy. ACA plans are already community rated, and larger employers effectively have a heterogenous risk pool already. The number of people in low-risk plans is small. But also, they are unlikely to lose, or lose significantly, under a national health plan for 2 reasons, first because research shows a single payer plan would reduce total spending compared to what we spend currently, and second because of a progressive tax system that will put greater burden on higher incomes and larger and more profitable businesses.
> For people who are paying out of pocket, the average person will pay no more in tax than what they're already spending out of pocket.
need evidence for this don't believe it. Sorry the 47% of Americans on Medicaid/Medicare aren't paying much already and then there's a chunk of Americans with gold plated employer provided health care plans that aren't paying much out of pocket and only have to pay a lot when the rare out of the blue emergency happens. Once again their situation changes dramatically when they have to pay a mandatory tax for a service they don't use.
Healthy Germans pay 7% of their income (on top of high income taxes) mandatory for their healthcare that they never use and many are not happy about it.
first because research shows a single payer plan would reduce total spending
My main point is that as weird and flawed as the American healthcare system is a significant portion of Americans are satisfied with their personal healthcare plan situation. If you make big changes that negatively effect just 10% of the population that was happy with what existed before it will have a big negative effect on whichever political party forced those changes on them.
9/10 of these people are buying ACA plans which are already community rated. Why would they pay more by switching to a national plan? They would save money because a national plan costs less per person, and the cost burden would be skewed towards high earners.
>Sorry the 47% of Americans on Medicaid/Medicare aren't paying much already
This is irrelevant, tax payers are already footing the bill for them.
>and then there's a chunk of Americans with gold plated employer provided health care plans that aren't paying much out of pocket and only have to pay a lot when the rare out of the blue emergency happens.
I already explained why this isn't an issue. Address what i said instead of repeating the same thing again
>Healthy Germans pay 7% of their income (on top of high income taxes) mandatory for their healthcare that they never use and many are not happy about it.
Yeah this is how insurance works. Americans are already doing this, and americans are very unsatisfied with out of control premium growth
>My main point is that as weird and flawed as the American healthcare system is a significant portion of Americans are satisfied with their personal healthcare plan situation.
And they're going to be even more satisfied under a single payer system, given that medicare produces higher satisfaction ratings than private insurance. It's going to get even better when there are no more deductibles or prior authorizations
>If you make big changes that negatively effect just 10% of the population that was happy with what existed before it will have a big negative effect on whichever political party forced those changes on them.
Okay, but what will be the net effect on the party when you include people that are happier with a single payer plan?
ok go ahead and make this your platform. Unless the numbers are fake the bottom line remains that a significant number of Americans are happy with their healthcare coverage situation as it currently stands.
Even if the NBC poll is off by a bit NBC is not a particularly biased source.
End of the day we have to deal with the fact that we live in a Democracy where people vote for their own interests first and foremost like it or not.
If an immediate and dramatic switch to universal healthcare is implemented, and a significant chunk of the population ends up paying way more in taxes than they did for premiums... then whichever political force instituted that policy will be dead and gone forever (progressives of course). Just a fair warning
our outcomes are not competitive globally. we underperform for what we spend. the people who think they are satisfied with their health care arent really sick yet. when you get really sick is when you find out how bad the system is
> I have long been a vehement Libertarian and I say what is considered heresy in my political sphere. I would rather have a single payer healthcare system than what we have right now if I had to make a choice. I think single payer is not great, but it's a hell of a lot better than the hybrid mess we have right now.
Also a libertarian, I agree. I’d prefer a more free market system where it’s not heavily tied to your employment (thanks FDR! 🙄) and where young healthy people have the option of a high deductible catastrophic plan.
But the current mess we have is insane. I’d take single payer over this if it were the only option.
I've never heard a good argument for why other multipayer countries do so well in that case. It's always Switzerland, France, and Israel having less American vibes.
Because you have no power. Your employer chooses your insurance. That’s where the problems lie. Make it like any other insurance that you buy. It would be nice if it were non profit.
i also like the idea of being insured against the "risk" of routine vaccinations. "you need a covid booster? wow! nobody could have seen this coming... except of course our advanced risk-modeling algorithm"
A family with two gainfully employed parents who have “good” insurance can still easily pay $1000 a month in premiums after employer paid benefits. I can’t wait for the finance bros to chime in and talk about how doctors and nurses are overpaid.
Rather have German Model of healthcare. Basic UHC for everyone. With UHC issues of longer waits, delays, denials. Or individuals and company can choose private insurance. Private insurance is highly regulated. Individuals/Companies get bothers for healthcare taxes paid.
Get better healthcare, longer life, faster visits and less denials.
Yes thank you. Another thing people forget is that taxes are meant to be progressive for a reason. The more you benefit from society, the more you support it. Pretty much all tax structures are like this to one extent or another.
When you have tax funded healthcare it also works this way.
The way we have it now in the US is not progressive at all. Everyone pays the same. There are many subsidies and assistance programs for those who could not afford it such as elderly retired or low income, so they aren’t supporting the system much at all. The top earners pay the same as the average Joe so they don’t support it much either because there aren’t that many of them. The top .01% I bet doesn’t even have insurance, why would you need it when you can just pay cash if you need something. If it was cheaper to have insurance it wouldn’t be a very good business model.
Those 2 things mean that most all of the burden of our current system falls on the middle class, ESPECIALLY families with kids that are also are on insurance. Medical costs are a huge part of their income unlike the top and bottom. And they are effectively a tax because they are not wealthy enough to decide not to pay them, and this also takes from their ability to save for retirement. In many ways our system is the dumbest possible way to do this.
I'm reading Hayek's "The Road to Serfdom" and even he's fine with this. Healthcare doesn't and shouldn't operate according to regular economic trends, so it makes sense to separate it from the free market.
I’m not interested in kicking in another 10% of my paycheck to fund the health expenses of a generation that already is sucking social security dry, cut their own taxes during their working years and didn’t invest in the country (note we haven’t had a gas tax increase in 30 years, fucks them roads right).
You know how they say got mine? Apparently not because I can vote. They can dump their 401k and SS into the nursing home for all I care.
I agree with you in principle, but we're already paying for the retirees who screwed everyone behind them, the public option would be for a demographic that is "generally" more healthy than they are and would lead to better long term outcomes, it in effect would reduce costs later.
Gas taxes didn’t use to be like this - historically most projects were federally funded. Hence why our roads and bridges are falling apart since they haven’t increased it since the 90’s.
They should lend some tech for their backend. They are chickens with their heads cut off trying to play catch up on record keeping in my state. We may not even know how old everything is to know when it needs to be repaired.
Healthcare has some unique traits that make it difficult to run as a fully free-market enterprise. I could list them out, but I'm short on time.
Basically it boils down to the nature of medical care not really being compatible with consumer agency. And the US exacerbates the problem even more with its special type of bureaucratic medical hell.
We are not just doing things inefficiently, we are doing them EXTRA inefficiently, and it's not likely that any amount of market options can fix it.
When people hear of markets, they think "supply and demand" as perfection and fairness in a free market.
What they miss is the principle of inelastic demand.
If the price of the newest iPhone is doubled, demand will drop. If the price is cut in half, demand will rise.
This is not the case with chemotherapy or cardiac pace makers.
Yup. As a type 1 diabetic, I can’t just boycott insulin manufacturers or insurance companies if the price rises too much. I’d literally die if I tried that. I’m forced to pay for insulin no matter what the price is. The demand for insulin is a lifelong constant for me, which a lot of “free market” supporters don’t understand.
Moreover, there is asymmetry of information, where providers are vastly more capable of evaluating care, and there is often urgency (you can't actually shop around for an emergency room). The vast majority of providers accept Medicare, and it is estimated that universally using Medicare rates would save over $1 TRILLION per year, in part bc of reduced overhead and faster pay cycles. And don't get me started on loop holes, like either/or arbitration on reimbursements.
Anyone who argues we that can have a nationwide “free market” healthcare system is an idiot.
You can apply principles of it here and there in certain instances but anyone who argues it can be the basis of a nationwide system is a partisan hack or deeply unserious person. Either way they are not worth paying much attention to in regards to healthcare policy.
It’s silly because when we have tried it (e.g., high deductible health plans) it has been a failure especially in terms of healthcare access and outcomes.
Bundled payments have been underwhelming too. ASCs can do them cheaper and offer guarantees but it’s like charter schools skimming the profit from public schools.
Let hospitals and other providers off services that are loss leaders/make no money including primary care.
Healthcare pricing transparency would in theory help but it applies to a pretty narrow range of diagnostic services.
Anyone who just argues “free market healthcare” without clarifying what they mean is a waste of time to speak with them.
So to repeat, no one is arguing for "free market healthcare," I was responding to some one criticizing free market healthcare as if it explains the problems with the US healthcare system.
The US system is far from a free market with the government accounting for the vast majority of spending and an immense amount of price regulation on both federal and state levels.
Anything close to being called a "free market" system would be wildly different than what the US has. It would either have to accept some things that aren't politically viable, like allowing refusal of emergency care based on ability to pay, or have a completely different type of regulatory structure to fully internalize all costs / benefits properly.
Absolutely this. Is that surgeon good or do they just cherry pick all the easy patients? Should I do X procedure or Y procedure when the science isn't clear?
We spend a ton of money on the elderly at end of life. When is it time to let go and what does letting go mean? Massive stroke, severe dementia seems like a clear case, but sometimes the body just keeps going. What if that massive stroke, or more often, severe traumatic brain injury happens to someone in their 20's? And what about less clear cases, perfectly active 80 year old gets cancer...treat or not?
And then there's the whole scope of practice morass. No one wants to say, sure, someone with 6 months of training could do this part of my job. And there are many areas where that's true. Until that training fails and the adorable 10 year old dies from a missed diagnosis.
One interesting point I saw is that because of the total employees working in the inefficient system makes it sticky to solve without laying off a ton of people. Like if tomorrow insurers were made obsolete that’s prob a few million employees and some very large companies taking a hit. So the transition to a solution is probably as important as the actual solution
It’s a massive jobs program and healthcare providers are now often the largest employer in a lot of counties along with school systems or local/state government. It’s not a good thing necessarily but it a reality in the U.S.
The laws of supply and demand go out the window when you’re dying and need life saving medical care. Medical care cannot be a free market system because people will die en masse.
The routine stuff behaves just like a regular market. Look at eye care. Eye exams, eye wear, even surgery all done independently of insurance system responding to patient customer price pressure.
The solution is less care within the insurance system.
This is also how I view electricity generation and distribution. It's not something that should have a profit motive. It's something that should be maintained and charged only the amount needed to reasonably maintain and add resilience and upgrades to. Getting rich off of a company's ability to freeze or overheat people to death is fucked up.
The supply-demand forces only work if both buyers and sellers have agency, transparency and limited barriers. The act of a consumer buying something, aka voting with their wallet, is where value in the exchange of goods happens.
The problem with healthcare is there is no price that someone won’t pay to live. It’s not like an apple where you can just skip it and buy an orange instead; you will sacrifice literally anything to live. So the value proposition, the fundamental building block of the free market, is broken.
I pay almost three hundred bucks a month out of pocket for my insurance.
Today, after fighting with Kaiser for years, I finally got to see a doctor who would clear me for PT for my lower back… my copay was a hundred dollars to have this man just be like “uh, yup, your back hurts, you’ll need to sign up with PT.” I already know the PT is probably going to cost another hundred, maybe even more than that.
What is the 300 bucks for a month? What in the actual fuck are we doing?!
I was on a business trip in Israel years ago and got injured and had to go to the hospital. While I was there they had to bill me for it and it was like $90, something I didn't even think twice about, but they were apologizing profusely to me for it being so expensive. I did a little research and one interesting thing I remember is that in Israel insurance companies are strictly regulated on how much profit they can make and even though they don't have socialized healthcare it keeps the costs way down. I've also been to South Korea and needed care and similarly the price was ludicrously low. These weren't elective procedures but were situations where I got injured or was feeling unwell enough that it pushed me to seek medical care.
It seems like the U.S. is doing something really wrong in healthcare. One thing I've always wondered is if health insurance is just a tax on healthcare dollars being spent with the money going to a private company. It certainly doesn't seem to be going to providing better quality of care.
It's for profit, and often publicly at that. Thats the entire issue. When Healthcare companies ultimate directive is to make as much money as possible for shareholders this is where it ends up.
We made it a for-profit for-graft industry where everyone gets a full slice of pie except the end user. Publicly traded global companies running for profit healthcare is a demonstrated disaster
US health care insurance companies are required to spend 80-85% of premiums on delivering care and improvements, which in theory caps maximum profit, before overhead.
Yeah, insurance companies aren’t the ones with supernormal profits in the healthcare sector. That’s pharmaceutical benefits managers (though the biggest is owned by an insurer, IIRC) and specialty doctors in hospital affiliated practices.
Our healthcare system is both the envy and the laughing stock of the world. We have some of the most sophisticated and cutting edge tech in the world and we use it to provide care that is unattainable anywhere else.
We also limit access to that care to the wealthiest families in the world. We could easily provide fantastic healthcare to every citizen, yet we don't. We could easily be the envy of the world, but we aren't.
Some people are so afraid that someone might get something they don't deserve that we do nothing.
I've done some research on this, years ago. The basic conclusions (I am happy to provide papers if people want to read them).
The U.S. IS uniquely inefficient in producing healthcare; doesn't matter whether you measure outcomes by mortality rates (outside of cancer), disability adjusted life years, life expectancy, ... This holds EVEN if you control for causes of death that are largely outside of the purview of the healthcare delivery system (auto accidents, homicides).
The most efficiency systems are those with a broad (but basic) public option, with the ability to purchase private options. The German system would be an example.
3.The expansion of the PPACA was not inefficient, and that states that did expand have performed more efficiently than states that do not. It may have cost more, but the outcomes did improve to outweigh that effect.
Access to care is a major impediment, and though it will not cure the issue, allowing more practice autonomy for NP's, PA's, or other healthcare professionals does not meaningfully degrade quality (at least for primary care), but improves access. States that have allowed for more independence for PA's and NP's specifically tend to be more efficient.
However, there are some important caveats with regards to U.S. healthcare which makes it a bit more unique, and that any improvements MUST address.
U.S. citizens are much more likely to try to extend life without palliative and hospice care (or seek alternatives) when given a fatal diagnosis. https://www.ncbi.nlm.nih.gov/books/NBK233601/
The rural health issues (food deserts, but for healthcare) are much more prevalent, just given the geographics of our country. So, lack of access to care is much more a geographical feature here than it is elsewhere.
Behavior; we tend to be considerably more time inconsistent (smoke a cig today, telling myself I'll quit tomorrow).
Distrust of medical professionals/public health professionals. We are closer to a developing country with these.
Isn't this kind of looking to not acknowledge the profit motive as a priority? It seems senseless to not acknowledge that desire for quarterly profit as the reason care access has declined so heavily.
I guess I'd argue it is the dominating factor. High prices in the US for healthcare aren't encouraged just for the sake of profit maximization. The companies selling saline, insulin, and other items people can't live without are certainly exploiting the "you'll pay any price to be well" component of healthcare, and know they can get away with it in the gilded ecosystem they've designed.
Looking at the original BCBS plan intent and what we've end up with today, it seems like profits are genuinely the only serious motivator in a system that intentionally overprices the cost of every good to claim care was more expensive than it was and increase profitability.
Something that will also have to be addressed, that might be different since you did your research, is private equity getting into the game and buying hospitals and emergency rooms. That is likely exacerbating some of the current issues too.
It's *MOSTLY* negative, but there are some papers that MAY find benefits. At best, you can say confidently that PE acquisition didn't improve patient outcomes uniformly.
Yes; cited Starr's "The Logic of Health Care Reform" in several papers, and read the original "Transformation of American Medicine", but haven't read the updated version.
I teach a lot of Dr. Reinhardt's ideas (estimation of moral hazard, supply-induced demand, ...) in my class, and actually got to deal with him several times when he was an editor. This, however, is my favorite Reinhardt paper. https://www.healthaffairs.org/doi/10.1377/hlthaff.22.3.89
Edit: this op-ed also helped drive (and shape) large parts of my dissertation.
Isn't Germany, like its multipayer peers, private orgs unless you're unemployed?
You forgot that the American system also makes much more inefficient spending decisions like high physician pay and minimal wait times (high excess capacity).
