'A full-blown crisis': Americans brace for a surge in healthcare costs
ft.comhttps://archive.is/UwqzL I was paying around $1200/month last year (a little under that with subsidy). This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before). So I guess I'm on a primary care physician merry go round :D I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered. But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :( > But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :( These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020. This is not specifically just a lapse in subsidies for high earners, this is for everyone which is telling how little people actually understand what will happen when the subsidies expire. The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1]. [1] https://www.kff.org/affordable-care-act/aca-marketplace-prem... I'm so, so sorry to hear this. Can you share which state you're in? My man, this is the Raspberry Pi guy, Jeff Greeling. He lives in St. Louis, MO. He is a god, and we mere mortals. You go without coverage of course. Unfortunately. (It's getting late, Jeff. I'm heading to bed myself.) I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees. I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(" my premium actually went down because my carrier left aca, but there are no longer any carriers with a decent network in the exchange. the networks in the illinois aca suck if you live in the chicago area. > This year I'm paying $2100/month for a family of five, blink Top cover in Australia for a family is about USD$400 per month. Excuse me, but how in the world were you able to afford 1200/month, you know that's like cheap rent right? If you're getting health insurance through your employer, that's a pretty standard price (counting both your contribution and your employer's together). I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month. It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately. My Employer sponsored supposedly nice insurance (I say supposedly because they keep being a pain in the ass for pretty much everything) is $200+ per paycheck for me and my spouse, i.e. ~$450/month. That is after my employer covers most of the cost. This stuff is ridiculous. That’s absolutely not an exception. I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half. A switch to a private insurance would lower the costs around half. I was under the impression that German healthcare was essentially free (government funded) at the point of delivery, with additional top-insurance carried by most people similar to how it is in here in France. Here I am self-employed and pay about 100 euros a month in top-up insurance (mutuelle) for myself and a couple of kids. Of course, the healthcare costs more, that’s why my taxes are high; but the insurance cost is about €1200 a year, not €2200 a month. Free at point of delivery does not mean free at all. Netflix is also free when delivering you movies, but it costs a monthly fee. I think it’s time that we all stop with the nonsense that government funded healthcare is free. Because who ends up funding the government are us, the citizens, and that costs lots of money. Some governments, like the German one, still make the costs transparent to the citizen, something you can even see in your payslip. Other governments, after failed policies and extreme inefficiencies, hide that and just budget healthcare costs out of the rest of the taxes. In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. When governments hide that type of information is because they actually do have something they don’t want the normal citizen to see. And that’s worrying and not democratic at all. >> In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. I absolutely do not believe my healthcare costs only €1200 a year. As I wrote, my top-up insurance costs about €1200 a year, and the healthcare costs more and that is why my taxes are so high. Ok, then I misinterpreted you. However it’s still unclear how much you’re paying, as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever. There are of course also negative second order consequences. In socialized health care systems, where doctors and hospitals are payed the same no matter their performance, the economical incentives to provide modern treatments or provide better services do not exist, so best professionals need to leave the public systems if they believe they are being underpayed according to their value. I’ve seen that happening in Germany and Spain a lot. Best doctors I had left their public healthcare position to open their own private business as that was the only way to be compensated economically according to the level of service they were providing. > as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever. Also true in America, in which there is no socialized healthcare. (In any standard use of the term) Hell, even Medicare ended up partially privatized. (At huge extra cost) The worst thing about government-run monopoly services is there's little bottom-up incentive to optimize. The worst thing about private-run services is there's little incentive for anything other than profit. Given the fundamental realities of must-deliver services (e.g. healthcare, prison, etc.), I'd rather have them government-delivered than some bastardized free market without competition. At least the former has a path to excellence. The latter just inevitably turns into a hostile hellscape for the end consumer. Hot take - the private doctors tell you they are great but the public doctors can often be spectacular because their motives are not primarily economic. For example, the absolute best diagnosticians in Houston are at the public hospital primarily serving Medicaid and Harris Health patients. Super evidence based, order tests for differential diagnosis not to make $$. Passionate about what they do. In a unexplained emergency my doctor friends would go there to be diagnosed and then the fancy privates to be treated. Bro, try going to the doctor in America's not socialized services. You have zero idea how much that specific visit is going to cost, on top of the tens of thousands in insurance premiums paid on your behalf yearly. My understanding (British citizen living in Berlin) is that the German system looks and acts like a tax, but is actually mandatory payments to one of a handful of almost-but-not-quite-identical private insurance companies, with care being free-at-point-of-use. It's possible to opt out if you're rich enough, but if you change your mind later it's very hard to return to the normal system. I'm currently not working*, my monthly insurance cost is €257,78. * thanks to my very cheap lifestyle, my passive income of only about €1k/month means I don't strictly speaking need to work ever again. Nevertheless, I am treating this time as a learning opportunity with a view to being able to change career path, given that I think LLMs make the "write the code" skill I've been leaning on for the last two decades redundant in favour of, at a minimum, all the other aspects of "engineering", "product management", and "QA", and possibly quite a bit more than that. Plus, y'know, get that B1 certificate so I can get dual citizenship. That will be hard to explain in English but you can find what you're paying to French healthcare system by looking at your paycheck (the document you receive every month that detail your paycheck rather). It basically either 7% or 13% of your paycheck (and .5% of non-work income via the CSG), and you have a hard cap on total contributions (4k/month, and healthcare if a bit more than half of that, so a bit more than 2k/month). It cover universal healthcare of course , but also maternity/paternity leave and invalidity benefits. Paternity/maternity also cover the pension parents get (half a year of contribution to the pension system per child if you take care of them til they are 13, plus half a month for giving birth) (that's so awkward explaining this in English, sorry) Thanks for this. I work independently (no CDI or CDD) so I don’t get the paycheck/payslip. I imagine it is broken down somewhere in the different taxes I pay, but unfortunately I don’t get the monthly reminder. You must be mistaken… The maximum personal contribution to public health insurance (GKV) is capped at around 400/m for healthcare (and an additional 200 towards long-term/elderly care). Spouse and children are free if they are unemployed. https://www.tk.de/resource/blob/2189790/9321e565c304a9cc33bb... If you are paying more than that then you are already paying for private health insurance (PKV) or private supplementation on top of GKV for some premium coverage. I am not mistaken. I know how to read my own payslip. Both me and my wife are employed. We have GKV both and we’re basically paying the maximum rate. That’s around €1100/month each, pre-tax. Half of it comes from my official bruto salary and the other half comes from my unofficial bruto salary. Which is how governments hide the costs of public healthcare. Ultimately is part of my salary deductions for the finances of my employer. Kids are not free: kids doctors don’t work for free. They need to be payed, and they’re paid from the contributions me and other employed fellow citizens pay every month. You're still allowed to visit the same PCP although it might not be covered, or covered out-of-network with a higher patient responsibility. >Allen is herself a casualty. While she used to pay $487.50 a month, her new healthcare plan, with reduced coverage, has monthly premiums of $1,967.50. Brutal. Meanwhile the White House calls it all "fake news". > Meanwhile the White House calls it all "fake news". The truth is a lie and only government lies are the truth. Orwell would be so proud. Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all? Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.) Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter. One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely. Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US. Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.” Aka Republicans being pissy about the ACA (despite having come up with no feasible alternative plan at the time and unanimously voting against it even after it incorporated Republican characteristics) and choosing to try to intentionally financially torpedo it so they could campaign on its failure. I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling. Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now). Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations. Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way. You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse. Medicare Advantage? Health care is fine here if you have a decent job. Health care is not that great in public systems and you still pay for it with higher taxes And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right? As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States. I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot. In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people. In this day and age public healthcare system are not efficient and bill the wrong people. They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners. However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country. These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system. Private systems work better because each citizen pays into his old age health coverage during his young years. > In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people. The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket. Actually the solution is to go full private. Costs when you get older skyrocket, but not your monthly contribution. You subsidize your own elderly costs by paying slightly more during your younger years. That slightly more is part of the insurance companies Float, which gets invested and is used 30-40 years later to cover your extra costs in old age. In a public system there’s no float. Everyone pays to cover the costs of the healthcare for that budget year. Which has the consequence that whenever there are population age shifts, the system becomes not sustainable, which is our current situation in Germany. If everyone (except unemployed) had private health insurance, population age would be non-problem. So your complaint is that the young subsidize the old in a public system, and your solution is a private system that somehow doesn't raise rates on high risk (older people) and to use the young...to pay for the old? You also ignore that you can't switch and magically have 30-40 years of float for old people currently receive healthcare, so you have to keep the same system in place until they are gone because insurance companies would instantly go bankrupt under your plan (since they have yet to build a float but have payouts instantly), so now young people subsidize old and have to pay for their non-subsidized future so they will basically have to pay double. Or do you plan just leave old people out of the public system? Pretty nice demographic to just ignore in your plan. > Health care is fine here if you have a decent job This statement is at odds with itself. ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population. It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace. They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care. Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system. The ACA had its most effective cost-control mechanisms stripped by its political opponents. Sen. Lieberman (a turncoat Dem who had campaigned for John McCain) forced the removal of the public option, which would have helped hold prices down through competition. The Supreme Court struck the requirement for states to participate in Medicaid expansion, which limited the benefits for millions in a swath of conservative states. And Republicans in Congress removed the individual mandate, which enabled healthy people to go without coverage, raising prices for everyone else. It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity. You shouldn't change all the parts in an engine to different specifications at the same time. The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward. The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!) The previous system was broken. The current system is less broken. It's possible to create an even less broken future system. The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.' In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward. Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work) was that the bold changes of Obamacare left too many victims behind who ended up worse off. You have to start with the principles of the country and work with them in mind, if you expect to be successful. You also have to assume future change will be dependent on the political winds of the future. There is likely a lesson somewhere here about introducing “lean healthcare” style of changes instead of “big bang,” but I haven’t taken the time to articulate them. Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward. > Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward. I'd trend in the opposite direction. The death of bipartisanship (due to changes in media, education, and gerrymandering: none likely to change soon) render democracies incapable of solving large problems over a multi-voting cycle timespan effectively. Ergo, the best solution is to punt to an independent body, in the same way central bank management was done. It makes more sense to have democratically-elected government responsible for and deciding the details, but not the strategic arcs. Healthcare, national debt / budget deficits, military procurement, voting rights enforcement, education policy would all be better off in consistent hands, even if occasionally less capable ones. Sometimes, it's more important to keep to an approach than have the optimal approach. Now? Most democracies get the worst of both worlds there. The problem, at least in our American mindset, is that since America’s birth, there has been a marked reluctance to have unelected bodies be responsible for anything that impacts the people, ESPECIALLY anything that presumes some globalization intention or some overarching aristocratic ruler (and with good reasons). Central banking works because problems are instantly catastrophic to the system, whereas healthcare systems are not that fragile. They can survive broken for a long time. Everybody is okay having a central lender of last resort because the problem is technical, typically unemotional, and in general, benefits every participant equally (because everybody loses is the system collapses). Healthcare is different in that it affects MY decisions on a regular basis. America is individualistic and self reliant. We never want some government bureaucrat deciding what treatment [I] should or shouldn’t get if [I] can afford it with my own independently earned money. [You] should take care of [Yourself], save your own money, eat healthy, exercise, or not, and live with your consequences. States have power too. So it does not matter much if some Bernie politician has some fantasy about some central single payer system that has some theoretical average benefit if it restricts ME from making my own choices. Other countries have other cultures and foundational principles, so Bernie may have better luck there. But not here. Is it limiting? Probably for this case. But the fact is the system works for many other things. Everyone wants to come here. It’s the best country in the world etc etc. It does not have to be perfect. But it’s the best we get with the philosophy that made the country what it is. Does it suck for healthcare? Overall, probably. But not for [ME]. We saw the system has limitations in other cases (think pandemics etc, but even now, many Americans can’t forgive the politicians that kept them imprisoned in their own homes). You have a right to life, liberty, and pursuit of happiness. But not to anything that must be provided by someone else, like healthcare. The Supreme Court is not “a political opponent.” It’s literally the way the country works. It found the requirements for states to participate to be unconstitutional. In fact, it was also SCOTUS who eventually determined in 2012 that the individual mandate penalty was functioning as a tax for constitutional purposes. This was the basis for upholding the law. The mandate itself was not upheld under the Commerce Clause but survived because the financial penalty was deemed a tax. > The ACA had its most effective cost-control mechanisms stripped by its political opponents. Because of lobbyism, healthcare sector is extremely strong politically and don't want to reduce their income, Democrats aren't immune to that they have mostly been just as pro corporate as the republicans are they just are pro different corporates. Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you: > Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year. You comment sounds like snark but I understand if you don't know what Obamacare is. (And I'm not an expert so hopefully people will correct any mistakes) "Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse. On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc. All house and senate GOP members voted "no" on ACA. Obamacare is a lot of things, but a "GOP healthcare plan" isn't one of those things. Strangely it actually was based on the GOPs 'Romneycare' that was promoted by The Heritage Foundation. Qft. Many of the provisions in ACA are direct GOP asks from the bipartisan negotiations around it... before the party decided to unanimously vote against it at the 11th hour. This is exactly what I was referring to. And I pointed that out to contrast with something more leftist, like government single payer. It's always cost ~$2k a month, the only difference is the previous administration thought everyone else should be "temporarily" paying for her plan. I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper. > the previous administration thought everyone should be "temporarily" paying for her plan. Moving money from person A to person B obviously doesn't make anything cheaper No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal. I support subsidies to help low-income citizens who legitimately can't afford health insurance, but some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line. https://www.cnbc.com/2025/10/17/aca-enhanced-subsidy-lapse-g... I don't want my tax dollars wasted on subsidizing them. Give the money to someone who actually needs it. (Of course the real problem is healthcare costs accelerating out of control. Insurance subsidies won't fix that problem. In fact they make it worse by encouraging healthcare providers and drug companies to raise prices even faster.) If we start to think about who "actually needs" things, we need to question whether any of the very wealthy "actually need" their wealth. I would be fine with seizing all of anyone's income (including unrealized capital gains) in excess of, say, $20 million just to give everyone else some cute stickers and lollipops. The giant flow of wealth to those at the top is a far greater misallocation than any amount towards the healthcare of anyone not at the top. It's fine to hold fringe viewpoints, but it's on the <20% side of an 80-20 (or less favorable) issue electorally. It isn't happening. > some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line These are legitimate complaints. Trashing the system because it's overly generous in some respects is insane. 400% FPL is $62,000 for a single person. Not exactly rolling in it. Income isn't wealth. Someone making $62,000/yr in income without working at 55 (i.e. no Social Security) is likely comfortable. That's >$1m in invested assets plus whatever is owed to them as retirement income when they reach retirement age. It's especially unclear if everyone else's payroll taxes should be spent allowing this person to retire a few years earlier. This is all before including the other large personal expense (housing) for this person is likely imputed rents from homeownership which aren't counted as income but function that way. If this is your concern, why not oppose all subsidies? There are also early retirees who keep their AGI below 400% FPL. Surely you are capable of thinking there are tradeoffs here where one can set a level without dealing in absolutes. Put differently why not expand Medicaid to cover every American regardless of income? 