So there is a broad German public option, but they are non-profit, non-government organizations that deliver. I still call that a public option (heck, even Commonwealth does), but I guess people can further delineate from it that it's NOT one public plan. https://www.commonwealthfund.org/international-health-policy-center/countries/germany
> I tend to believe more of the Reinhardt "it's the prices, stupid" argument. https://www.healthaffairs.org/doi/10.1377/hlthaff.22.3.89
I don't think this answer gets us anywhere. The profits aren't remotely close enough to fill in the implied gap from looking at the problem as a pricing problem. So where is the excess pricing going to? That's the question that drives the true costs of the system.
Can you point to any research that shows that pricing is irrelevant? Because the other authors followed up in 2019, and I haven’t seen anything that suggests it’s not only incorrect, but has zero explanatory power.
It's been difficult for me to find as well because it seems like most of the research is trying to break down the differences between US and other places from an accounting perspective. That gets you to "pricing failure". I don't think it's incorrect, I'm just stating it doesn't help answer the important questions. The gap between what the US system costs versus what an equivalent UHC system would cost is nearly $2,000b.
To explain where the price is coming from or where it is flowing to, I've looked into the cost structures and spending of insurers and providers. It's not going into profits, not much anyway. Even approximating "profits" as a kind of nonprofit waste spending only gets to about $320b as a high estimate. Ceo salaries are a drop in the bucket. Doctors salaries explain another $330b ish, but after accounting for doctor debt and higher (general) US pay, and subtracting what doctors get paid elsewhere, most of that number vanishes as a comparison. Nurses, same rough outcome - higher paid but still nowhere near enough to explain the gap.
Medicare underpayment shortfalls might explain somewhere as high as 180b. Medical malpractice is well under 100b. Using generous high-side estimates, there's still $1,000b that the US is overspending that's not showing up in provider salaries, medicaid shortfalls, malpractice costs, or profits. So... Why? Pricing failures can be technically correct while still not explaining why the system is creating the results we observe.
It is. That's what the whole Obamacare imbroglio was about. To ban preexisting conditions without making insurance something you get after diagnosis, it placed a mandate on the populace.
When the biggest players in health care corporations are public, which depends on growth of revenue to support the stock price, that inevitably means that costs will rise across the system. At some point it becomes unsustainable (one could easily argue that we are well past that point).
HC is used as a tool to create modern day indentured employees. Tying HC to a job makes is nearly impossible to to relocate or quit a job without taking serious risk to your physical and financial health. It should be noted that HC debt is the highest in the world and one misfortune can destroy entire families instantly. Is a scam, created in the Oval Office when Nixon decided that HC should be privatized.
US healthcare system is for profit, as in maximizing profits in quarterly reports. One spends less and collects the same premiums, profits will be soaring.
The philosophy of the healthcare system is also broken. In America it is viewed as a commercial service, while the rest of the world views it as a public service.
Yeah, tell me something we don’t know. The United States spends more per capita on health insurance than the other industrialized country with the worst results. America spends very little on prevention. America allows its food to be poison through excess sugar, excess chemicals, excess pesticides, and little to no regulation.
It’s Health Profit not health care. When medical professionals are given KPIs that reward for finding as many complex patients as possible. That treat charting complexity and length like its own kpi we have a problem. Not to mention the egos within every single aspect of the healthcare industrial complex. The only solution is to start at zero and figure out the best way forward. And it certainly isn’t charting more to uncover more because that hasn’t led to better outcomes physically or monetarily for anyone.
No, they're not. The health care system is working exactly as designed: Extract as much premium as possible, reject as much care as possible, funnel profits to the executives.
Yes. Morally and financially. Capitalism is all good and fine, but some things shouldn’t be involved in the unsustainable cycle of ever growing profits, and the right to life is one of those things.
In 2008 and 2020, the federal government backstopped state health programs (mainly Medicaid) when states were fiscally unable given fiscal shortfalls due to significant revenue declines.
Given the current projected outlook of the federal deficit and mountain of annual interest payments by 2030+, I don’t see how the federal government is going to be able to do this during the next significant economic downturn.
Stop calling it broken, its not broken, it just wasn't built for the advertised purpose. It's a system built by the wealthy to extract the most money possible from captive customers. You either pay or die, its a capitalists wet dream. Oh, and next year you will pay more.
Make everything transparent when it comes to pricing and give people the ability to opt out of coverage for minor procedures and illnesses going through their insurance. The reason premiums are so high is because nearly everything needs to be covered nowadays. The closer you get to 100% of medical procedures being covered, the closer you need to your insurance basically just pre-paying 100% of your future claims so they can pay for the current claims of everyone who is older than you (at a time when population decline means the Ponzi scheme is starting to fall apart).
There should be due diligence, but it's definitely like pulling teeth getting approval for suitable care. They need to reject blatant fraud, not tangentially questionable approval for stuff that has even some kind of better than placebo treatments.
I'd be willing to bet the vast majority of people here would love to have his problems.
If a quarter of his monthly pre tax income is $5000, his annual income is $240,000. This would place him in the top 5% of incomes.
He has chosen a healthcare plan that costs twice what the average plan on healthcare.gov costs. The highest price plan on healthcare.gov I can find, in my area, is around that price when plugging in his info that is known. However there are many options that cost half that.
The healthcare system there is pretty much just all middle men as can be seen by what it costs to negotiate research costs vs regular costs through insurance
make more things over the counter with software screening and on site labs at the pharmacy. subsidized by govt.
get stable people with basic issues treated by meds with decades of data on safety and efficacy out of the medical system.
same thing for physicals. annual lab work at your local pharmacy.
and everyone gets an HSA. HSA should not be tied to your employment. your employer should get a tax break for contributing to them and you should get tax breaks for your contributions to the HSA. at least give people a chance to save up for their health care.
So a health insurance CEO wants price control regulations.
Not really surprising the coalition he is part of all want price controls. Big employers self insure acting as their own payer they want to get costs down of course. Unions same thing.
The providers of course are mad because they would lose under price controls.
Value based care helps. Fee for service in complex patients is terrible for costs.
A modified capitation system with incentives for better outcomes and penalties for worse outcomes makes the most sense for funding. That aligns the interest of providers and payers to get the best care for lowest costs.
The economics are not entirely broken. There is unlimited money in healthcare. Pharma industry is having record IPOs and record profits and there are trillions $$ in investments pouring into pharma every month with millions of jobs created this year.
At the consumer level, the economics are broken, but the govt just runs up more debt and pays for everything. Healthcare is too big to fail with absolutely zero pressure to improve anything or contain costs because it’s literally all fueled by debt and money printing so no point to try to improve any aspect of the system. Same in Pharma, zero pressure on pharma companies to do better or innovate. They get paid no matter what.
Healthcare is expensive because humans don't scale, but healthcare workers still have to be paid a wage that is competitive in a world where most industries can be scaled.
You see the the same effect in all service industries. For instance imagine how expensive it would be to hire a plumber or a professional marching band vs in contrast with a hundred years ago.
The Obummercare architect J. Gruber admit over a decade ago it was never designed for users to save money. It was designed as a precursor for Medicare for All = inadequate delayed subpar socialist medicine. And just like Sayed in Michigan, the true agenda isn't revealed until it's too late.
I was curious of the margins on medical insurance providers and it was supprisingly low. Don't know if the government could be more efficient. Definitely a huge amount of money
Darkpriest667 | 21 hours ago
So lets have an honest discussion about what the US healthcare system is. It is a hybrid of both social and private healthcare. The problem with that isn't that hybrid systems aren't good, the problem is the American solution was to take the worst part of private healthcare, the worst part of socialized healthcare and then combine them.
I have long been a vehement Libertarian and I say what is considered heresy in my political sphere. I would rather have a single payer healthcare system than what we have right now if I had to make a choice. I think single payer is not great, but it's a hell of a lot better than the hybrid mess we have right now.
What is the point of insurance? They are supposed to cover you if you have an issue, yet their entire business model, to quote United, "Delay, Deny, and Defend" <--- edited for correction
anewleaf1234 | 21 hours ago
Also large companies get to use benefits like health care to be able to outcompete smaller companies for workers.
I know multiple people who work jobs they hate to afford health care.
My friend has a kid with cancer and she is stuck
ActualSpiders | 21 hours ago
What exactly does the US health insurance industry add to the process? My impression is that they are 100% parasitic; costing trillions in additional expense & contributing nothing to the process for patients or hospitals (unless you're a shareholder).
classicalySarcastic | 20 hours ago
Absolutely fuckall.
That’s not true, they add a ton of headache for literally everyone else involved in the process (care providers, pharmacies, and of course the patient themselves), all while collecting premiums for absolutely no services rendered. They are the only industry in the US whose entire business model is entirely based on NOT delivering the service they’re notionally being paid to deliver (hell, even their property & casualty siblings manage that and still turn a tidy profit).
In reality, they provide legal compliance to our employers who are required by law to provide “health insurance” once they reach a certain headcount. That’s it. They don’t actually provide the health insurance part to you the employee. That would cost money!
Prestigious_Load1699 | 12 hours ago
I mean, lack of spending is hardly the problem with America’s healthcare system.
classicalySarcastic | 11 hours ago
Ah, see, the problem is you’re expecting those dollars to go to actually providing healthcare, instead of lining the pockets of Wall Street investors. That’s simply not how this country works!
The stupid thing is that a Single Payer Healthcare System absolutely would be cheaper than forking over several hundred to several thousand dollars to a useless corporation every month for nothing in return, simply because there’d be fewer bureaucrats involved (which, if you think about it, that level of inefficiency is kind of impressive).
Prestigious_Load1699 | 6 hours ago
I mean, a single-payer system in America would absolutely entail thousands of dollars being paid to the government to fund it.
You don’t actually think “free healthcare” is free do you?
bobandgeorge | 5 hours ago
>The stupid thing is that a Single Payer Healthcare System absolutely would be cheaper
Hey bud, here's that answer to that dumb question you asked.
EndonOfMarkarth | 3 hours ago
Oh well if classicallysarcastic said it, it must be correct. Why would we ever doubt what one person on the internet had to say?
farshnikord | 16 hours ago
It's not so much like a weight strapped onto our economy dragging down progress. It's more like you put on a second engine on a car and hooked it up so it tried to drive in the opposite direction of where you're trying to go while someone yells "look how much gas we're using, we must be going so fast!"
And then also the car kills you by denying you medical care.
ApplicationCalm649 | 20 hours ago
The primary benefit is *theoretically* efficiency. Having an insurance company rewards effective price negotiation with providers and balancing health outcomes against cost of treatment with profit while achieving a positive, cost effective outcome for consumers.
Competition should keep costs down while keeping quality high, again, *theoretically*. The problem is that our rats nest approach to rules and regulations around healthcare has created a lot of inefficiencies. The existence of insurance to begin with has also obfuscated the actual cost of care so people don't see it. The fact that a lot of employers provide health insurance even hides the bulk of that cost from consumers.
We either need to scrap the insurance model entirely and switch to a government-backed catastrophic plan/HSA system with enforced price transparency to optimize efficiency or take a single payer approach. The medical bankruptcy rate in this country clearly indicates that our current system isn't working.
Sofer2113 | 19 hours ago
It doesn't help that Healthcare has a cash price and an insurance price that is anywhere from 2 to 10 times the price of the cash price. A $3,000 insurance billed procedure could be billed at $500 for a cash paying patient. Anyone insurance wouldn't opt for that because it completely bypasses the insurance for deductible and out of pocket maximums. A family member was trying to get Zepbound, it was going to cost them $1200 a month through insurance but $450 cash pay direct through EliLilly.
anabanana100 | 4 hours ago
I think it’s criminal that paying cash for services instead of going through insurance doesn’t get counted against your deductible and OOP limits.
EndonOfMarkarth | 3 hours ago
Different costs between OOP and insurance should also be illegal. Why should a person without insurance get to pay less than thousands of people paying collectively through insurance? Also, what on Earth accounts for that delta other than provider greed? You might say admin costs for dealing with an insurance company, but with those price differentials, you shouldn’t be saying it with a straight face.
PAJW | 3 hours ago
> The primary benefit is theoretically efficiency. Having an insurance company rewards effective price negotiation with providers and balancing health outcomes against cost of treatment with profit while achieving a positive, cost effective outcome for consumers.
And that might even be true in a world like auto insurance, where the consumer pays the full cost, and there are 15 different insurance companies and numerous repair shops to choose from.
But in medical care, your prices are generally set by one to five medical systems serving your area, and there are only a handful of insurers. The Obamacare exchange for my ZIP code has three insurers, and there are two medical systems within 25 miles of my address.
I think it is fair to say that any system which has so few sellers of a service is a broken market. Simply because what should happen is collusion between hospitals and the insurers to raise prices.
Slunkx | 20 hours ago
Nothing, it's a greed game. China a power house for making the ingredients pretty much every major country uses to make medicine and mostly all European countries for top medical help, with Japan and South Korea. US not shown in top 10
Special_Ad712 | 19 hours ago
You have this thing where the US is essentially subsidizing the drug development of the whole world because the vast majority of profit is found within the US.
Like: GLP-1s from Novo literally doubled Denmark’s GDP growth because 70% of the revenue is found from the US. Countries get to implement stringent price controls because of the US Market.
so what’s the fix to this really? If you remove the profit motive there will be far less drugs developed, but you’ll probably have cheaper drugs. MFN clauses? Then either countries that cant afford them get priced out or they just dupe drugs (and then if they are violating your IP and getting away with it, there’s pressure to fix it… so trade conflicts). Honestly I don’t know if there is a good solution.
apophis-pegasus | 2 hours ago
> so what’s the fix to this really? If you remove the profit motive there will be far less drugs developed, but you’ll probably have cheaper drugs.
But theres still a profit motive just not as big of one. And a lot of care is conventional, and doesnt require (but is greatly helped by) new drugs.
insightful_pancake | 24 minutes ago
The high current prices mean more drugs are pursued than their otherwise would be. A company with a drug with 20% probability of success in clinical trials facing potential profit of 1 billion vs 500 million (200mm NPV vs 100mm NPV) may not pursue that drug in the lower priced scenario when trial and development costs cost 100mm.
nik-nak333 | 16 hours ago
Its a bureaucracy of malignant middle men. Each one exists only to extract their share of profit from the whole endeavor, and is completely unconcerned with the final product(access to healthcare) being of reasonable quality or affordable.
CommitteeofMountains | 20 hours ago
Same oversight and monetary management as NICE in the UK, Medicare in "single payer" countries, and insurance insurance companies in multipayer countries (France, Germany, Switzerland, Netherlands, Israel, Medicare Advantage).
asbestosmilk | 17 hours ago
The only benefit I’ve seen is they can flag truly unnecessary and expensive tests and procedures coming from corrupt doctors / dentists trying to squeeze as much money out of their patients as possible.
While that can be helpful in some cases, I’m not sure it’s worth all the extra money Americans pay into the healthcare system. Not to mention, insurance companies flag legitimate tests / procedures constantly, and for no other reason than they just don’t want to pay for it.
Pure-Science-7774 | 18 hours ago
I had a doctor literally tell me “We are just ordering all these extra tests so everyone gets more money” I was a medical record reviewer, so I was livid.
equivocal20 | 17 hours ago
Yeah, that's the part everyone forgets about the medical insurance industry. At some point in the system, someone has to prevent this kind of abuse. It's done in Europe far more upstream. It's on the health insurers in the US to prevent this abuse, and it creates problems where procedures and tests are denied that should be allowed.
There are bad actors, in the from of doctors and other clinicians, who would love to get rich by just ordering every test and procedure under the Sun.
And if you don't think they'll do that, remember there were a bunch of doctors ostensibly running opioid pill mills from the country club golf course.
SomeRandomSomeWhere | 16 hours ago
I was under the impression that US doctors order alot of tests so that they dont get sued by patients for missing something.
Of course money could be a motive as well.
Consistent-Fig7484 | 15 hours ago
It’s both. More CYA though. In most cases the doctor ordering all those tests is either a family practice doc or an ER doc. As major hospital systems take over we’re seeing more and more physician employees who get paid the same whether they’re asleep or coding someone. Yes, it’s more complicated than that and they are always being judged on various productivity measures, but your doctor is almost certainly ordering a frivolous CT angiogram because there’s a 1% chance they find something and avoid a lawsuit, not because it puts an extra few bucks in their pocket.
Pure-Science-7774 | 6 hours ago
Actually lawsuits are very difficult to win against a doctor. You have to basically die to sue or have something catastrophic happen. Other “smaller” cases (less than $500k of damages) are very difficult to pursue.
Consistent-Fig7484 | 50 minutes ago
Sure, but hospitals operate from a risk management perspective more than anything outside of possibly airlines. Even a lawsuit that is ultimately settled or dismissed can still be bad PR.
Pure-Science-7774 | 49 minutes ago
I’m guessing you don’t work in a hospital lol.
Pure-Science-7774 | 6 hours ago
No I’ve worked in medicine for almost 20 years. It’s more like “I will order extra tests from my friend A, then my friend A orders extra tests from friend B. Then friend B orders extra tests from me.”
bbk13 | 3 hours ago
Money is the motive. They use the made up excuse of "defensive medicine" to blame lawyers for being forced to grift.
insightful_pancake | 21 hours ago
For one, it’s great for global biopharma/medtech development since potential payouts for success are so much higher (e.g., for a given drug, a pharma company will model ~60-70% of revenue from US, ~20-30% from Europe, and ~10% from RoW).
ActualSpiders | 20 hours ago
OK, but what does the US health insurance industry do there that the pharma industry can't/doesn't do for themselves?
insightful_pancake | 20 hours ago
The pharma industry does not decide how much payers (insurance) will pay. Clearly, US payers pay more than those in other countries.
EndonOfMarkarth | 20 hours ago
This is an important point that doesn’t get discussed enough. See figure 9, https://researchonline.lse.ac.uk/id/eprint/87362/2/jama_Papanicolas_2018_sc_180001_3_.pdf
Petricorde1 | 14 hours ago
That’s a great paper to understand
EndonOfMarkarth | 14 hours ago
Yeah, it’s aged a bit, but still very relevant to the discourse today.
EndonOfMarkarth | 20 hours ago
The U.S. health care industry is a more than $5 trillion dollar industry.
UNH’s profits account for less than a tenth of a percent of that marketplace. They operate on a sub-5% profit margin. The entire health insurance market made $6 billion last year. https://content.naic.org/sites/default/files/2025-annual-health-industry-commentary.pdf
Insurance is part of the problem, but they are far from being the primary driver of the cost.
We need more competition, but good luck getting a bunch of investors to throw in a bunch of capital for a 4% return.
ActualSpiders | 20 hours ago
That doesn't make sense, though. Let me turn that argument around:
>good luck getting a bunch of investors to throw in a bunch of capital for a 4% return.
Why are investors so dedicated to continuing an industry that *only* has a 4% return?
YouAndMeToo | 20 hours ago
Because the profit comes from the peripheral costs. Medications, devices, wages, etc etc. and because everyone of those jobs are wasted costs to the system
growaway9172 | 8 hours ago
Which investors are investing in legacy healthcare companies? These co's are not the recipient of new investments typically.
livingdeadghost | 6 hours ago
4% profit margin doesn't mean 4% return for the investor. If I have 10 customers paying me $100/yr in insurance, that's $1k with $40 profit. Next year, I have 20 customers, and my profit has doubled to $80. My profit margin remains the same but my earnings doubled.
The 4% is profit margin, not return on assets or return on equity.
EndonOfMarkarth | 3 hours ago
Yeah, this is an important distinction I should have made. I think if the incumbent companies were making a healthier margin, there would be more of an opportunity to attract new capital/start-ups into the marketplace. But why would you at this point, with a 4% margin and a very real possibility that the system will be socialized in the coming years.
EndonOfMarkarth | 20 hours ago
Lol, so not going to actually address anything and instead ask why investors behave the way they do? Well, Walmart has a 3% margin. Krogers has a sub-1% margin, why are investors so dedicated to continuing those industries?
I guess when you can’t defend your beliefs, one can always just change the subject instead of changing his or her mind.
ActualSpiders | 19 hours ago
ah, so clearly you're just a gaslighting troll who makes statements without support & resorts to insults & changing the goalposts when asked even the simplest question. I didn't change the subject - I asked you an extremely basic question *about* the subject. You failed.
Your complete dishonesty is noted. Good day.
EndonOfMarkarth | 19 hours ago
Uh, one person in this discussion provided sources and it wasn’t you 😂
Carry on, maybe one day you’ll use data to support your beliefs.
ActualSpiders | 18 hours ago
Sure pal. Tell your blog you won, when you ran screaming from the room when asked a simple question.
livingdeadghost | 6 hours ago
>They operate on a sub-5% profit margin.
This is true, for the last 10 years, their profit margins have ranged between 3-6%. I look at a lot of corpo financials.
WarAmongTheStars | 3 hours ago
You may want to consider the self-referral racket to subsidiaries such as their pharmacy profits. But hey, that'd make things more complicated.
People aren't making money off the insurance anymore and are vertically integrated instead.
EndonOfMarkarth | 3 hours ago
Are their subsidiaries cheaper than their counterparts outside the system?
Darkpriest667 | 17 hours ago
the money isn't in the profit margins, it's in the stock price :-)
EndonOfMarkarth | 17 hours ago
Then why hasn’t it happened? Seriously, the public opinion is UNH is making money hand over fist. I get it would be a big hill to climb, but there’s money out there if the returns match the rhetoric.
Darkpriest667 | 16 hours ago
It's a low margin (actually in reality if you gave the healthcare instead of denying it ZERO margin) business. That's one of the huge problems. There isn't profit in healthcare. It's one of those things like education that doesn't make money at it's core. It's there to make people better. Not make money, but we live in a society that is entirely driven by the profit motive and hell it's brought us some great things, but there are things that shouldn't be operated on the profit motive. Police, Firefighters, Education, and yes.. healthcare.
EndonOfMarkarth | 3 hours ago
Not trying to start an argument, but you don’t think there is value in having companies like Medtronic and Boston Scientific competing with each other on price? If Earl Bakken can’t make a profit on pacemakers, do we get insulin pumps?
Darkpriest667 | 3 hours ago
Oh I totally agree, the "free market" has inspired innovation in the medical field for sure. Like I said -- it's really complicated and I don't have the answers.
pugwalker | 2 hours ago
The incentives are completely fucked. They want healthcare costs as high in aggregate as possible because then they can charge higher premiums -> larger float -> more profits.
They’ve created an ideal situation for themselves. For example, a hospital charges $100k, the insurer negotiates it down to $10k, they tell the customer that they paid the full $100k and then ask for $5k more from them. All while charging more than $1k a month.
PinataofPathology | 5 hours ago
They act as a counterbalance to unchecked medical Care. unfortunately not all doctors are good at their jobs and not all doctors put their patients' interests first. so they can be an important check on medical quality but in reality it has become very predatory.
and they were supposed to be able to pool enough money together for people to afford care and they haven't been able to do that.
RAshomon999 | 4 hours ago
This is not the case. You are thinking about Medicare. Medicare collects and audits provider cost information to help establish its payment rates, which private insurers use as a benchmark when negotiating their own rates. Doctors assess what care patients need, and medical boards oversee professional standards.
All insurers do in the process is determine if they must pay, which they have an incentive to find ways not to (insurance paperwork is complex for a reason )
ActualSpiders | an hour ago
In what world is "unchecked medical care" a serious problem? And what impact does "making it too expensive to get even basic or preventative healthcare" any kind of check on unskilled doctors?
Retired-Yam8988 | 20 hours ago
Yep - and the fact that you’re paying out of pocket like 500-800 per month then have to shoulder 7500 in deductibles annually before they pay for anything is insane. Plus you have your copays when you visit too. System is nearly pointless
Sharticus123 | 20 hours ago
Which basically means most of us who have insurance really only have catastrophic coverage.
My wife and I have decent insurance through my employer but it’s only really good for emergencies.
If either of us got cancer or contracted a mysterious illness that required endless batteries of tests and specialist visits we’d be broke in less than a year.
Reznerk | 20 hours ago
Until you have a 7 figure procedure or require a 6 figure medicine annually to treat a condition. One of my best friends had both and ended up with his deductible as the price. It's great if you need it, for most healthy adults it's hard to see the point.
Retired-Yam8988 | 20 hours ago
Fair point but we live in Asia and insurance and procedures are much less expensive. I fly to Singapore for my medical care and it’s still than I’d pay in the US
Hidden_Landmine___ | 7 hours ago
Okay but most other systems handle those procedures just fine, so we're talking about achieving the bare minimum, with a ton of other downsides as well.
Sea-Ambition-451 | 3 hours ago
> Until you have a 7 figure procedure or require a 6 figure medicine annually to treat a condition. One of my best friends had both and ended up with his deductible as the price. It's great if you need it, for most healthy adults it's hard to see the point.
EXCEPT, the entire rest of the world doesn't fuck you over completely, like the USA does.
Reznerk | an hour ago
Well not the entire rest of the world, but yeah of course lol. I was just pointing out why someone might really need healthcare in the US. Inversely, single payer systems have their drawbacks too, insulin pump use is exceptionally far behind in Europe compared to the states.
I'm not an advocate for the US healthcare system, but I think it's disingenuous to act like single payer is better in every way. At this point I think that's true economically, and I've become really disillusioned with our system and it's unnecessary complications.
Sea-Ambition-451 | 4 hours ago
I pay $3000 a month to cover family of 4 people.
There is a 7k deductible for each person. So, if I go see a doctor it costs me about $250 out of pocket for a 15 minute appt.
I have paid more for health insurance than anything else, more than my house. Way more.
WTF
Tigerianwinter | 21 hours ago
Another element is the fundamental change in workforce participation should healthcare ever become a public option.
I fully expect to see a mass exodus of people leaving their jobs to do what they might love more rather than being chained to a job they hate to get benefits they can’t live without.
The current healthcare model is a mechanism of the slave owner mindset.
Lazy-Ad-7236 | 17 hours ago
it would be a boon for small business
Hippopotasaurus-Rex | 5 hours ago
It would help but let’s not act like the lack of social safety nets to create significantly better small business participation aren’t still going to be a wall people run into.
TaylorSwiftian | 15 hours ago
Then why aren't Europe and Japan entrepreneurial powerhouses instead of America?
Lazy-Ad-7236 | 15 hours ago
Expand? Economies are different in different countries.
Tough_Journalist400 | 20 hours ago
A huge issue is many of the people leaving will be healthcare workers. You’re going to hit them with lower wages, higher tax rates and more work all at the same time. It’s a recipe for a mass exodus.
Tigerianwinter | 20 hours ago
So I’ve been working in healthcare IT for the past 10 years and I think this bit is interesting…
There will likely not be much change for the care side (doctors, nurses, etc), but the question will be what is to do with all of the corporate workers.
If we for example expanded Medicare to all Americans, it would dramatically increase the number of folks needed on the backend to gather and process healthcare access requests etc.
Right now, the best company that does this is Kaiser - as they have a closed loop system. I’d imagine a dramatic expansion of Medicare would work similar.
So we would need a ton of workers to support the expanded demand of Medicare.
They won’t all get picked up, but I think a decent number of them would be.
Tough_Journalist400 | 19 hours ago
Nursing turnover is already huge. It’s ballooned from 11% to 18% annual turnover in just the last 7-8 years.
By 50 most doctors who aren’t horrific with their money are in a position to retire outside of their own healthcare needs.
These are high earning W2 positions which will be where the tax increase will need to concentrate to cover the new system. The only way to pencil out the math is to expect salary reductions from high earners in the healthcare sector.
It’s a perfect storm or end up with massive healthcare shortages. I know my spouse, myself and a number of people I’ve talked to would bail on clinical care tomorrow if we move to a system like those proposed here constantly. For us, we’re also dual nationals so we’d also consider bailing on the US without the better wages.
Tigerianwinter | 19 hours ago
Fair. But whether we roll out Medicare for all, single payer or whatever, those issues will persist. Care providers and solving their quality of life and pay challenges would be a subset of the overall change to be addressed.
Maybe, because of the dumping of all the profit needs, those savings could go to the workers.
zephalephadingong | 16 hours ago
>For us, we’re also dual nationals so we’d also consider bailing on the US without the better wages.
Honestly curious where you would move that has lower taxes, and a not significantly worse standard of living. It's not like there are decent countries to move to that don't have single payer or significantly socialized healthcare systems
bigbabyb | 20 hours ago
I think single payer isn’t politically feasible in our braindead political landscape so I would be fine with busting up the regulatory restrictions for consumers and the tax incentives for companies to buy expensive plans and instead give everyone HSAs and ram that money into there and force hospitals to publish prices, as a start.
Then monthly payments for catastrophic policies only if you want, as an option
Just rip the money the fuck away from these health insurance predators and let us go doctor shopping for PCPs ourselves and get insurance to just fuck off and have actual transparent pricing on drugs and standard procedures
dust4ngel | 19 hours ago
> force hospitals to publish prices
this will help people to shop around for ambulances when they're dying
bigbabyb | 17 hours ago
Lots of care is elective and can be simplified. Not everything is emergency medicine. Could sell a catastrophe policy for that
Not_FinancialAdvice | 14 hours ago
> force hospitals to publish prices
Trump actually already did that during his first term. A bunch of hospitals just didn't comply.
https://www.healthcaredive.com/news/hospital-compliance-price-transparency-regulations-pra-report/830087/
Likely because enforcement isn't too strict:
https://www.beckershospitalreview.com/finance/hospitals-received-price-transparency-warnings-but-few-penalties-in-2026/
>The administration sent warning letters to 519 hospitals for failing to provide transparent pricing information, according to a June Associated Press report. Hospitals in every state except Alaska received at least one letter.
...
>By contrast, CMS has fined one hospital in 2026. Pinnacle Hospital in Crown Point, Ind., was fined $51,615 on Feb. 4 for 155 days of noncompliance. The fewer-than-30-bed hospital was the 28th facility fined since the rules took effect Jan. 1, 2021. Pinnacle drew a second penalty of $40,356 in June for continued noncompliance, bringing its total to $91,971.
>That pace trails 2025, when CMS fined 10 hospitals, with penalties ranging from $32,301 to $309,738. CMS fined three hospitals in 2024.
bigbabyb | 13 hours ago
No, it was the ACA, so Obama there, then Trump’s HHS/CMS released the rule under the ACA on Jan 1 2021 while Trump was doing his insurrection stuff.
And I have a bit of depth of knowledge on this because I started building an “uninsure-me” website with data scrapes of every hospital system in the United States in April 2026. The machine readable code is a fucking mess. Zero standards. It’s all over the place.
It needs to be less purposefully granular and instead abstracted up a bit, too. It’s just purposeful noise but the price differences between uninsured (cash pay) vs insured is often astounding.
Pure-Science-7774 | 18 hours ago
Gotcha we can build data centers in space but we can’t do a single payer health system like almost every other country in the world.
OSPF99 | 3 hours ago
Only a few countries in the world have single payer, most countries in the world have universal public options or private health insurance in some way
bigbabyb | 17 hours ago
Well we can’t do either because of the same root cause, propaganda
No one is building a space data center, and even if a genie got single payer up in the USA, shit would get sabotaged constantly, worse than Obamacare, by the right wing of this country.
PinataofPathology | 4 hours ago
and make more medications over the counter. statins asthma inhalers birth control pills HRT etc. you can require people to go through software education at the pharmacy before they buy them so there's at least some counseling on how to use things safely but get medicine out of the way.
and put labs in all the pharmacies and make most of the blood work direct access for consumers and let companies compete. there is no race to the bottom in medicine. there's a race to the top. we need to flip the dynamics.
If you just let women check their ferritin at will for like 10 bucks that will remove millions of dollars of expense from the medical care system frex.
Illustrious-Lime-878 | 14 hours ago
Simply adding back the mandate would at least get you 90% of the way there from "completely broken, ass backwards incentives" that we are at now. I think that actually is feasible at least.
prosocialbehavior | 5 hours ago
I don’t think we have the political landscape for that either. Both ways to fix would face major propaganda from the other side. I think the anti-regulatory fix is the less popular opinion too. Especially if there were no safety nets.
jakderrida | 13 hours ago
To corroborate your point... United States Domestic general government health expenditures per capita ranks 4th after Monaco, Norway, and Luxembourg according to OECD...
https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD
So even if you deduct all the private expenditures that come out of our pockets for health insurance, we still rank 4th in how much GOVERNMENT spending we do per American.