400% is just as arbitrary as 1000000%. I do actually think that universal healthcare is the best policy. But that will mean some wealthy people get coverage paid for by the state, which aggravates some people. A substantial amount of discussion in early retirement communities is about how to stay below 400% AGI, which is why I found it odd to see a criticism of healthcare subsidies going to early retirees in the context of the expanded subsidies. Great then you have even bigger problems to wrestle with regarding solvency. Americans won't choose cost effective treatments, and if you force them to pay out of pocket for experimental therapy you will be accused of running death panels. Good luck with that. On top of all that, they are also unhealthy due to a variety of lifestyle factors including that their primary mode of transportation likes maiming them. I’m one of those retirees. It’s OK. I was prepared for this, and can afford it, but a hell of a lot of others on a fixed income, are totally screwed. > Give the money to someone who actually needs it. Like billionaires. They are the ones that really need it, and they get it; every time. Those yachts don’t pay for themselves. If anyone thinks poors will be getting any help, they are fooling themselves. Helping poor people is quite unpopular, in the US (where they conveniently forget that most of them are born in the US white, but politicians make it seem as if they are all dark-skinned immigrants). Many of the hardest-hit states will be ones that enthusiastically voted for this. It doesn't add to the discussion, but an anonymous upvote wouldn't convey my appreciation for how apropos this comment is. Why is buying first class tickets bad? GP is saying that they’re okay giving up buying first-class tickets if it means someone else gets to live. (Because they pay more for health insurance, which allows someone else to pay less.) It’s good that they choose to do that themselves. In fact, the US allows you to SEND THE GOVERNMENT A GIFT at https://www.pay.gov/public/search/global?formSearchCategory=... (You can even Venmo) If you want to do it, do it for real, instead of just being performative. But don’t try to force everyone to follow your performative pseudo gift. > the US allows you to SEND THE GOVERNMENT A GIFT How is this relevant? Cutting the deficit doesn’t solve the problem. And the folks who created this mess just blew out the deficit by trillions. It’s relevant because while the comment says that “they’re okay giving up buying first-class tickets” what they really imply is that they want everyone to give up buying first class tickets. If they want to constrain their own choices to help a nameless “someone,” they can literally do that themselves without involving the taxpayer at large. Just send the check to HHS or to a specific charity or individual. As a supporter of single payer(or really, anything else), I support this move. When half the nation is on subsidized healthcare they aren't so likely to care about costs. Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families. when the gov foots the bill, there's no reason to have competition. Before 1985, there was no for-profit healthcare. Worked pretty good. Before 1985 healthcare costs were very low, and population was way younger. > Before 1985, there was no for-profit healthcare Wait, what changed in 1985? HMO laws allowed for-profit healthcare insurance. Groups of doctors banded together and carved out exclusive contracts to sets of hospitals and providers. Before this I recall seeing $7 taken out of my paycheck and there were no deductibles or copays. Meds were $5. The govt also acts as a monopsony and forces lower prices. Same effect [0] different mechanism. [0] actually a better effect - the govt actually does force lower prices, whereas competition is subject to all sorts of other effects where it doesn't actually function to lower prices. No, it definitely did not always cost $2k a month. Bronze plans with $5-6k deductibles have always ran more than what people paid for rent. Healthcare is the one thing that's outpaced inflation in higher education. Very good unsubsidized health insurance wasn’t anywhere close to 2k/month inflation adjusted the last time I used COBRA to continue my employer’s insurance after getting laid off. The underlying issue is inflation adjusted healthcare related spending increased 6x per person since 1970. Some of that is an increase in quality, but middleman are a huge factor. So first you say it has always cost this much, but in the next breath you say that its cost has outpaced a high rate of inflation. Mathematically, these can't both be true. A) Inflation in healthcare costs is well documented and unrivaled B) Biden papered over A) with "temporary" covid subsidies in 2021 and those are going away, revealing A) again > Bronze plans with $5-6k deductibles have always ran more than what people paid for rent. Unsubsidized bronze plans were in the $250-350 range in 2016/2017. That's nowhere near rent. Mine has tripled, but last year, I was actually getting some govt help. Not this year. I am fortunate to be able to afford it, but it’s just less than my mortgage. This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home. Obamacare is like the NHS, in the UK. Everyone likes to bitch about it, but woe unto the politician that messes with it. The equally insidious thing is that when they get hit with the new premium anyone who took better coverage, like a silver plan for the ACA, will likely be "forced" to downgrade to a lower (bronze) plan, which means that when they actually get services their costs will further skyrocket (higher deductibles and out of pockets). Talking about all hell breaking loose... Marjorie Taylor Greene announces her resignation specifically because of rising health care costs (yeah, I'm cynical,there's maybe more to it). Mamdani gets elected on a platform that's essentially "shit costs too much." Maybe folks on both sides are starting to wake up. A guy can dream... MTG just got her pension. I doubt healthcare costs have anything substantively to do with it. Someone just wants to avoid digging a hole any deeper than they have. Isn’t obamacare what caused all these problems in the first place? NHS is public. Obamacare was just a blank check to private companies > Isn’t obamacare what caused all these problems in the first place? I don’t think so, but it’s a fairly poor attempt to address the industry problems. It’s a lash-up “solution” to a problem caused by our entire healthcare structure. > Obamacare was just a blank check to private companies And healthcare providers. No one wants to fix the real issue, so this was the only thing all those lobbyists would allow. That doesn’t change the fact that it has actually become quite popular. One thing that I’ve been trying to understand about this discourse: Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed? In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total? Yes to both. High costs were previously partly hidden by subsidies for some consumers purchasing individual or family policies on state ACA exchanges, and now many of them will be forced to pay something closer to the true market price. But just like with college tuition, when the government throws money at a problem that ends up causing costs to explode without permanently improving affordability. > true market price There can be no market clearing price, because healthcare demand is unlimited. In some countries supply is rationed by using different means such as waiting lists, budgets for funding, or even corruption (I witnessed this in Cuba). > because healthcare demand is unlimited. How's that? Beyond some level of care I suspect demand drops of a cliff. No one goes to the doctor for the fun of it. I'm sure they're talking about necessary healthcare - e.g., cancer drugs, insulin, dialysis, heart surgery, etc. When giving the option of parting ways with some more money or dying, virtually no one is going to choose the latter. Unfortunately, the US healthcare system is set up to extract maximum capital from people who interact with it. Worse: it's not alone. For example, the reason food in the US has so much sugar, salt, and fat in it is that the food industry has carefully engineered processed foods to be more addictive so people will buy more of it. We live in one of the most exploitative societies in the world, and it's only getting worse over time. > No one goes to the doctor for the fun of it. "Fun" isn't the right word, but ~hypochondriacs will get unnecessary care if they perceive it to be free. This adds cost to the system without improving outcomes. Yes, and there is also an enormous amount of low-value or unnecessary care delivered which also doesn't improve outcomes (or even makes them worse). Depending on which estimate you believe this might be a quarter of all healthcare spending. Better answer (and child comment too): There's a third piece too, which is that insurers are ramping price much faster than inflation. Our (unsubsidized) premiums increased 20% year-over-year, after also increasing faster than the rate of inflation the last few years. Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get very weird in the near future. That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much. Percentage wise profits might not increase, but 10% profits on a $2000 plan make an insurance company (and execs) more than 10% profits on a $200 plan. It's in their interests and income stream for costs to constantly go up so they can get their 10% take. Efficiencies and price savings would actually hurt them (can't have plan rates go back down and only get their 10% off of $200). That ignores competitive pressures. Commercial health plans aggressively negotiate rates with their network providers in order to get market share with cost sensitive customers. If your claim was accurate then insurers would just take whatever rates that providers set but the reality is that doesn't happen. Health plans routinely drop more expensive providers from their networks. Rental companies have incentives to get market share with cost sensitive customers too. They would totally never have a system (or use colluding software) where everyones rates just go up. Fun fact, people in fact can't just 'do without' for housing/medical care, so can't act in a manner that keeps the market in check. Therefor neither of those two segments can be treated as actual markets, or expect the typical benefits of actual, working markets. > Rental companies have incentives to get market share with cost sensitive customers too. They would totally never have a system (or use colluding software) where everyones rates just go up. If you're talking about RealPage, the actual effect it had was putting more units on the market and lowering rents, not raising them. I'm surprised so many people miss this. The insurers have an incentive for medical costs to go up, so that their (capped) share results in higher profits. But isn't it insurers actually set how much a service is going to cost you and then make "a discount" on that figure? Yes and no. What happens in practice is that a provider charges $200 for "distributing Advil" and $50 for two pills. Then the insurance company, whose legally allowed profit is proportional to payouts, "negotiates" the price down to $150 total and claims to the person "we saved you $100". Then their accountant says "we paid out $150, so we get a profit margin of $40" (instead of the $0.50 they would get with a real at-cost charge). But the price is made up nonsense and 100x actual cost for 15 seconds handing a 1¢ pill over. Which is why asking for an itemized receipt and saying you can't afford that suddenly drops the bill to $1.50. When providers don't "play ball" with the price fixing the way insurance company wants, they go off network. Medicaid and Medicare set service rates by fiat, which is why many providers don't accept patients on those plans. Commercial health plans have to negotiate service rates with their network providers. There's no discount as such: if you receive service from a network provider then they have to charge the negotiated rate. Insurer premiums are capped and rise with costs. To the extent they're rising faster than inflation, that is only possible because their costs are rising faster than inflation. Costs are rising in large part for demographic reasons -- boomers are getting older. Year-over-year increase in GDP in the U.S. right now is almost exclusively “production” output from the healthcare industry, whose profits are stratospheric and rising. So there’s two useful datapoints here: first, the bill must be paid, or U.S. GDP growth year-over-year falters, not because healthcare costs this much; and second, household debt continues to increase year-over-year to permit continued wage stagnation. Whether insurers end up lowering their profits (and thus prices) as the subsidy expires centers around whether banks extend further debt as a household wages subsidy. As of right now, that seems to be continuing, even though some of that debt market is in the midst of a small crash, so insurers (who have no regulatory limits on profit levels) are unlikely to lower their profit targets as subsidies end. So long as the political will of U.S. leadership supports that continued profit, and either government and/or banks subsidize worker wages to cover the increased profits, then we’ll continue seeing growth in costs on paper before subsidies. This growth in profits/prices could not be sustained on wages alone, given the continuing decline of inflation-adjusted worker earnings; and so to answer your question, yes: the act of subsidizing is what’s enabling the prices being charged; but, no: the costs of providing healthcare to any one person of a given age are not increasing due to subsidies; just the profits. Commercial health insurers have relatively low profit margins. This is forced by the ACA minimum medical loss ratio. In theory Congress could increase that ratio slightly but it wouldn't do much to improve affordability for consumers. That restriction is mysteriously absent from the actual published data showing their revenue growth rate spiking sharply when ACA was passed. There’s lots of sources for that data, but I liked this chart for its simplicity: https://images.jacobinmag.com/wp-content/uploads/2024/12/111... It presents nice easy datapoints: Cigna raised its profits by $40B/yr, an increase of 400% of its pre-subsidy profits, in just a decade — and one can safely assume that now that they’re accustomed to the new profit levels, there is no way they’ll voluntarily give them up. Whatever was intended with the medical loss ratio, Congress fucked up by not including a simple dollars-per-subscriber cap on net revenue. The subsidies are going down, but the base price of the plans are going way up. The plan I'm on increased from $800/month to $1150/month next year, and that is a modest increase compared to most others I've heard about. I'm switching to a maybe cheaper plan - if I use less healthcare, but if I use too much it will be more expensive due to much higher deductibles. Insurers haven't really explained why the base prices of plans are going up so much. Perhaps GLP-1 drugs but that doesn't seem like enough (those drugs often aren't covered by ACA plans anyway due to their brand-name status). It could be a delayed effect from all the inflation a couple years ago - health care contracts are negotiated on the order of years, and a bunch could have just been renegotiated to reflect current market prices. Yes, sort of. ACA insurers are required to pay out N% of their premiums. This means that a really important way of keeping premiums down is to make sure that people who use less medical care are in the insured pool. But if somebody is looking at a $20,000 annual bill in premiums and is generally healthy they might look elsewhere than the ACA markets or just simply go uninsured. That person leaving the insured pool means that everybody else's premiums go up. The ACA had two strategies to keep these people in the pool: the individual mandate and the subsidies trying to keep prices lower. The mandate was removed years ago. And while we still have subsidies below 400% FPL, the ones for people above 400% FPL are gone. A self-employed person making $75,000 annually who previously could afford insurance might now be looking at alternatives. Where does all that money go to, though? Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care? If you want to understand where the money is actually going then this Peter Attia Drive podcast episode with Dr. Saum Sutaria is the best high level overview that I've heard. Seriously it's worth listening to and will clear up a lot of the misconceptions that many people have. Both. Also there's a culture of infinite consumption of medical services. > Where does all that money go to, though? Nearly all of it goes to grifters who hang on to the system but don't contribute anything. The obvious ones are all the insurance company employees who don't provide any healthcare, just push paperwork to try to find ways to deny coverage. And all the oberpaid administrators, and of course those multi-million bonuses to all executives involved need to be paid somehow. If that sounds overly cynical, consider a primary care doctor visit. I get about 15 minutes of the time of a nurse assistant (some searching suggests average wage 50K) and 12 minutes with the doctor (searching suggests average wage of 250K). So the cost of salaries to the people that actually provided me healthcare that day, is $6 + $24 = $30. Even if we double the salaries of both nurse and doctor, it'd be a $60 visit. Of course, there's office overhead like rent, utilities, etc. But I get billed $500 for that visit. SO where is all that money going? Obviously not to the health care professionals. If we simply removed all the grifters from the system, health care would be quite affordable. > But I get billed $500 for that visit. That does not match your earlier statement about administrators or health insurance, though. Or does your primary care doctor work in a big hospital that takes a 400% margin? I don't know where the majority of the money goes, if you're looking for a precise breakdown. The point I'm making is that only a very very tiny fraction of the bill goes to the people actually providing healthcare (the nurse and the doctor). Of course some overhead is inevitable, but there is very clearly a vast amount of waste here that could be eliminated. A nurse + a doctor provide $30 of their time, and $470 of overhead is tacked on to that. That's why healthcare is so insanely expensive in the US. Doctors are by far the highest paid professional occupation in America. The AMA is the most powerful trade union in history and restricts the number of new doctors, pushing up prices. Specialist doctors are one of the highest paid professions in almost all countries. There are hardly any jobs more important than those of say a heart surgeon or a neurosurgeon. I have changed my mind on this after looking at the data. Not much cost can be attributed to the doctors. What data was that? Here is some from the BLS: https://www.bls.gov/ooh/highest-paying.htm Highest 20 occupations by median annual income, the bottom is pilots, everyone else is a medical specialty. This ignores the number of administrators. You can’t assume number of doctors are equal to administrators. Nationalize health care. Doctors should work for the government, hospitals should be owned by the government; for profit health care is a scam. Your taxes would double, and don't even bother trying to say they wouldn't literally every country with public health care pays twice as much as we do in tax We pay more tax for healthcare in the US than virtually anyone else. Last I looked, only Norway had us beat in terms of taxes for healthcare. The average cost per person is more in the US (quite a bit more), but as with all statistics the devil is in the details. In a public system like Canada, while the average cost for health care per person is lower, if you make above average income you are paying more than average in taxes, and hence more for (everyone else's) health care. Combine that with a far lower average income across the whole country than even the poorest US states, and the relative impact on you can actually be far higher. In my case my effective tax rate was about 45%, which meant I was paying 4-6x average taxes, most of which went to health care. I haven't lived in European countries, but it's virtually certain to be a similar story. Then how our taxes are lower on average than most other developed countries? Because we pay less tax for other things; for example, making post-secondary education affordable. Our taxpayer-funded system for healthcare-over-65 costs us more than Germany's taxpayer-funded system for healthcare-over-0. Our incomes are far higher too. Health care in the US isn't perfect, but public systems aren't either. The flaws of private health care seem to be a favorite target by people who are biased against the US. Does it really matter if cost is in "insurance" or in tax? Wouldn't overall lower total be better? Some people would rather pay $4000/mo to an insurance company than $2000/mo in taxes. I don't get it, either but here we are. That's obviously a false dichotomy. Almsot no one is paying $4k/mo for insurance premiums. And nobody is paying $2K a month for healthcare taxes either! One again, HN rat-holes on a detail rather than the overall message. Replace what I wrote with "Some people would rather pay $2X/mo to an insurance company than $X/mo in taxes." Jeez! It just doesn't have the same rhetorical effect when you make it even, does it? When I lived in Canada I paid about $4k a month in taxes, the majority of which went to health care Even if my taxes doubled, it would be less than just the premiums on my current family health coverage. How much of those premiums are paid for by your employer? The root cause of this is, in my opinion, that in 2009 instead of getting the Healthcare system that Obama promised, we got the one that Rahm Emanuel substituted for reasons unknown. I will never forgive Rahm for this sin. Actually socialized medicine would give us better outcomes for less spending. Instead we have a pork barrel project that has become "too big to fail". Eventually we'll get Medicare for all, but it'll be hell in the meanwhile. I have some questions but I don't want to offend anybody. Aren't there any methods to contract the healthcare to lower the prices down? I heard that in UK they have some requirements that the prices must not go higher than... For a given type of service. Also I read a lot of articles that giving a tablet to a hospitalised person costs 20-50 bucks and people are generally running away from ambulances to not pay It's a twisty maze of passages, all alike as they say. They have entire classes of certifications for understanding how medical and insurance billing works in this country. Japan has something to that effect. There are ways to make it happen. Corrupt congress people will vote down any such proposals. I read healthcare now amounts to buying a new car every year. (Except, of course, nothing new in your driveway, nothing to resell, etc.) This is misleading. Health insurance premiums cost about as much as buying a new car every year. Healthcare is generally on top of those premium payments. Yep, you and your employer pay $3500/month for the premium. Then you as an individual have a $12k to $15k per year deductible before the insurance even kicks in. That’s grossly exaggerated. Individual deductibles are limited by law to ~$6500 even on the worst plans. And no one is paying $3500 per month for individual coverage on one of those plans. The actual rates depend on age and zip code, but I’d be very surprised if they’re that high anywhere. To see the actual costs for yourself, go to healthcare.gov. The “bronze” plans are the ones with high deductibles. If you’re young and healthy, a high-deductible plan combined with an HSA is a very good idea. > Individual deductibles are limited by law to ~$6500 even on the worst plans This was not the case for 2025, so I just did a search to determine whether you are referencing a new law. No, you are just flat wrong on this claim. In Georgia (georgiaaccess.gov), the first bronze plan I looked at has an individual deductible of $10,600 (family deductible is $21,200). The plan's SBC is available to the public[1]. > no one is paying $3500 per month for individual coverage on one of those plans You are correct, but also many people are not single and live in family units where the family unit is on the hook for $3,500 per month. 