Before finding this, I had no idea how completely warped and broken our system is. Not to mention that DOES NOT include private expenditures and, on top of that, our healthcare outcomes rank just below Russia (in terms of Healthy Life Expectancy) and Croatia. (in terms of Overall Life Expectancy)
The US government expenditures per capita are $7,269.29, Russia's is $2,244.05, and Croatia's is $2,713.16.
That's under 1/4th and under a half the government spending on healthcare per capita to achieve BETTER results.
Prestigious_Load1699 | 12 hours ago
I mean, are people going to Russia or Croatia for treatment more than the United States?
Outcomes are a bit peculiar. Higher life expectancy is intimately tied to behaviors and eating habits.
What I, of course, allude to, is America’s obesity epidemic.
jakderrida | 11 hours ago
Two reasons for this often repeated claim from those our educations system has failed...
Our system allows for insured Americans that need surgery to be pushed to the back of the line by anyone willing to buy your spot from hospitals that face no risk of losing government funding from your taxes for doing so. Why wouldn't they let gullible chuds like you die when there's no risk of losing government funding for cancelling on you for some Australian billionaire or Middle Eastern dictator?
The reality, though, is that estimates of others coming to US specifically for Healthcare always falls under 500,000 per year, which is dwarfed by the over 1.1 million Americans that fly to other countries for the same purpose. This is especially pronounced when you consider that the only 4.2% of the world population is American while non-Americans number about 7.84 Billion non-Americans across the world. So a MASSIVELY higher percentage of Americans travel outside of America to receive healthcare while an incredibly tiny fraction of non-Americans come to America for healthcare.
If you're not too busy indulging in Fox News and 8chan for the rest of your life, I strongly encourage you to look up what I'm saying. Don't respond to me with your results, either. Just do it for yourself this time and blame your sources for making a fool out of you instead of blaming me.
Prestigious_Load1699 | 6 hours ago
Insured Americans with the cash to pay for it absolutely do not get pushed to the back of the line.
That’s literally what happens in single-payer healthcare systems.
That alone is just a wild claim.
jakderrida | 4 hours ago
> Insured Americans with the cash to pay for it absolutely do not get pushed to the back of the line.
Should I believe an obnoxious incel on reddit that still lives with his mom and has no idea what "single-payer" means?
Or the American Medical Association and the numerous studies they've put out on this subject?
https://journalofethics.ama-assn.org/article/requests-vip-treatment-pathology-implications-social-justice-and-systems-based-practice/2016-11
https://journalofethics.ama-assn.org/article/why-vip-services-are-ethically-indefensible-health-care/2023-01
https://journalofethics.ama-assn.org/article/profiling-patients-identify-prospective-donors/2013-02
choochin_12_valve | 6 hours ago
Government healthcare wait times are insane. Look at NHS, it can take 8+ years to see a psychiatrist for an autism or ADHD evaluation for kids. Do you think we would accept that in the US??
jakderrida | 4 hours ago
Eight years is outrageous! America’s fix? Price people off the waitlist entirely. In a 2024 survey, 57% of underinsured Americans skipped needed care because of cost. That’s not efficiency, it’s rationing by wealth. And our government alone outspends the UK’s entire system per person to deliver it. A waitlist you can’t afford to join isn’t shorter. It’s just invisible.
https://www.commonwealthfund.org/publications/surveys/2024/nov/state-health-insurance-coverage-us-2024-biennial-survey
Djonso | 2 hours ago
You do know that countries with universal healthcare also often have private healthcare sector as well? So you can pay to get to psychiatrist quick, or you can wait in line and eventually get there. And no, before you misunderstand, emergency procedures are not pay to get, private sector usually does not even do them where I'm from but directs customers to private sector. They are done quick.
sharkinwolvesclothin | 4 hours ago
The point of insurance in general is selling risk, with the insurance company as the buyer and individuals or companies as the sellers. It works pretty well for this with reasonable regulation (e.g. rules on what happens with catastrophic correlated risk realizations).
The US health insurance system is a hybrid between risk selling and just healthcare bundling. "There's a 1% chance I get cancer over time frame x and I'm willing to pay 0.011x the cost of cancer treatment for insurance per time frame" is an insurance market situation, "there's a 100% chance I want an annual checkup or age appropriate screening" is not really. The hybrid of these combined with a lot of regulation has lead to a fairly messy situation in the US now.
jonzezzz | 20 hours ago
Most of the countries with single payer still have private insurance market too. It’s just that in the US the public healthcare sucks even though we pay the same for it as single payer would cost
Sofer2113 | 19 hours ago
The only "public" Healthcare we actually have is the VA system for vets and glorified health clinics in the form of county health departments.
prison-break-free | 20 hours ago
The elephant in the room is also the pay for doctors, nurses, and specialists are insane and unsustainable.
Every other country that has socialized healthcare pay them a fraction of what they can get in the US.
In order to transition to this model in the US, you will need doctors and nurses to accept lower pay
Edit: every1 in comments disagreeing with me and bringing up arguments, except they can’t explain why every country with much better healthcare pay their doctors and nurses much less.
You all support socialized healthcare but won’t put your words where your mouth is.
BBenzoQuinone | 19 hours ago
Physician compensation accounts for roughly 7.5-10% of total U.S. health care expenditures
Edit because people seem to be misunderstanding me: What I am saying is that in the US physicians are compensated a SMALL fraction of the overall expenditure pie; and thus "paying them less" would do fuckall to improve things. Ditto for nurses and other hospital staff
aettin4157 | 16 hours ago
And has remained remarkably stable for the last 40 years
flakemasterflake | 4 hours ago
Physician pay has gone down over the last 20 years. Genuinely think it needs to be higher
organikmatter | 2 hours ago
Yeah, it’s bloat from administration, legal, over treatment, and a host of other issues that make healthcare so expensive, as I bet you know.
Salt_Lie_1857 | 10 hours ago
Nurses 12-15%
mistressbitcoin | 19 hours ago
Replace ALL the admin (in hospitals and insurance companies) with AI, and cut the price correspondingly.
Even replace some of the doctors - a lot of people get better results from AI than from a real person (sadly).
AI/tech assisted/remote surgeries.
Let Europe/China lead the way on research, and cut all of those expenses that the US currently subsidizes the rest of the world with. Instead, we can just steal their innovations for the fraction of the cost.
Thats just what I would do 😀
Effective_Worker_234 | 18 hours ago
Europe wouldn't pay for the research, and China would run out of existing innovation to copy poorly
MRG_1977 | 14 hours ago
A lot of biotech and pharma innovation has moved to China including western companies who foolishly continue to either put research hubs there or do joint ventures.
You also have more Chinese grad students and early career scientists coming home vs staying in the U.S. like they did 10-15 years ago.
thepinkdread2026 | 18 hours ago
Replacing humans with Ai is a recipe for disaster particularly in healthcare. We need to get rid of insurance. They are leeches that have no reason to exist. The system is complex because of insurance because the business model is not health its profits over everything.
mistressbitcoin | 18 hours ago
AI is close to (or already has) surpassed some doctors in some areas.
MRG_1977 | 14 hours ago
No it hasn’t. Using AI model results from MCAT or USMLE tests isn’t remotely the same thing as a physician making a general diagnosis and a treatment plan.
In the near term future, it is what I expect poor people will get before they are triaged to a physician for possible care.
thepinkdread2026 | 18 hours ago
That’s fine. That doesn’t mean Ai should take over everything. We also have shitty politicians and that’s where I think Ai would be more useful. CEOs don’t need em, Ai can do that. Humans, don’t need em, Ai can do it.
mistressbitcoin | 18 hours ago
Sure, but this post was about healthcare.
flakemasterflake | 4 hours ago
Where does the liability lie? Who are you suing when AI fucks up?
mistressbitcoin | an hour ago
Like vaccines, make it impossible to sue, because net value is positive.
Petricorde1 | 15 hours ago
I could agree with the former, but I think it’s important to keep pharmaceutical research in America. It not only because removing our best minds from healthcare research would be depriving us and the world of life-changing healthcare, but because it brings tremendous value to our economy through private innovation and agglomeration effects.
NickDerpkins | 11 hours ago
This is top to bottom awful approach
Research generates more money than invested
AI makes mistakes in the life sciences all the time and is a walking privacy violation
Lonely-Notice1828 | 19 hours ago
The far far bigger elephant in the room is that the legal system gets to dip their beaks into the medical system. Currently working in a single payer system after having left the US and the lack of defensive medicine here is so refreshing, also no Press Gainey.
MRG_1977 | 14 hours ago
This is a complete red herring and it has made ZERO difference in medical costs in states that have hard cap tort limits.
It’s mostly red states because trial attorneys donate to Democrats to ensure those caps don’t come into effect. It’s a rounding error in terms of overall U.S. healthcare costs.
espressocycle | 5 hours ago
It's maybe 3%
organikmatter | 2 hours ago
It’s not the cost of the lawsuits themselves, which is relatively low as you say. It’s the fear of lawsuits that leads to a much larger amount of unnecessary testing, treatment, and use of resources.
MRG_1977 | 2 hours ago
But again if it is capped to dramatically lower costs that you should evidence that there is a reduction in the practice of defensive medicine in those states. There is no clear definitive pattern like that on diagnostic and imaging services utilization.
GOP politicians can say whatever they want to but it doesn’t make it remotely true in actuality.
organikmatter | an hour ago
Even in tort reformed states, doctors don’t want to be sued because it’s still money, time, and possible license issues. On top of that, the culture is still defensive. It’s not necessarily rational to worry about lawsuits that much but it’s widespread.
To be sure, this isn’t the only or main thing driving up costs, but it’s a factor.
JockoMayzon | 19 hours ago
Doctor pay is lowering in the GP and other basic areas, and many doctors are being replaced with lower cost nurse practitioners.
TryptaMagiciaN | 17 hours ago
This is curious. I think it partly relates to the entire education->debt trap sort of design we see with these profession. Like yes, those countries pay their doctors way less, but they also don't levy 400k of debt onto their medical residents.
Which makes me more curious. If we want to address healthcare and therefore professional pay, we may also have to address student loans and the cost to become a doctor. The BS Biology/Premed alone is often several 10s of thousands. If we forgave student loans for those degress and made the tuition for those programs the same cost as other countries.. would healthcare professionals be able to accept less pay.
But it's all linked together. I dont see how any of it is honestly address without each being so.
NickDerpkins | 11 hours ago
The system to train them and put them into indebted servitude is broken too. The problem extends to academic training.
That said, these individuals are often overworked and it’s not exorbitant per the effort. Few clinicians make more or have a greater net worth in their 40s than they would had they chose a different path in college.
flakemasterflake | an hour ago
> and put them into indebted servitude is broken too. The problem extends to academic training.
It's working by design. A LOT of doctors would quit midway through training if they didn't have that crazy debt burden looming over their heads
Substantial-Ad-8575 | 11 hours ago
lol,
Good luck getting US healthcare workers to take less pay. That will not happen…
Ok, so main reasons why healthcare workers are paid less? Because they can and higher costs for each employee in those countries.
My company? I work in the US and earn 3.25x what the same job in France pays, 2.9x what the same worker in Germany pays. Because my company has higher taxes and costs, so there are less funds for worker wages. Higher corporate taxes, higher payroll taxes, and higher costs due to higher benefits/leave costs.
Some workers in those countries, recieve lower wages.
US? Low company taxes. Low payroll taxes. Less cost since there is no/little maternity leave or disability leave, and less regular PTO also.
So my company and others can offer workers higher wages.
monk2019 | 6 hours ago
US is indeed good for lower company and payroll taxes, which means companies can offer people more money, Also people can be fired a lot easier in the US then in most european countries. and less PTO in general. Sick leave as well, most european countries you can just call in sick for months and a company cant do anything about it.
Substantial-Ad-8575 | 3 hours ago
All of those items that Europe has? Absolutely leads to lower wages.
aettin4157 | 16 hours ago
Physicians pay has remained remarkably stable around 7-8% of healthcare dollar over the last 40 years.
Substantial-Ad-8575 | 11 hours ago
Overall wages/labor spending for US healthcare is 40-45% of total spent. Nurses account for larger portion than physicians.
The_wiggle_in_JELLO | 19 hours ago
How do you suppose that overpaid doctor is to pay for the $250,000+ student loan because god forbid the public proactively support education through taxation. Somebody is going to pay eventually. If it doesn’t come out from taxes, then they will take a bigger cut from your wallet.
Walk into any cardiac Operating Room in the U.S. and the combined education of student loan debt in that ONE room is ONE million dollars between anesthesia, the CRNA, the surgeon, the PA/NP, the perfusionist, and the nurses/surgical techs. Those professionals need to pay the loans by themselves that Americans feel shouldn’t be their burden despite wanting their services….they aren’t for free.
Maybe start looking at the real problem….why is the CEO of Banner making 20+ million/yr or the CEO of Jefferson making 5+ million/yr. These are not for profit healthcare networks. A salary like that is stealing from the community. The people doing the work (who you blame) are just trying to pay their fucking bills too.
thepinkdread2026 | 18 hours ago
Just like nobody cares about forgiving student loans for people that are obviously not making doctor wages, nobody cares if the overpaid doctor can pay his or not. The problem is health shouldn’t be a profit center. If we want to fund research stop fighting moronic wars. We have the money it’s just not going where it should.
flakemasterflake | 4 hours ago
You can’t lower doctor salaries and leave them with that debt burden. That’s how you get no more doctors
thepinkdread2026 | 4 hours ago
Yeah we can and we should. If the only reason people become doctors is to make tons of money there’s is something completely wrong with our system. Pretty soon they won’t have that many people to treat anyway because nobody can afford them.
flakemasterflake | 4 hours ago
You can’t get rid of student loans in bankruptcy
You think it fair to burden someone with 400k student loan debt + halving their salary?
After they have made the decision to go to med school. That's a 10 year+ journey, you can't pivot on a whim bc the government just randomly decided to fuck you before you graduate and make any money
thepinkdread2026 | 4 hours ago
Yeah and that’s a problem. Banks get bailed out for irresponsible financial decisions, they can help crash an economy and everything, but when it comes to the average folk and that could be a doctor a teacher or whatever, no they are expected to carry that debt forever regardless of the economic conditions of the country. And then we use that debt to justify higher healthcare costs including medical staff compensation yet the average person which is the bulk of who these people treat right because the billionaires go to Europe for that, the average person can’t even afford to see the doctor they have paid for 30times over…at what point can we all agree that the system is fucked and it’s not working for us???
flakemasterflake | 4 hours ago
Doctors salaries have decreased over the last generation and don’t make up a huge part of healthcare costs
And of course billionaires go to top hospitals in NY, LA, Mayo Clinic. They don’t go to Europe.
What exactly are you trying to fix? These posts about doctor salaries just read like salary jealousy
I can’t buy a home until my 40s bc I’m still in medical residency. My youth was sacrificed.
We are not like teachers and no one would ever advocate cutting a teachers salary in half
bbk13 | 3 hours ago
What!? People call for cutting teachers salary and benefits constantly. All public sector workers. That's like a core part of republican policy. Doctors are going to have to buck up and start imagining salaries more like doctors are paid in Australia or Germany. A friend of my parents when I was growing up in Australia was an orthopedic surgeon who collected Ferraris. So you'll live. A lot of my family in Australia were/are doctors and they do fine. Not American doctor fine, but no one is crying for them.
flakemasterflake | 4 hours ago
Medical education is brutal and grueling. I’m not doing 3 x 24hr shifts this week where I am the ONLY doctor on call for my health
You live in fantasy land if you think there are enough people who would do this nonsense for low salaries
thepinkdread2026 | 4 hours ago
You are proving my point. Why is working like this considered acceptable in the profession if these are people responsible for human lives? Why does becoming a doctor, which society really needs, why is it so astronomically expensive? Why does it require astronomical debt? You are defending your compensation for enduring a broken ass system that makes zero sense in the real world yet do not question why it operates that way. If medical professionals really put their foot down the system would be permanently changed. You are important not insurance. But they won’t do anything because in this country we prioritize profits over all. No doctor would want to go without pay because insurance companies are predatory monsters right? I don’t think medical professionals should be paid less, I think they need courage. I think insurance companies need to be banned and healthcare needs to go back to prioritizing patients and the people caring for them over profits. While you struggle with these crazy shifts and the stress that comes with that, and some patient dies because they afford to see you, some insurance shareholder is buying their 17th mansion in who knows where.
Substantial-Ad-8575 | 11 hours ago
Hmm, take all the war money and defense spending? Still not enough to cover UHC
So tax more. More company faces, more payroll taxes, and more personal taxes. And still about $800B-$1T short.
So what’s the next cuts???
bbk13 | 3 hours ago
The "cuts" are to the amount we pay for healthcare right now. That's the current "spending". Is the required taxation lower or higher than what we pay for in premiums, deductibles, co-pays etc? The evidence seems to suggest it could be. Whenever people start going on about "well, where are you going to get the money" it's like they forgot we already pay for healthcare right now. We don't have to "find" some new source of revenue. It's us. Redirecting other current government spending would either help make the system better or lower costs by some amount.
Substantial-Ad-8575 | 3 hours ago
Issue is new costs will eat into savings. Yes UHC can have some cost savings in 2-4 areas of spending. But that does not reflect more patients, more visits, higher pay rate needed, more subsidies, and higher malpractice costs. Which many proponents either gloss over or try to dismiss entirely.
*****
As for saving money? For me and my company? New payroll taxes will be more than I spend today. So yes, in my case and 14,800 workers. We’ll be paying more. My company especially, and workers will see less raises, less compensation as a result.
My wife’s small business? She Webber offered healthcare. Now would see a significant payroll tax. She will either lay off or try to raise prices. If raising prices does not bring in revenue to afford new tax, lay off or just close. If she closes, 30-40 employees looking for new jobs.
*****
So you are saying the govt can move funds from other social, defense, education, and transportation sectors. To make up needed funds to lower costs?
Of course they can do that. Would be prudent to also balance budget, cut spending in all areas to shift to UHC and raise normal income tax brackets at the same time. So a new individual payroll tax of 4.5-7% and increase of federal income tax of 5-10%. To align more with countries that offer UHC. Higher taxes at all levels…
Mamasugadex | 18 hours ago
Every profession earns more in US than any of those countries you have in mind.
Why not look at Canadian physician salary?
zephalephadingong | 16 hours ago
>Every other country that has socialized healthcare pay them a fraction of what they can get in the US.
This is true for a lot of industries though. The US is just straight up rich enough to overpay. For example my wife and I looked into moving to Europe and we could expect to make about half of what we do now. Neither of us are in healthcare, and we are both in different industries
Substantial-Ad-8575 | 11 hours ago
Wow, wife and I have been offered jobs in Europe. We would be looking at a 65-75% pay cut. And for similar housing costs. Ouch…
zephalephadingong | 3 hours ago
My wife had her heart set on moving to Dublin if we moved. Half the pay plus a higher cost of living :(
Substantial-Ad-8575 | 2 hours ago
Yes, wife and I lived in London, Berlin, Madrid, Barcelona. Loved living in Europe. But with growing family, moved back to US.
We were able to leverage higher US wages/lower taxes. Allowed us to more easily retire at 48/43. Our coworkers still in Europe? 52-58 and still working, with less investments/retirement savings…
zephalephadingong | 2 hours ago
I'm kind of hoping to do the opposite. Move to Europe and use my retirement savings to retire to a cheap eastern European country in my 50s
Substantial-Ad-8575 | an hour ago
An, so levering higher wage potential in US. Accumulate larger funds for retirement. And then move to Europe.
Yes, that can be done easier. Why many coworkers at my comment come to US. Bank that extra income, let it earn more in investments. And retire back in their home country.
Best of luck. Make sure you have run the numbers, as US citizen still responsible for US taxes.
As for me and wife? We travel, 8-9 months a year. Typically spending 3-4 months in Europe. Just can’t see moving there permanently. We have 4 children and 3 grandchildren under 18 months. So staying in US.
Salt_Lie_1857 | 11 hours ago
Unions are mafias. They sacrificed the public good for their pensions and perks.
Nice-Cow-8827 | 7 hours ago
People say this, but I have a couple close friends that are doctors. But not the rich kind. Most jobs in the US pay more than Europe. Software engineer pays like 40k in EU compared to an average of probably around 120k in the US. Lawyers in the US definitely make more than the UK or the EU. Regular white collar finance jobs definitely make more in the US than the UK or EU.
Also it’s only some kinds of doctors that make a lot. Pediatricians in the US make like 140-150k. Family medicine I’ve heard is like 180k-240k.
I don’t know where you live, but these aren’t astronomical numbers. Me and my wife have very middle of the road jobs, she is in supply chain, and I work in sales, and we each pull in around 130k each. We live in a sort of mid to HCOL on the east coast. In a good year, I know I’m probably making more than most pediatricians, and I work with dudes who pull in multiple hundreds of thousands a years, and I’m sure they make more than the “average” doctor. And there’s definitely more sales people making that money than there are doctors out there.
I don’t quite understand where the money in healthcare is going. There are some doctors out there that don’t take insurance and seemingly make millions. So it seems like you would make more by not taking insurance in the first place.
UncommonSense12345 | 3 hours ago
Thank you for this. I have patients complain to me constantly “you must be making a fortune off of me” and you must be rich…. I’m a physician assistant in FM who graduated with ~100k in loans. I make 140k a year with 1 week vacation if I hit all my production and quality bonuses. Unlike a lot of people I have no sick time and no PTO. I only get paid when I work. I take call 1 weekend a month and work some extra shifts on weekends throughout the year. I average 50-55hrs of work per week. Do I make a good living yes and I’m grateful for that but I also did 7 years of post high school education and had to take 2 years after undergrad to work/apply for PA school. I’d hardly say I’m the problem with health care being expensive. I see 20-22 pts per day 4 days per week and I have a wait list over a month long for a primary care appointment. I could go get a bunch of other jobs with way less stress and liability for similar pay (yes I know it would take me a few years but that’s not the point). My pay has not gone up in the past 3 yrs meanwhile your insurance premium (and mine) has shot way up. It ain’t me being the reason for the cost increase I literally get poorer by the year on the current system.
ResurrectedBrain | 19 hours ago
More unsustainable than the executives making millions upon millions or worrying about running a business more focused on shareholders than patients?
curio_123 | 14 hours ago
The vast majority of people want cheaper healthcare so they really don’t care to understand the economics behind it cos they have very fixed beliefs and mindsets and they do not want to change them.
Cheaper healthcare requires a lot of things that will be unpopular, e.g. a higher ratio of patients to healthcare workers so longer wait times. Also, the system must suppress wages for healthcare workers and impose price controls on drugs and expensive diagnostics but this also has the effect of making shortages more acute cos lower wages push people away from healthcare work, and price controls make drug and equipment vendors divert supply towards markets with higher pricing so there’s less for markets with price controls, etc. The right solution isn’t obvious at all, but some form of consumption control is almost certainly going to be necessary and none of it will be popular. e.g. docs won’t prescribe services that aren’t necessary or effective, long wait times will deter people who don’t need the treatment from using them, etc.
Also, I’m constantly surprised that alot of people have this misconception that if they pay annual premiums for health insurance, the cost of ALL treatments should be covered. No ifs, no buts. This mentality jacks up pricing for insurance and contributes to severe cost inflation. We live in a world of scarce resources, and especially so in healthcare, so no matter how much your annual premiums are, it’s not possible for any healthcare system to cover everything so the least necessary treatments must be curtailed in order for prices to remain affordable for others who truly need them more.
Health insurance isn’t meant to be a buffet for anyone to use limited healthcare resources in irresponsible ways. It exists to mainly protect you from catastrophic outcomes, e.g. a $200k brain surgery that will bankrupt you if you didn’t have health insurance. If everyone wants unnecessary MRIs, CT scans, etc “just in case” it shows something, then the cost will rise for everyone.
Finally, the cost of healthcare in a country isn’t just about how the healthcare system is designed (e.g. single payer, hybrid, how the insurance industry works, govt policies etc); it also has ALOT to do with how people choose to live and how their culture affects their healthiness, and Americans have perhaps the riskiest lifestyles due to the prevalence of highly processed foods, cities designed for driving not walking, guns, culture for binge drinking, insanely large portions at restaurants, etc.
civgo987123456 | 14 hours ago
I fucking hate arguments like yours. “The rest of the world figured it out but you’re all too dumb to understand that we’d have to make compromises, and therefore we’ll just stick with what we have”
So what’s the fucking solution then bud? Stick to the system we have so that I keep paying $700 bucks a paycheck to UHC so when I get cancer, I can pay another $10,000 out of pocket, to then get billed another $15,000 cause the janitor in the oncologist office wasn’t in network, to then get denied medicine cause it’s not covered, to then spend hours of my fucking life on the phone with these cretins explaining why I need medicine my doctor prescribed? Meanwhile, the leeches at the top get fat and rich off my money? And the same leeches get government handouts with my tax dollars on top of my premiums?!
On scarcity: this is artificial. We have all the money on the fucking planet for our war, Israel’s war, ukraines war but we don’t have money to help alleviate scarcity in medicine? First off, Is scarcity the reason an aspirin costs $1,500 bucks at the er? No it’s not. But we could found new medical schools to get more doctors, fund innovation in genetic drugs to get cheaper drugs, build new hospitals, etc. the scarcity here is artificial.
Our system is legal extortion. I’d happily make compromises so that all Americans have access to affordable healthcare. It’s honestly change the system or it’ll collapse.
Sammystorm1 | 12 hours ago
The rest of the world has made unpopular compromises in many areas to get cheap healthcare. Are you willing to do that?
espressocycle | 5 hours ago
40% of Americans are already on Medicare, Medicaid, CHIP or VA benefits. Plus you have all the people with nearly free ACA plans. We're halfway there.
civgo987123456 | 2 hours ago
Yupp. The only people who aren’t allowed socialized medicine (but are allowed to pay for everyone else’s) are regular working taxpaying citizens. Not sure why everyone else gets it but regular taxpayers get to be consistently fucked.
Sammystorm1 | an hour ago
Correct and it has caused severe strain on our system
Brightbane | 4 hours ago
What compromises did they make? And if you're going to say wait times don't bother. My pcp is booked out 3-4 months. I had to wait months to get a colonoscopy, and a dermatology appointment needs to be booked out at least 6 months ahead of time.
bbk13 | 3 hours ago
They're talking about compromises made by some imaginary person with some imaginary health care plan who can waltz into their pcp's office (let alone a specialist...) for any old boo boo. Trying to scare us if we don't have long wait times right now! That bs might have worked in the 90s. But it's not going to work anymore. We live in the modern US private healthcare system. It sucks. There are no redeeming features that you can't get elsewhere for much less.
Sammystorm1 | an hour ago
The reason our healthcare access sucks is largely driven by the shitty adoption of a public and private option.
Sammystorm1 | an hour ago
Depends where you are talking about. Combination of many things from wait times, availability of imaging, availability of procedures, and ability to drive your own care.
For wait times specifically it depends on what you are waiting for. But your unsourced wait times must be true.
AlorsViola | 12 hours ago
??
Most countries simply don't have the military budget that the United States has
Sammystorm1 | 11 hours ago
Ok and? We could cut the entire military and not pay for healthcare.
growaway9172 | 8 hours ago
Healthcare and most other services are not zero sum like most of your arguments imply. Good investments in supply side technologies could actually make cheaper healthcare, but hiring more people or giving more demand side subsidy (which is what the current US spending policy is all about) wont help.
espressocycle | 5 hours ago
Yup. People love to hate on insurance company denials but most of that utilization management is an attempt to keep costs down for everybody. The profits just aren't enough to explain all those denials.
StoneyBalogna7 | 11 hours ago
$200k for brain surgery? In the US?
I broke an ankle and it cost more than that.
Sammystorm1 | 12 hours ago
I would also argue we need to spend less on end of life. No your 91 year old grandpa shouldn’t be able to have everything done
flakemasterflake | 4 hours ago
90% of healthcare costs are about needless procedures at end of life. We would save a ton by rationing care past a certain age
shinyxena | 14 hours ago
It’s worse than that, they make them work more for less. It’s one of the reasons I can’t move to Canada. My wife is a nurse and the patient ratio is much higher in Canada and the pay is a fraction of what you can make here. No one wants to work more and be paid less. It’s why socialized medicine will always be much more expensive here. Cutting out insurance will save some money but it’s not gonna do anything crazy like reduce it by half or something. That said we should still do it. But it won’t be cheap.
Sammystorm1 | 12 hours ago
I work in north Washington and Canadians are my coworkers
espressocycle | 5 hours ago
The insurance and billing is about 30%. Exorbitant brand name drugs are a big chunk too. There's a lot e could cut before lowering pay for the people providing care.
Xyzzydude | 3 hours ago
Where is your source for that 30% figure?
Because according to this table the insurance overhead is less than 20% and that includes administration which absolutely would not vanish in a single payer system.
Actual insurance company profits are less than 2% of total annual US health spending.
Pure-Science-7774 | 18 hours ago
Just remember that the doctor gets paid for treating a patient. Not curing a patient. I was “treated” in the United States for knee pain for 5 years and got progressively worse. I was treated in Europe for 1 week, had a small procedure and was cured. 60 visits in the US = $12,000 versus 2 visits in Europe for $15 after my insurance. Doctors don’t have an incentive to cure you quickly.
SunnyChicken2 | 17 hours ago
Administrative bloat is a larger problem than doctors or nurse wages.
Substantial-Ad-8575 | 11 hours ago
Bloat accounts for 6-7.5% of all US healthcare spending. Accounting for $275B-$300B of the $6.3 trillion spend in 2025…
espressocycle | 4 hours ago
Where are you getting that number?
Substantial-Ad-8575 | 3 hours ago
JAMA report from over a decade ago.
Newer reports are all over, with none of them peer reviews and thereby are untrustworthy for estimates.
https://jamanetwork.com/journals/jama/fullarticle/2785479
datalicearcher | 11 hours ago
and why can't the pay for everyone in the current health insurance industry go instead toward the pay of doctors, nurses, specialists, janitors?
organikmatter | 19 hours ago
Doctors in the US make much more than their European counterparts. As do most US workers. Should we cut every worker’s pay too to equalize with Europe? Maybe go even further and peg it to Chinese salaries?
bbk13 | 3 hours ago
Yes. We should. By increasing taxation on income and capital, especially for the highest paid/most wealthy. Did you think that was a "gotcha"!
organikmatter | 2 hours ago
Their salaries are lower regardless of taxes, which are higher. Different issue. Interesting you’d like lower pay though. That’s not a popular sentiment.
featherygoose | 17 hours ago
While you're not wrong, it's probably worthwhile to compare liveable wage - aka the average healthcare workers' ability to pay for food and rent abroad where their minimum wage equivalent hasn't stagnated for the past 40 years.
The UK pays its healthcare workers meager wages, but it pays everyone meager wages compared to us. They can eat and have a roof over their head. We pay a whole lot of jobs so little that some work 80+ hrs/week and can't make ends meet, and it's not getting better.
Super_Mario_Luigi | 20 hours ago
Reddit will assure you that $600,000+ for a specialist is nothing more than a rounding error. We only mention "the developed world" when it's convenient
ludogjr | 7 hours ago
What should someone who goes to school for 12yrs, goes into massive high interest debt, gives up their 20s and early 30s, working and studying 60-80hrs/week get paid when it's all said an done? They are providing an actual measurable good to society. Plenty of other professions pay more without as concrete of a benefit to society.
Super_Mario_Luigi | 6 hours ago
These talking points come around like clockwork. How about I put the shoe on the other foot and use the lazy speaking point of "the developed world has figured it out!"
In reality, you already gave the answers on what we could fix. Instead, we will just continue to pay for everything at a premium price and pretend we have no solutions.
flakemasterflake | 4 hours ago
Way to not answer his question
Super_Mario_Luigi | 4 hours ago
Artificially limiting the amount of doctors, absurdly high education costs, long training periods are nothing that need to be discussed at nauseum, complete with gotchas and talking points. If we increased the supply of specialists, they could make $400,000 instead of $600,000 and the world will be fine.
flakemasterflake | 4 hours ago
Which specialists? Anesthesia near me is already averaging 400k
The amount of specialists making 600k are such a drop in the bucket, it would make no difference
And MD salaries have gone down over the last 20 years.