1 - https://sbc.anthem.com/dpsdeeplink/deepLink/AnthemBronzeBlue... I stand corrected. > Individual deductibles are limited by law to ~$6500 even on the worst plans. Deductibles can be higher, but more importantly it's very important to undertand that "out of pocket maximum" does not mean the same thing to normal people vs the insurance companies. One would think that a 10K/yr "out of pocket maximum" means in the worst case scenario you may have to pay 10K/yr and then insurance covers the rest. Which wouldn't be that bad. If that were true the US wouldn't have the epidemic of people going bankrupt over medical costs. What really happens is you get hit with a 200K bill from a hospital visit and the insurance company decides unilaterally they don't really feel like paying based on some obscure technicality, so then that amount does not count towards your "out of pocket maximum". So now you're on the hook for the 200K, good luck. 12-15k? Lol the highest one Ive ever seen in a high deductible plan was $7500 and that still had some co-pays and coinsurance I suspect it was health insurance premiums being discussed. Thanks. I was being a little facetious and using your comment as a way to point out to non-Americans that being insured is miles away from getting healthcare. This is also not a normal thing. I pay $120/mo. I don't understand. Are you including the employer paid share in this calculation? You are lucky to have employer-provided health care. Seems 48.6% of US employees had employer-provided health care in 2023. Lower than I would have thought. https://www.kff.org/state-health-policy-data/state-indicator... Every employer in the United States with >50 employees must provide health care. It's weird to me that americans, especially educated professional americans, have become much more quiet in their online presence due to all the crisis they are facing- what we have now is pretty different At what point does it become a better financial decision to do telehealth and medical procedures completely in a different country? Can you be health insured outside of the country you live? People do do that in some limited cases, but it's often impractical. Two common cases are a) there is a need for urgent/emergency care; or b) the patient is generally frail and infirm. In these cases it can be impossible or impractical to arrange for treatment outside the US. That's leaving aside the logistical difficulty of arranging it (plus the costs for travel, etc. associated with carrying out the plan). Never, because the person who cleans your toilet cannot simply hop on a flight to Mexico every time she needs surgery. But that's also not a great solution for society, to have the software developer caste be the only ones who can afford medicine by taking an expensive vacation. Sometimes it doesn't matter about the insurance if the price is right. Medical tourism is a thing already. Ironically, a great many people from public systems actually come here to pay for procedures they cannot get or have to wait ages for. I'm expecting all of my early social security payment plus a bit of my spouses to pay insurance next year. This is insane. Yeah, it sucks living in a society where the people in power have contempt for you and your family, doesn't it. I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing looks daft from that angle too. The US, today, is set up very well for wealthy people. The health care system works great for them. Their doctors are amongst the best in the world. Same with the hospitals they use. The costs are manageable if not reasonable for all of those people. And you can actually go beyond health care and find that almost everything in the US is pretty high quality for wealthy people. Housing, their neighborhoods, their schools, etc. That might help explain why the system is set up the way it is. Everything cascades from there. A mate of mine (who allegedly has decent health insurance but that seems questionable) was trying to get a simple surgical procedure done, and the quotes he received ranged from anywhere between "We cant tell you" to multiple thousands, ultimately he found a small private hospital that sorted it out for him for 700 USD. I actually think the 700 USD price is very reasonable. But I dont care how rich you are thats a terrible consumer experience. > Housing, their neighborhoods, their schools All of these can be great, but the class of people that make a neighborhood in "the heights" won't have dog barking, basketballs, drugs and gunshots. The people that don't live in "the heights" could decide tomorrow to no longer have those 4 things either - but they don't because - it's a different class of people. There is no US healthcare "system" in the sense of having a cohesive entity pursuing a unified goal. It's a bunch of separate entities each pursuing their own goals, often in conflict with each other. If we were designing a healthcare system from scratch it obviously wouldn't look anything like what we have today. But we arrived here through a process that economists call "path dependence", and this makes it stubbornly resistant to systemic improvements. Thus the quotes, but thanks for the link about path dependance, thats a concept I have been aware of but unable to name for a long time. Lucky 10000. Blame the misguided belief elevated to State motto that "private is always better than public". They've shoe-horned a profiteering class of parasites into an inelastic market, free to jack up prices of literally vital goods as much as they want. And the current administration, who holds much contempt for life, is perfectly happy to tear down the last poor band-aid the previous admin half-assedly put in place. I am honestly convinced a purely private system would work better than the weird situation in the US. I am also convinced likewise that a more public system would also work better than the weird situation in the US. If you want to know whom US healthcare is for, look at who makes the most money from it. There's your answer. >other than maybe US Corporations on the list of approved medical vendors. Think I hung a lantern on that stopped buying insurance when the co-pays became unaffordable and you never find a real doctor anymore anyway We desperately need to vastly increase the number of physicians in this country to decrease costs. The AMA is the most powerful trade union in history and has locked the number of new doctors a year for many years now. Restricting supply for a service with inelastic demand skyrockets prices and lines their pockets. Bullshit. The AMA is a voluntary membership organization, not a trade union. They have no power to set prices or engage in collective bargaining. The immediate bottleneck on producing more physicians is limited Medicare funding for residency slots. Every year some students graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back. Who lobbies for the regulations that limit funding for residency and have these ridiculous regulations to start with? Which ridiculous regulations? Can you give us a specific CFR reference? I don't understand your question. > At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back. Yes, this is one of the cartel/union-like behaviors people complain about with the AMA. There are more examples: https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p... Private equity should be banned from healthcare. What could go wrong putting a bunch of finance bros at the wheel of a "Pay this amount or suffer/die" industry? PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, which doesn't seem politically likely. Isn’t it fair to argue that it’s PE doing all this consolidation? No, it's not fair to argue that. While PE has done some roll ups with certain specialties in certain areas the big health systems are mostly not owned by PE firms. In some areas they're literally owned by churches. I'm not defending abusive PE practices here but if we want to fix anything we need to