This sub is economically illiterate
Super_Mario_Luigi | 2 hours ago
What a brain rot response. Thinking you can just use smoke and mirrors to make whatever point you want. If you want to use Anesthesia as your example, that is fine. They still make considerably more in the United States than they do anywhere else. That is the point. Period. Instead, I already know your response is talking points (shuffles papers) "well they deserve more because they do good and study good!"
Like debating with a toddler
flakemasterflake | 2 hours ago
No, my response is that doctors salaries don't move the needle on healthcare costs. At all. Canadian doctors have similar salaries and they have socialized medicine
It has nothing to do with "studying good" and everything to do with the exorbitant level of student loans MDs are saddled with.
There is no hope of paying off 400k on a 200k salary and affording any kind of life. NO ONE would become a doctor using that calculation
The actually expensive things doctors must carry is MALPRACTICE INSURANCE. If you made it impossible to sue doctors, then costs would actually go down
ludogjr | 3 hours ago
You could drop all physician pay to $0, and it would decrease overall healthcare spending by 8-10%. Imagine that. The people actually doing the diagnosing, testing, and treating, only get 8-10% of all the value they generate. If you want healthcare costs to decrease, there's bigger fish to fry than squeezing the people providing the service that enables this whole freaking machine. Look at the median length of careers, they're getting shorter. Burnout is already pushing people out of the field and you want to decrease their pay? Other countries have figured it out, and guess what, the US isnt the other countries. Public health and healthcare spending in the US are much more nuanced than just going after physician pay.
bbk13 | 3 hours ago
No one is talking about "fixing" US healthcare by just making physicians slaves to the government. But reducing their compensation is definitely part of the overall mix necessary to fix the system.
ludogjr | 3 hours ago
I don't think physicians would mind being government slaves if it meant fair compensation for value provided. A few things to consider when dialing in physician pay. There's already a shortage and people are also leaving the field sooner than before. Decreasing pay will only exacerbate the shortage problem. I personally think an easier solution would be to limit insurance company profits, so they focus on actually just serving their customers rather than their shareholders.
flakemasterflake | 2 hours ago
Medical Residents are ALREADY government slaves. They are legally barred from calling in sick, they cannot NOT show up to work and they can't get other jobs- they are legally indentured to the government for 65k a year with 80hr work weeks
If you told me that I would have to continue this career at 200k then I would quit tomorrow and go work as a medical advisor for Goldman or something
Super_Mario_Luigi | 2 hours ago
This is why I didn't care to engage. I already knew you were only going to bring disingenuous talking points. We have the highest salaries in the world. Fact. Higher salaries bring higher costs. Fact. Just because other things are broken, doesn't mean you act like a 5 year old and fix none of it.
ludogjr | an hour ago
Feel free to lookup the data. Here's a decent source.
https://bfi.uchicago.edu/insight/research-summary/who-values-human-capitalists-human-capital-the-earnings-and-labor-supply-of-u-s-physicians/
Happy to engage in conversation in reducing healthcare costs and making it more efficient. I'm just also pointing out other facts that there's already a physician shortage. There's also a high rate of burnout with the way things are. Why spend all the resources it takes to train these professionals when you're not going to work on retaining them. Seems like an inefficiency that should be addressed. It's easier to retain someone than it is to send someone through the training pipeline, and the effects are immediate. Plenty of experienced docs who left because of burnout that could be reactivated given the right incentives. I agree that physicians in the US are the highest paid in the world. And that their salaries contribute to healthcare costs. Im also saying that US salary, in any profession, is also the highest paid when compared to other countries, so it's not really a fair argument to say because other countries pay less, so should we. A doc in France making 150k and a doc in the US making 150k are not living the same lives. I personally think limiting insurance company profits to refocus on serving patients rather than shareholders is a good start. Also having am honest conversation about preventative care and what it means to have robust public health would go a long way. And then also setting better expectations about end of life care, when care costs can blowup exponentially, when it doesn't extend quality of life. Those are alluch bigger potatoes in my opinion. Say you cut physician pay by 50%, their compensation makes up such a small portion of overall spending that the negative consequences would have worse repercussions on the system.
I also forgot to address your point about increasing supply earlier. Increasing supply without mainting pay would only help the shortage in the immediate term, but discourage next gen from entering the training path. It also doesn't decrease overall system cost. Going from 1 doc making 600k to 3 docs making 200k costs the same in the end, except you had to spend resources to train 2 more people and now the peeps that are 13 years younger will no longer enter the field. People think docs and their salaries should purely be based on free market supply demand, but they forget that healthcare services are inelastic and the supply takes a long time to come online. If you want people to go through it, the incentives have to be there. People who can become docs can also just as easily go into any other lucrative field. Once you force them to make that choice, you lose out on a potential doc.
HappyTopHatMan | 18 hours ago
Did you bother looking at the pay of the office workers? They are not important, nurses and doctors are and when you look at the medical debt to train a doctor and tell them there’s a massive pay cut coming you get no doctors. These people earn their pay, the white collar workers do not. Cut the real chaff first and the budget will magically fix itself.
Yellowdog727 | 12 hours ago
Which I think also ties into how expensive education is here
ludogjr | 7 hours ago
Cut physician pay to 0 and healthcare costs decrease by only 8%-10%. The professionals trained and educated to deliver the care and push research are already feeling burnt out and you want to further decrease their compensation?
espressocycle | 5 hours ago
You need to look at as it relates to GDP and GDP per capita. Administrative costs associated with insurance and billing are about 30% of overall costs and that's about what separates our costs from Switzerland, which has a similar GDP per capita.
flakemasterflake | 4 hours ago
Who is going to authorize wiping out student loan debt for doctors then? You can’t have someone be 400k in medical debt and cut their salary in half
Also, no one would go through the medical training system in the US for only 200k a year. It’s too grueling and there are better things to do at that salary level
flakemasterflake | 2 hours ago
> with much better healthcare
Canadian doctors are payed similar to the US and they have socialized medicine. They also have a very hard cap on the number of doctors that are allowed to graduate from medical schools in Canada so the state doesn't have to pay so many salaries
Which is why so many Canadian doctors immigrate to the states
FIST_FUK | 19 hours ago
Lol no it isn’t. That accounts for a small minority of what medical spending is from.
HODL_4_GODL | 16 hours ago
First step would be to get rid of astronomical tuitions and nationwide tort reform. Then consolidate into a single payer and redistribute the market cap of the largest payers back into the pool.
AlorsViola | 12 hours ago
How does tort reform do anything other than hurt people with the most serious injuries?
Substantial-Ad-8575 | 11 hours ago
One of the largest costs for healthcare in US? Malpractice Insurance. Which will skyrocket if US goes to UHC. With less patient time and more patients, will lead to more medical issues, turning into more lawsuits…
Estimates are under M4A under Sanders? That malpractice insurance would go up $175B-$225B, erasing any gains from
Prescription drug savings…
HODL_4_GODL | 6 hours ago
Why would you assume that people with serious injuries got them due to malpractice?
Why would physicians practice under single payer for a fraction of the pay without tort reform?
The point is to figure out a way to solve this medical crisis.
AlorsViola | 6 hours ago
Tort reform usually means damages caps that limit the amount injured people can recover from negligent doctors. I'm not sure denying legitimate claims full compensation really accomplishes anything.
humanreporting4duty | 13 hours ago
The pay is not even the issue. Money is not an issue. Do we have enough healthcare supply? No we don’t. What stands in our way? Time, space, and incentive structures.
somecisguy2020 | 20 hours ago
I’m not sure why it would be heresy when the Cato institute completely agrees.
Darkpriest667 | 18 hours ago
I'm a party member, a delegate at both the state and national levels, and heavily involved in the party. To say you support a socialist policy of any kind is almost considered treason to a Libertarian.
somecisguy2020 | 18 hours ago
One might argue that if you are pilloried for supporting reasonable policies because of how they are labeled, it may not be such a great party/economic philosophy.
Not_FinancialAdvice | 14 hours ago
Honest question; if you're pretty far deep as an "insider" so to speak, aren't you a prime candidate to turn that tide?
Darkpriest667 | 5 hours ago
No there are several factions within the party and none of them would agree to move in that direction. I am a single delegate voter.
prosocialbehavior | 5 hours ago
Right the theory behind private healthcare is price transparency and choice which we have none of. In theory the competition should drive the price down but there is very little competition.
The theory behind socialized medicine is that everyone has access and doesn’t go bankrupt when provided care. Which we also don’t have.
Darkpriest667 | 4 hours ago
Yes, and what we have is privatized healthcare with heavy government regulation and intervention, so it's literally the worst of both worlds. I mean think of this, it's illegal for many insurers to insure you if you don't live in a certain state. Most of them don't even compete with each other. They have "vertical" integration which means they own the hospital, the pharmacy, every doctor you see, and of course the insurance company.
shwaynebrady | 20 hours ago
As much as everyone likes to shit on Insurance and cherry pick talking points, there are people out there who consume millions in healthcare spending yearly that are covered. It’s how the entire system works.
25% of heath care spending is consumed by 1% of the population. 50% by the top 5% and the bottom 50% accounts for roughly 2-3% of total spending
The biggest issue with the US is there a ton of chronically un-heathy people here who consume an insane amount of drugs, services and procedures.
frozenminnesotan | 18 hours ago
Yeah, we forget this. We are a very unhealthy population, or rather we have kept alive a subset of the population that is chronically unhealthy, for reasons their fault or not. Its the moral thing to do, in my opinion, but that also comes with a bill they will never be able to pay.
Not_FinancialAdvice | 14 hours ago
> The biggest issue with the US is there a ton of chronically un-heathy people here who consume an insane amount of drugs, services and procedures.
The chronically ill and people at end of life. Many people online love to advocate with medically-assisted suicide; having cared for (and continuing to do so) for some family at end of life and seeing the aggressive tactics that the hospice providers (which I see as a "soft" MAID) use in person, I'm very against it.
Here's an example from ProPublica: Endgame: How the Visionary Hospice Movement Became a For-Profit Hustle
>Farmer was selling hospice, which, strictly speaking, is for the dying. To qualify, patients must agree to forgo curative care and be certified by doctors as having less than six months to live. But at AseraCare, a national chain where Farmer worked, she solicited recruits regardless of whether they were near death. She canvassed birthday parties at housing projects and went door to door promoting the program to loggers and textile workers. She sent colleagues to cadge rides on the Meals on Wheels van or to chat up veterans at the American Legion bar. “We’d find run-down places where people were more on the poverty line,” she told me. “You’re looking for uneducated people, if you will, because you’re able to provide something to them and meet a need.”
...
>Once a prospective patient expressed interest, a nurse would assess whether any of the person’s conditions fit — or could be made to fit — a fatal prognosis. The Black Belt, a swath of the Deep South that includes parts of Alabama, has some of the highest rates of heart disease, diabetes and emphysema in the country. On paper, Farmer knew, it was possible to finesse chronic symptoms, like shortness of breath, into proof of terminal decline.
Remote-Resource1172 | 17 hours ago
The government is already the largest payer of private health insurance, so there’s that.
platanthera_ciliaris | 14 hours ago
One big problem is we have all different kinds of health insurance policies from hundreds of insurance companies, not to mention some government-run health insurance with byzantine regulations, and all of this greatly increases administrative costs, with hospital staff and physician staff arguing with the insurance companies over the phone whenever something gets denied (which happens often). The government regulations involving insurance, hospitals, etc., are also really complex, requiring expensive specialty lawyers, and our expensive legal system involving malpractice lawsuits and other legal problems further adds to the cost. These are all extra expenses that fall outside of actually providing health care to clients.
Phunkychikn | 4 hours ago
The quote you listed was from Luigi’s bullets. The accurate United strategy is Delay, Deny, and Defend.
Darkpriest667 | 4 hours ago
I'll fix it. Google lied to me. I didn't remember the exact saying just 3 Ds. :-) Thanks for the correction!
thedisciple516 | 17 hours ago
> I would rather have a single payer healthcare system
the counter argument would always be this.
Medicare for All is likely to increase federal costs by between $25 trillion and $35 trillion over ten years
To finance $30 trillion – a rough midpoint – policymakers would likely adopt a combination of approaches that are equivalent to a 32 percent payroll tax, 25 percent income surtax, 42 percent value-added tax (VAT), a $7,500 per capita mandatory public premium, doubling all income tax rates, reducing non-health spending by 80 percent, or increasing debt 105 percent of GDP. Taxes on high earners and corporations alone could not finance Medicare for All
https://www.crfb.org/papers/choices-financing-medicare-all
Are you SURE "but no more premiums or co-pays or dedcutables ever!" will convince the American people to accept those costs?
Another issue with America's hybrid system is that many (most?) receive high quality care they can afford that they are happy with. 82% percent of Americans are satisfied with their personal healthcare.
https://www.nbcnews.com/politics/politics-news/poll-are-satisfied-health-insurance-quarter-report-denials-delays-rcna248908
Also what happends to Medicare (92% satisfied) and Medicaid (82% satisfied). Do those go away?
The American healthcare system is crazy and convoluted for sure by Western standards but we need to determine whether a majority want it radically changed or (as with so many things in American society/politics) a very very very very loud minority.
Darkpriest667 | 17 hours ago
And those are all good counter arguments. I just know the current system is not great. Healthcare is primarily attached to either your employer or you being so destitute you cannot afford healthcare. I'm not sure what the best solution is, I know what we have right now isn't it. I personally know of two people who died of cancer because health insurers refused to run the tests to detect it when it would have been treatable. Sure they paid for their chemo when they had stage IV and were dying. Both would be alive right now if the tests had been run most likely. That's NOT an efficient use of resources.
HarmfuIThoughts | 13 hours ago
It's not good counterarguments. Yes, the government will have to find new revenue, but that doesn't mean it will be hard because the money already exists. We already spend trillions every year on healthcare, it just goes to private insurers instead of one public insurer. On average, people will not be worse off trying to fund a single payer system, because people are already paying for healthcare.
If the total cost of the new system is less than current spending (and there are several estimates that suggest this is true), then the average person wins financially. The tax quotes are scary, but what that post omits is that by lifting the burden of healthcare away from business, wages will rise dramatically. That's where current healthcare spending largely comes from, wages that never get paid out to workers because they are diverted to healthcare spending.
thedisciple516 | 13 hours ago
> We already spend trillions every year on healthcare
We as in the government and individuals combined. 47% of Americans are on Medicare or Medicaid and aren't paying all that much out of pocket right now.
There's also a lot of people who are paying their fairly low premiums and staying healthy and therefore not paying much for healthcare. Universal healthcare advocates sometimes seem to suggest that most Americans have expensive catastrophic medical issues yearly (or often) and that's just not the case. Those people will be very unhappy paying the added taxes while staying healthy.
Point is it's a democracy and even if what you're saying makes sense there will be a big backlash at the ballot box from people paying into a system they don't use. In a lot of cases private insurance is there to keep your personal spending on healthcare low while you are healthy (most people most of the time) and the help you out when the rare out of the blue expensive emergency occurs.
HarmfuIThoughts | 11 hours ago
medicare and medicaid spending is already on the government books, there will be no tax increase for this.
It's the private spending that will be new, but the funds for that private spending already exist, it's just a matter of how are we going to redirect this to the government's health plan? This is where tax increases come in. For people who are paying out of pocket, the average person will pay no more in tax than what they're already spending out of pocket. For people in a group plan, wage increases will offset tax increases for the average person.
>Those people will be very unhappy paying the added taxes while staying healthy.
These people are already paying for health insurance while staying healthy. ACA plans are already community rated, and larger employers effectively have a heterogenous risk pool already. The number of people in low-risk plans is small. But also, they are unlikely to lose, or lose significantly, under a national health plan for 2 reasons, first because research shows a single payer plan would reduce total spending compared to what we spend currently, and second because of a progressive tax system that will put greater burden on higher incomes and larger and more profitable businesses.
thedisciple516 | 11 hours ago
> For people who are paying out of pocket, the average person will pay no more in tax than what they're already spending out of pocket.
need evidence for this don't believe it. Sorry the 47% of Americans on Medicaid/Medicare aren't paying much already and then there's a chunk of Americans with gold plated employer provided health care plans that aren't paying much out of pocket and only have to pay a lot when the rare out of the blue emergency happens. Once again their situation changes dramatically when they have to pay a mandatory tax for a service they don't use.
Healthy Germans pay 7% of their income (on top of high income taxes) mandatory for their healthcare that they never use and many are not happy about it.
first because research shows a single payer plan would reduce total spending
My main point is that as weird and flawed as the American healthcare system is a significant portion of Americans are satisfied with their personal healthcare plan situation. If you make big changes that negatively effect just 10% of the population that was happy with what existed before it will have a big negative effect on whichever political party forced those changes on them.
HarmfuIThoughts | 10 hours ago
>need evidence for this don't believe it.
9/10 of these people are buying ACA plans which are already community rated. Why would they pay more by switching to a national plan? They would save money because a national plan costs less per person, and the cost burden would be skewed towards high earners.
>Sorry the 47% of Americans on Medicaid/Medicare aren't paying much already
This is irrelevant, tax payers are already footing the bill for them.
>and then there's a chunk of Americans with gold plated employer provided health care plans that aren't paying much out of pocket and only have to pay a lot when the rare out of the blue emergency happens.
I already explained why this isn't an issue. Address what i said instead of repeating the same thing again
>Healthy Germans pay 7% of their income (on top of high income taxes) mandatory for their healthcare that they never use and many are not happy about it.
Yeah this is how insurance works. Americans are already doing this, and americans are very unsatisfied with out of control premium growth
>My main point is that as weird and flawed as the American healthcare system is a significant portion of Americans are satisfied with their personal healthcare plan situation.
And they're going to be even more satisfied under a single payer system, given that medicare produces higher satisfaction ratings than private insurance. It's going to get even better when there are no more deductibles or prior authorizations
>If you make big changes that negatively effect just 10% of the population that was happy with what existed before it will have a big negative effect on whichever political party forced those changes on them.
Okay, but what will be the net effect on the party when you include people that are happier with a single payer plan?
thedisciple516 | 10 hours ago
ok go ahead and make this your platform. Unless the numbers are fake the bottom line remains that a significant number of Americans are happy with their healthcare coverage situation as it currently stands.
https://www.nbcnews.com/politics/politics-news/poll-are-satisfied-health-insurance-quarter-report-denials-delays-rcna248908
Even if the NBC poll is off by a bit NBC is not a particularly biased source.
End of the day we have to deal with the fact that we live in a Democracy where people vote for their own interests first and foremost like it or not.
If an immediate and dramatic switch to universal healthcare is implemented, and a significant chunk of the population ends up paying way more in taxes than they did for premiums... then whichever political force instituted that policy will be dead and gone forever (progressives of course). Just a fair warning
PinataofPathology | 4 hours ago
our outcomes are not competitive globally. we underperform for what we spend. the people who think they are satisfied with their health care arent really sick yet. when you get really sick is when you find out how bad the system is
suspicious_hyperlink | 17 hours ago
The point of insurance is to collect more money than it pays out
Darkpriest667 | 16 hours ago
It was rhetorical, it's a business specifically a corporation -- it's primary objective is to make profits for the shareholders.
Seicair | 4 hours ago
> I have long been a vehement Libertarian and I say what is considered heresy in my political sphere. I would rather have a single payer healthcare system than what we have right now if I had to make a choice. I think single payer is not great, but it's a hell of a lot better than the hybrid mess we have right now.
Also a libertarian, I agree. I’d prefer a more free market system where it’s not heavily tied to your employment (thanks FDR! 🙄) and where young healthy people have the option of a high deductible catastrophic plan.
But the current mess we have is insane. I’d take single payer over this if it were the only option.
chris92315 | 3 hours ago
More and more the only plans anyone has access to are high deductable catastrophic plans.
CommitteeofMountains | 20 hours ago
I've never heard a good argument for why other multipayer countries do so well in that case. It's always Switzerland, France, and Israel having less American vibes.
Crazy_Decision_954 | 20 hours ago
Because you have no power. Your employer chooses your insurance. That’s where the problems lie. Make it like any other insurance that you buy. It would be nice if it were non profit.
dust4ngel | 19 hours ago
> What is the point of insurance?
i also like the idea of being insured against the "risk" of routine vaccinations. "you need a covid booster? wow! nobody could have seen this coming... except of course our advanced risk-modeling algorithm"
Consistent-Fig7484 | 16 hours ago
A family with two gainfully employed parents who have “good” insurance can still easily pay $1000 a month in premiums after employer paid benefits. I can’t wait for the finance bros to chime in and talk about how doctors and nurses are overpaid.
AdFlat3754 | 15 hours ago
The problem is healthcare companies are publicly traded
Substantial-Ad-8575 | 11 hours ago
Rather have German Model of healthcare. Basic UHC for everyone. With UHC issues of longer waits, delays, denials. Or individuals and company can choose private insurance. Private insurance is highly regulated. Individuals/Companies get bothers for healthcare taxes paid.
Get better healthcare, longer life, faster visits and less denials.
Firestar222 | 4 hours ago
Yes thank you. Another thing people forget is that taxes are meant to be progressive for a reason. The more you benefit from society, the more you support it. Pretty much all tax structures are like this to one extent or another.
When you have tax funded healthcare it also works this way.
The way we have it now in the US is not progressive at all. Everyone pays the same. There are many subsidies and assistance programs for those who could not afford it such as elderly retired or low income, so they aren’t supporting the system much at all. The top earners pay the same as the average Joe so they don’t support it much either because there aren’t that many of them. The top .01% I bet doesn’t even have insurance, why would you need it when you can just pay cash if you need something. If it was cheaper to have insurance it wouldn’t be a very good business model.
Those 2 things mean that most all of the burden of our current system falls on the middle class, ESPECIALLY families with kids that are also are on insurance. Medical costs are a huge part of their income unlike the top and bottom. And they are effectively a tax because they are not wealthy enough to decide not to pay them, and this also takes from their ability to save for retirement. In many ways our system is the dumbest possible way to do this.
seffay-feff-seffahi | 3 hours ago
I'm reading Hayek's "The Road to Serfdom" and even he's fine with this. Healthcare doesn't and shouldn't operate according to regular economic trends, so it makes sense to separate it from the free market.
Darkpriest667 | 2 hours ago
Love Hayek, "The Road to Serfdom" is fantastic.
MidlifeWarlord | 2 hours ago
I’m right leaning and was a long time opponent of (more) socialized healthcare.
I then found myself working in healthcare for a decade as a vendor to payers, working specifically on prior auth systems.
Now, I sometimes throw out a random “Free Luigi” to make my day happier.
Lazy-Ad-7236 | 17 hours ago
yup, its time to sledge hammer the whole fucking system and start over.
Open_Pollution_8038 | 21 hours ago
I’m not interested in kicking in another 10% of my paycheck to fund the health expenses of a generation that already is sucking social security dry, cut their own taxes during their working years and didn’t invest in the country (note we haven’t had a gas tax increase in 30 years, fucks them roads right).
You know how they say got mine? Apparently not because I can vote. They can dump their 401k and SS into the nursing home for all I care.
Potential-March-1384 | 21 hours ago
You’re already paying for socialized healthcare for retirees. How do you think Medicare gets paid for?
Open_Pollution_8038 | 21 hours ago
I’m happy with the care they get with the current level of Medicare and Medicaid.
It’ll buy them a real nice nursing home (not).
Darkpriest667 | 20 hours ago
I agree with you in principle, but we're already paying for the retirees who screwed everyone behind them, the public option would be for a demographic that is "generally" more healthy than they are and would lead to better long term outcomes, it in effect would reduce costs later.
Open_Pollution_8038 | 20 hours ago
Not true, as it is once they get too sick and can’t afford medicine they go on Medicaid and Medicaid homes is what these people deserve.
shwaynebrady | 21 hours ago
Gas taxes are largely funded and enacted at the state level.
Open_Pollution_8038 | 21 hours ago
Gas taxes didn’t use to be like this - historically most projects were federally funded. Hence why our roads and bridges are falling apart since they haven’t increased it since the 90’s.
shwaynebrady | 20 hours ago
That is very state and county dependent. Of all the things that should be federally consolidated, infrastructure isn’t one of them IMO.
Open_Pollution_8038 | 20 hours ago
Lol have you drive on the interstate highway system?
That’s 90% Fed funding.
Want to know what feds not funding cross state bridges look like? Tolls.
XNo_Notes | 20 hours ago
They should lend some tech for their backend. They are chickens with their heads cut off trying to play catch up on record keeping in my state. We may not even know how old everything is to know when it needs to be repaired.
fromkentucky | 20 hours ago
We’d all spend significantly less with a single payer system.
Open_Pollution_8038 | 20 hours ago
This is so false lmao.
We’re not paying UK prices for US healthcare.
fromkentucky | 17 hours ago
No it isn’t. We pay 2-3x more per capita on healthcare than developed nations with single payer systems.
ICLazeru | 20 hours ago
Healthcare has some unique traits that make it difficult to run as a fully free-market enterprise. I could list them out, but I'm short on time.
Basically it boils down to the nature of medical care not really being compatible with consumer agency. And the US exacerbates the problem even more with its special type of bureaucratic medical hell.
We are not just doing things inefficiently, we are doing them EXTRA inefficiently, and it's not likely that any amount of market options can fix it.
JockoMayzon | 19 hours ago
When people hear of markets, they think "supply and demand" as perfection and fairness in a free market.
What they miss is the principle of inelastic demand.
If the price of the newest iPhone is doubled, demand will drop. If the price is cut in half, demand will rise.
This is not the case with chemotherapy or cardiac pace makers.
diabeetus-girl | 15 hours ago
Yup. As a type 1 diabetic, I can’t just boycott insulin manufacturers or insurance companies if the price rises too much. I’d literally die if I tried that. I’m forced to pay for insulin no matter what the price is. The demand for insulin is a lifelong constant for me, which a lot of “free market” supporters don’t understand.
StrngThngs | an hour ago
Moreover, there is asymmetry of information, where providers are vastly more capable of evaluating care, and there is often urgency (you can't actually shop around for an emergency room). The vast majority of providers accept Medicare, and it is estimated that universally using Medicare rates would save over $1 TRILLION per year, in part bc of reduced overhead and faster pay cycles. And don't get me started on loop holes, like either/or arbitration on reimbursements.
JockoMayzon | 40 minutes ago
Indeed.
We all have an idea of how much a new roof would cost, or a new refrigerator, or brake job, but medical care?
Illustrious-Lime-878 | 14 hours ago
But the US doesn't have anything close to a "free-market" heath care system.
MRG_1977 | 14 hours ago
Places where a “free market healthcare system exists in any industrialized county”
Zero!
Illustrious-Lime-878 | 13 hours ago
Point is "free market" is not why US healthcare system sucks.
MRG_1977 | 12 hours ago
Anyone who argues we that can have a nationwide “free market” healthcare system is an idiot.
You can apply principles of it here and there in certain instances but anyone who argues it can be the basis of a nationwide system is a partisan hack or deeply unserious person. Either way they are not worth paying much attention to in regards to healthcare policy.
Illustrious-Lime-878 | 5 hours ago
No one is saying that. That's why its silly to point out as some criticism of the US's system.
MRG_1977 | 2 hours ago
It’s silly because when we have tried it (e.g., high deductible health plans) it has been a failure especially in terms of healthcare access and outcomes.
Bundled payments have been underwhelming too. ASCs can do them cheaper and offer guarantees but it’s like charter schools skimming the profit from public schools.
Let hospitals and other providers off services that are loss leaders/make no money including primary care.
Healthcare pricing transparency would in theory help but it applies to a pretty narrow range of diagnostic services.
Anyone who just argues “free market healthcare” without clarifying what they mean is a waste of time to speak with them.
Illustrious-Lime-878 | an hour ago
So to repeat, no one is arguing for "free market healthcare," I was responding to some one criticizing free market healthcare as if it explains the problems with the US healthcare system.
The US system is far from a free market with the government accounting for the vast majority of spending and an immense amount of price regulation on both federal and state levels.
Anything close to being called a "free market" system would be wildly different than what the US has. It would either have to accept some things that aren't politically viable, like allowing refusal of emergency care based on ability to pay, or have a completely different type of regulatory structure to fully internalize all costs / benefits properly.
NoamLigotti | 7 hours ago
If lack of "free market" can be anything, then "free market" can too.
Illustrious-Lime-878 | 5 hours ago
huh?
moufette1 | 20 hours ago
Absolutely this. Is that surgeon good or do they just cherry pick all the easy patients? Should I do X procedure or Y procedure when the science isn't clear?
We spend a ton of money on the elderly at end of life. When is it time to let go and what does letting go mean? Massive stroke, severe dementia seems like a clear case, but sometimes the body just keeps going. What if that massive stroke, or more often, severe traumatic brain injury happens to someone in their 20's? And what about less clear cases, perfectly active 80 year old gets cancer...treat or not?
And then there's the whole scope of practice morass. No one wants to say, sure, someone with 6 months of training could do this part of my job. And there are many areas where that's true. Until that training fails and the adorable 10 year old dies from a missed diagnosis.
NOLA-Bronco | 20 hours ago
Correct
Basically every component you need to have a high functioning market is perverted or busted when it comes to healthcare.
leaky_shrew | 16 hours ago
One interesting point I saw is that because of the total employees working in the inefficient system makes it sticky to solve without laying off a ton of people. Like if tomorrow insurers were made obsolete that’s prob a few million employees and some very large companies taking a hit. So the transition to a solution is probably as important as the actual solution
MRG_1977 | 2 hours ago
It’s a massive jobs program and healthcare providers are now often the largest employer in a lot of counties along with school systems or local/state government. It’s not a good thing necessarily but it a reality in the U.S.
xblackout_ | 13 hours ago
No, basically it boils down to takers and makers
TheUnderCrab | 4 hours ago
The laws of supply and demand go out the window when you’re dying and need life saving medical care. Medical care cannot be a free market system because people will die en masse.
personAAA | 2 hours ago
The routine stuff behaves just like a regular market. Look at eye care. Eye exams, eye wear, even surgery all done independently of insurance system responding to patient customer price pressure.
The solution is less care within the insurance system.
FlufferTheGreat | 2 hours ago
This is also how I view electricity generation and distribution. It's not something that should have a profit motive. It's something that should be maintained and charged only the amount needed to reasonably maintain and add resilience and upgrades to. Getting rich off of a company's ability to freeze or overheat people to death is fucked up.
MRG_1977 | 14 hours ago
Kenneth Arrow won a Nobel Prize for this nearly 75 years ago.
RAND Health Insurance experiment was more than 50 years ago.
LuckyPlaze | 9 hours ago
Exactly.
The supply-demand forces only work if both buyers and sellers have agency, transparency and limited barriers. The act of a consumer buying something, aka voting with their wallet, is where value in the exchange of goods happens.
The problem with healthcare is there is no price that someone won’t pay to live. It’s not like an apple where you can just skip it and buy an orange instead; you will sacrifice literally anything to live. So the value proposition, the fundamental building block of the free market, is broken.
Postsnobills | 13 hours ago
I pay almost three hundred bucks a month out of pocket for my insurance.
Today, after fighting with Kaiser for years, I finally got to see a doctor who would clear me for PT for my lower back… my copay was a hundred dollars to have this man just be like “uh, yup, your back hurts, you’ll need to sign up with PT.” I already know the PT is probably going to cost another hundred, maybe even more than that.
What is the 300 bucks for a month? What in the actual fuck are we doing?!
TimSylvester_ | 2 hours ago
>What is the 300 bucks for a month?
Well, it's for Kaiser.
>What in the actual fuck are we doing?!
Making Kaiser shareholders wealthier.
trilobyte-dev | 17 hours ago
I was on a business trip in Israel years ago and got injured and had to go to the hospital. While I was there they had to bill me for it and it was like $90, something I didn't even think twice about, but they were apologizing profusely to me for it being so expensive. I did a little research and one interesting thing I remember is that in Israel insurance companies are strictly regulated on how much profit they can make and even though they don't have socialized healthcare it keeps the costs way down. I've also been to South Korea and needed care and similarly the price was ludicrously low. These weren't elective procedures but were situations where I got injured or was feeling unwell enough that it pushed me to seek medical care.
It seems like the U.S. is doing something really wrong in healthcare. One thing I've always wondered is if health insurance is just a tax on healthcare dollars being spent with the money going to a private company. It certainly doesn't seem to be going to providing better quality of care.
cuoreesitante | 16 hours ago
It's for profit, and often publicly at that. Thats the entire issue. When Healthcare companies ultimate directive is to make as much money as possible for shareholders this is where it ends up.