be clear about what's actually happening. I'm so sick of this trope. "It's the insurance companies!" "No, it's private equity!" "No, it's the PBMs!" I don't care. Jesus Christ, going to the doctor is rapidly becoming unattainable for more and more people, including the PMC now, and all of the rich people are simply pointing at each other saying "it's the other guy!". Burn it all down, start over. Unpopular opinion: Evil and greedy insurers are not the biggest problem. The biggest problem is the socialized costs of sugar drinks, junk food, and sedentary life. The food industry operates like a drug cartel who starts the pipeline getting children addicted. That combined with outrageously expensive magic pill healthcare. A situation partly caused because doctors can't tell patients they are too fat and lazy. Because feelings and hate-crime. https://pmc.ncbi.nlm.nih.gov/articles/PMC7524435/ (I think their 27% figure is way too conservative) It's like the worst possible combination of free market capitalism/libertarianism with social liberalism. It should be mentioned that the US has very high wages, and even when subtracting substantial health care insurance cost, the income likely remains higher than what people earn in most other countries. If you have a high paying job in the US it usually comes with legitimate health insurance paid for by your employer, meaning most of the cost of most healthcare is covered. If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage. ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations. Reading this sent me down a bit of an OECD data rabbit hole. They seem to agree. However once you read the fine print I'm not so sure. Many things are much more costly in the US (education, travel, food, vehicles, houses...) and the OECD data seems to not control for that. Also my personal experience is there are a large number of very poor people in the USA. Seems like more than in Western Europe for example. People spend more on travel, food, and vehicles because they are richer. You should go tell that to the waiters who are working for tips. Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare. Not to mention you get actual vacation time in Europe and a higher standard of living generally. Don'tcha know, the only real jobs are "software developer" and "haver of lots of money for investing in software developers". Everyone else can pay $10,000 for their surgery. yes, but the people in europe aren't free(tm) /s how exactly ? it's sarcasm. a lot of arguments against social services like universal health care boil down to "well taxation is theft and therefore they're not actually free because they pay higher taxes" See /s flag ? Sorry not good with the recognizing these. Insufficient gunshots per diabetes. In case you are wandering where the money goes. If you need a gall bladder removed or an appendix removed the bill to you might be $10,000-30,000 but the surgeon, for all of their care and time with you, is compensated less than $100. It’s actually about $600 just for the surgery. It’s about 10 RVUs x $60 per RVU. You add some RVU modifiers to get it to about $1000. Your point still stands, but it’s still a bit more than $100 Source: I’m a MD I'm confident a surgeon in America is paid more than 100$ for a surgery. They are paid about 400k a year on average. Do the math yourself. On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations I did get my gall bladder removed in July, and I know paid my surgeon a lot more than a 100 bucks, which was just the smaller deductible portion of the bill. Bullshit. Even Medicare will pay a surgeon about $600 for CPT code 44970 and commercial health plans are higher than that. The root cause: https://www.researchgate.net/figure/Healthcare-administrator... "Healthcare administrator's growth in the US. Healthcare administrator's growth by 3200% between 1975 and 2010 compared to 150% Physician growth according to Athena Health analysis of data from Bureau of Labor Statistics, the National Center of Health Statistics, and the United States Census Bureau's Current Population survey in accordance to [26]. Admin: administration; HIPAA: Health Insurance Portability and Accountability Act; HITECH Act: Health Information Technology for Economic and Clinical Health Act; DRGs: diagnosis-related group's." The only class of medical services that has become more affordable over the last 50 years is cosmetic procedures and laser eye surgery: https://healthblog.ncpathinktank.org/why-cant-the-market-for... What value addition do the administrators provide? It might be helpful to understand why competing hospitals still find it useful to employ these people even if the cost is so high. If a competing hospital can provide equivalent service while also not spending so much on an administrator, why didn't they already do it? The administrative overhead is necessary in order to get money from the insurance companies. Without the administrators too administrate and fill out copious amounts of paperwork, the hospital won't get paid by the insurance companies, and if the hospital don't get no money, they can't pay their staff, and staff tend to like getting paid. This is how the world ends. Administrators on both sides being replaced by AI and consuming all the worlds available compute arguing with each other about healthcare bills. Answering myself, apparently it is a fight between administrators on the hospital end and the administrators on the insurance company end. The insurance administrators are fighting to provide as less reimbursement as possible and the hospital administrators are fighting to provide as much reimbursement as possible. The administrators are probably doing compliance work, negotiations. I wonder whether regulations can be used to cap the role of administrators at the expense of slightly less efficient market - this might work if administrators are just adversarially interacting and reducing their scope can help the overall picture. The actual problem here is the regulations that restrict insurance options to comprehensive ones and eliminate the option of getting catastrophic only insurance. This effectively leads to overconsumption of insurance. The other big problem is tax incentives that encourage people to get insurance through their employer. To elaborate on that, when one gets health insurance from their employer, they effectively get a tax cut, and this in turn leads to larger proportion of employment compensation being paid through health insurance benefits than it needs to be, which translates to extravagant health insurance plans for those who are employed. When people don't rely on insurance and pay out of pocket, generally prices go down over time and the industry as a whole becomes more efficient. The opposite trend has been in place in healthcare, with a growing percentage of healthcare spending being through insurance. And the result is the opposite of what's seen in more market-based industries: prices going up over time. You assume that there is any meaningful competition. What we are seeing, across industries including education, is a type of indirect collusion that is keeping prices crazy, not competition. Over regulation is a big piece of what enables all this. Some states require a "Certificate of Need" to open a new hospital so we ought to do away with those to promote competition. But beyond that, which specific regulations are harming competition? https://www.ftc.gov/news-events/features/certificates-public... Lack of health care records interoperability (locks patients into a system). Much of the well-intended regulation around healthcare ends up getting perverted to prevent competition. You misunderstand. We only have a degree of interoperability for patient records due to federal regulation. Regulation in that area actually helps competition. https://www.cms.gov/priorities/burden-reduction/overview/int...