AdFlat3754 | 15 hours ago
We made it a for-profit for-graft industry where everyone gets a full slice of pie except the end user. Publicly traded global companies running for profit healthcare is a demonstrated disaster
SpicyRice99 | 15 hours ago
We already do the same for utilities because they exercise a geographic monopoly. Arguably hospitals are the same
Moral-Relativity | 15 hours ago
US health care insurance companies are required to spend 80-85% of premiums on delivering care and improvements, which in theory caps maximum profit, before overhead.
czarczm | 14 hours ago
And the result is they have to blow up premiums every year to make any money.
DDGBuilder | 14 hours ago
No it doesn't, you can still increase premiums
Imaginary_Manner_556 | 14 hours ago
You are wrong
SisyphusRocks7 | 11 hours ago
Yeah, insurance companies aren’t the ones with supernormal profits in the healthcare sector. That’s pharmaceutical benefits managers (though the biggest is owned by an insurer, IIRC) and specialty doctors in hospital affiliated practices.
tiredprincess | 12 hours ago
The US funds Israel’s healthcare system - all money that could be used to benefit actual taxpayers here in the US.
mdcbldr | 20 hours ago
And have been broken for some time.
Our healthcare system is both the envy and the laughing stock of the world. We have some of the most sophisticated and cutting edge tech in the world and we use it to provide care that is unattainable anywhere else.
We also limit access to that care to the wealthiest families in the world. We could easily provide fantastic healthcare to every citizen, yet we don't. We could easily be the envy of the world, but we aren't.
Some people are so afraid that someone might get something they don't deserve that we do nothing.
EconomistWithaD | 21 hours ago
I've done some research on this, years ago. The basic conclusions (I am happy to provide papers if people want to read them).
The U.S. IS uniquely inefficient in producing healthcare; doesn't matter whether you measure outcomes by mortality rates (outside of cancer), disability adjusted life years, life expectancy, ... This holds EVEN if you control for causes of death that are largely outside of the purview of the healthcare delivery system (auto accidents, homicides).
The most efficiency systems are those with a broad (but basic) public option, with the ability to purchase private options. The German system would be an example.
3.The expansion of the PPACA was not inefficient, and that states that did expand have performed more efficiently than states that do not. It may have cost more, but the outcomes did improve to outweigh that effect.
However, there are some important caveats with regards to U.S. healthcare which makes it a bit more unique, and that any improvements MUST address.
U.S. citizens are much more likely to try to extend life without palliative and hospice care (or seek alternatives) when given a fatal diagnosis. https://www.ncbi.nlm.nih.gov/books/NBK233601/
The rural health issues (food deserts, but for healthcare) are much more prevalent, just given the geographics of our country. So, lack of access to care is much more a geographical feature here than it is elsewhere.
Behavior; we tend to be considerably more time inconsistent (smoke a cig today, telling myself I'll quit tomorrow).
Distrust of medical professionals/public health professionals. We are closer to a developing country with these.
vaskov17 | 20 hours ago
The goal of the US system is not to efficiently produce healthcare, it's to produce profits and the US healthcare system is exceptionally good at that
EconomistWithaD | 20 hours ago
American healthcare suffers because the maximization problem is, largely, different among different groups. And profits are a motive of some of them.
But, no, there are certainly aspects of American healthcare that have been shaped to address efficiency. Especially post-PPACA.
happymage102 | 16 hours ago
Isn't this kind of looking to not acknowledge the profit motive as a priority? It seems senseless to not acknowledge that desire for quarterly profit as the reason care access has declined so heavily.
EconomistWithaD | 16 hours ago
Profits are a maximization motive for some groups in healthcare doesn’t tell you that profits are an explanation?
happymage102 | 16 hours ago
I guess I'd argue it is the dominating factor. High prices in the US for healthcare aren't encouraged just for the sake of profit maximization. The companies selling saline, insulin, and other items people can't live without are certainly exploiting the "you'll pay any price to be well" component of healthcare, and know they can get away with it in the gilded ecosystem they've designed.
Looking at the original BCBS plan intent and what we've end up with today, it seems like profits are genuinely the only serious motivator in a system that intentionally overprices the cost of every good to claim care was more expensive than it was and increase profitability.
bloodontherisers | 20 hours ago
Something that will also have to be addressed, that might be different since you did your research, is private equity getting into the game and buying hospitals and emergency rooms. That is likely exacerbating some of the current issues too.
EconomistWithaD | 20 hours ago
It's *MOSTLY* negative, but there are some papers that MAY find benefits. At best, you can say confidently that PE acquisition didn't improve patient outcomes uniformly.
https://jamanetwork.com/journals/jama/fullarticle/2813379
Mostly reductions in quality, some improvements in mortality, but could be sample selection (they can't really say).
https://www.bmj.com/content/382/bmj-2023-075244.abstract
Costs rise, and evidence on quality is "mixed".
https://www.sciencedirect.com/science/article/pii/S0168851025000223
Benefits are going to not be universal, and are going to be limited to certain areas of care.
solomons-mom | 21 hours ago
Did you come across Paul Starr's book? Or any of the late Uwe Reinhardt's books or papers?
EconomistWithaD | 20 hours ago
Yes; cited Starr's "The Logic of Health Care Reform" in several papers, and read the original "Transformation of American Medicine", but haven't read the updated version.
I teach a lot of Dr. Reinhardt's ideas (estimation of moral hazard, supply-induced demand, ...) in my class, and actually got to deal with him several times when he was an editor. This, however, is my favorite Reinhardt paper. https://www.healthaffairs.org/doi/10.1377/hlthaff.22.3.89
Edit: this op-ed also helped drive (and shape) large parts of my dissertation.
https://canceradvocacy.org/wp-content/uploads/2013/02/march-delivery-quality-care.pdf
CommitteeofMountains | 20 hours ago
Isn't Germany, like its multipayer peers, private orgs unless you're unemployed?
You forgot that the American system also makes much more inefficient spending decisions like high physician pay and minimal wait times (high excess capacity).
EconomistWithaD | 20 hours ago
So there is a broad German public option, but they are non-profit, non-government organizations that deliver. I still call that a public option (heck, even Commonwealth does), but I guess people can further delineate from it that it's NOT one public plan. https://www.commonwealthfund.org/international-health-policy-center/countries/germany
I tend to believe more of the Reinhardt "it's the prices, stupid" argument. https://www.healthaffairs.org/doi/10.1377/hlthaff.22.3.89
Eating_Astros_9677 | 16 hours ago
> I tend to believe more of the Reinhardt "it's the prices, stupid" argument. https://www.healthaffairs.org/doi/10.1377/hlthaff.22.3.89
I don't think this answer gets us anywhere. The profits aren't remotely close enough to fill in the implied gap from looking at the problem as a pricing problem. So where is the excess pricing going to? That's the question that drives the true costs of the system.
EconomistWithaD | 16 hours ago
Can you point to any research that shows that pricing is irrelevant? Because the other authors followed up in 2019, and I haven’t seen anything that suggests it’s not only incorrect, but has zero explanatory power.
Eating_Astros_9677 | 12 hours ago
It's been difficult for me to find as well because it seems like most of the research is trying to break down the differences between US and other places from an accounting perspective. That gets you to "pricing failure". I don't think it's incorrect, I'm just stating it doesn't help answer the important questions. The gap between what the US system costs versus what an equivalent UHC system would cost is nearly $2,000b.
To explain where the price is coming from or where it is flowing to, I've looked into the cost structures and spending of insurers and providers. It's not going into profits, not much anyway. Even approximating "profits" as a kind of nonprofit waste spending only gets to about $320b as a high estimate. Ceo salaries are a drop in the bucket. Doctors salaries explain another $330b ish, but after accounting for doctor debt and higher (general) US pay, and subtracting what doctors get paid elsewhere, most of that number vanishes as a comparison. Nurses, same rough outcome - higher paid but still nowhere near enough to explain the gap.
Medicare underpayment shortfalls might explain somewhere as high as 180b. Medical malpractice is well under 100b. Using generous high-side estimates, there's still $1,000b that the US is overspending that's not showing up in provider salaries, medicaid shortfalls, malpractice costs, or profits. So... Why? Pricing failures can be technically correct while still not explaining why the system is creating the results we observe.
CommitteeofMountains | 20 hours ago
> but they are non-profit, non-government organizations
So private insurance companies. By your standard, all the Blue Crosses are a public option.
EconomistWithaD | 20 hours ago
To my knowledge, BCBS is for profit, and some plans don’t cover a baseline option, in certain states, that would be a minimum public standard.
CommitteeofMountains | 19 hours ago
Sorry, should have specified state plans rather than Anthem (which I tend to think of as a different brand because it plays down the BCBS). The state ones and Kaiser are the big players in why about 63% of U.S. health plans with over 100,000 enrollees are (were?)nonprofit..
That cite is always an amazing PITA to dig back up from memory.
EconomistWithaD | 19 hours ago
Those appear to be very close to the sickness funds in Germany, and would likely be the templates for a truly universal system in the US.
CommitteeofMountains | 19 hours ago
But that means that America and Germany equally have public options.
EconomistWithaD | 19 hours ago
Except health insurance is mandatory in Germany. It is not in the U.S.
CommitteeofMountains | 19 hours ago
It is. That's what the whole Obamacare imbroglio was about. To ban preexisting conditions without making insurance something you get after diagnosis, it placed a mandate on the populace.
ComfortableParsley83 | 14 hours ago
When the biggest players in health care corporations are public, which depends on growth of revenue to support the stock price, that inevitably means that costs will rise across the system. At some point it becomes unsustainable (one could easily argue that we are well past that point).
azhawkeyeclassic | 19 hours ago
HC is used as a tool to create modern day indentured employees. Tying HC to a job makes is nearly impossible to to relocate or quit a job without taking serious risk to your physical and financial health. It should be noted that HC debt is the highest in the world and one misfortune can destroy entire families instantly. Is a scam, created in the Oval Office when Nixon decided that HC should be privatized.
JumpyCandy6463 | 14 hours ago
US healthcare system is for profit, as in maximizing profits in quarterly reports. One spends less and collects the same premiums, profits will be soaring.
TheDoomBlade13 | 7 hours ago
The philosophy of the healthcare system is also broken. In America it is viewed as a commercial service, while the rest of the world views it as a public service.
BekindBebetter60 | 19 hours ago
Yeah, tell me something we don’t know. The United States spends more per capita on health insurance than the other industrialized country with the worst results. America spends very little on prevention. America allows its food to be poison through excess sugar, excess chemicals, excess pesticides, and little to no regulation.
ClaymoreMine | 16 hours ago
It’s Health Profit not health care. When medical professionals are given KPIs that reward for finding as many complex patients as possible. That treat charting complexity and length like its own kpi we have a problem. Not to mention the egos within every single aspect of the healthcare industrial complex. The only solution is to start at zero and figure out the best way forward. And it certainly isn’t charting more to uncover more because that hasn’t led to better outcomes physically or monetarily for anyone.
Pure-Science-7774 | 18 hours ago
The environment can be poisoned by large companies with no consequences as well.
Zlifbar | 18 hours ago
No, they're not. The health care system is working exactly as designed: Extract as much premium as possible, reject as much care as possible, funnel profits to the executives.
boomares | 17 hours ago
Shareholders, profits are designed to go to the shareholders. Executives are employees just like all the rest of the employees.
CormoranNeoTropical | 13 hours ago
Principal-agent problem going on here
boomares | 7 hours ago
True, I wouldn't throw the baby out with the bathwater and make private insurance illegal as the answer.
CormoranNeoTropical | 10 minutes ago
Is anyone suggesting that anywhere? If so I really want to know about it, please inform me.
cyberdude419 | 20 hours ago
Yes. Morally and financially. Capitalism is all good and fine, but some things shouldn’t be involved in the unsustainable cycle of ever growing profits, and the right to life is one of those things.
thedisciple516 | 17 hours ago
> and the right to life is one of those things
except the healthcare system has nothing to do with America's (slightly) lower life expectancy than peer societies.
It's all to do with life style choices (worse diets=heart disease), car accidents, murder rates and opiod epidemic.
MRG_1977 | 14 hours ago
In 2008 and 2020, the federal government backstopped state health programs (mainly Medicaid) when states were fiscally unable given fiscal shortfalls due to significant revenue declines.
Given the current projected outlook of the federal deficit and mountain of annual interest payments by 2030+, I don’t see how the federal government is going to be able to do this during the next significant economic downturn.
hw999 | 16 hours ago
Stop calling it broken, its not broken, it just wasn't built for the advertised purpose. It's a system built by the wealthy to extract the most money possible from captive customers. You either pay or die, its a capitalists wet dream. Oh, and next year you will pay more.
Ed_Radley | 19 hours ago
Make everything transparent when it comes to pricing and give people the ability to opt out of coverage for minor procedures and illnesses going through their insurance. The reason premiums are so high is because nearly everything needs to be covered nowadays. The closer you get to 100% of medical procedures being covered, the closer you need to your insurance basically just pre-paying 100% of your future claims so they can pay for the current claims of everyone who is older than you (at a time when population decline means the Ponzi scheme is starting to fall apart).
Zlifbar | 18 hours ago
How about "eliminate an entirely unneeded layer of insurance companies that do nothing but take money and reject care"?
Ed_Radley | 17 hours ago
There should be due diligence, but it's definitely like pulling teeth getting approval for suitable care. They need to reject blatant fraud, not tangentially questionable approval for stuff that has even some kind of better than placebo treatments.
boomares | 17 hours ago
I'd be willing to bet the vast majority of people here would love to have his problems.
If a quarter of his monthly pre tax income is $5000, his annual income is $240,000. This would place him in the top 5% of incomes.
He has chosen a healthcare plan that costs twice what the average plan on healthcare.gov costs. The highest price plan on healthcare.gov I can find, in my area, is around that price when plugging in his info that is known. However there are many options that cost half that.
jankyt | 5 hours ago
The healthcare system there is pretty much just all middle men as can be seen by what it costs to negotiate research costs vs regular costs through insurance
PinataofPathology | 5 hours ago
make more things over the counter with software screening and on site labs at the pharmacy. subsidized by govt.
get stable people with basic issues treated by meds with decades of data on safety and efficacy out of the medical system.
same thing for physicals. annual lab work at your local pharmacy.
and everyone gets an HSA. HSA should not be tied to your employment. your employer should get a tax break for contributing to them and you should get tax breaks for your contributions to the HSA. at least give people a chance to save up for their health care.
personAAA | 2 hours ago
So a health insurance CEO wants price control regulations.
Not really surprising the coalition he is part of all want price controls. Big employers self insure acting as their own payer they want to get costs down of course. Unions same thing.
The providers of course are mad because they would lose under price controls.
Value based care helps. Fee for service in complex patients is terrible for costs.
A modified capitation system with incentives for better outcomes and penalties for worse outcomes makes the most sense for funding. That aligns the interest of providers and payers to get the best care for lowest costs.
DimMak1 | 2 hours ago
The economics are not entirely broken. There is unlimited money in healthcare. Pharma industry is having record IPOs and record profits and there are trillions $$ in investments pouring into pharma every month with millions of jobs created this year.
At the consumer level, the economics are broken, but the govt just runs up more debt and pays for everything. Healthcare is too big to fail with absolutely zero pressure to improve anything or contain costs because it’s literally all fueled by debt and money printing so no point to try to improve any aspect of the system. Same in Pharma, zero pressure on pharma companies to do better or innovate. They get paid no matter what.
dually | an hour ago
Healthcare is expensive because humans don't scale, but healthcare workers still have to be paid a wage that is competitive in a world where most industries can be scaled.
You see the the same effect in all service industries. For instance imagine how expensive it would be to hire a plumber or a professional marching band vs in contrast with a hundred years ago.
RexRig04 | an hour ago
The Obummercare architect J. Gruber admit over a decade ago it was never designed for users to save money. It was designed as a precursor for Medicare for All = inadequate delayed subpar socialist medicine. And just like Sayed in Michigan, the true agenda isn't revealed until it's too late.
dmbgreen | 11 minutes ago
I was curious of the margins on medical insurance providers and it was supprisingly low. Don't know if the government could be more efficient. Definitely a huge amount of money