The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it.

Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well.

Individual practitioners and medicial facilities and facility groups have incentive to bill more things.

People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level.

Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers.

Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.

Why don't you think of the poor anesthesiologists, hospital admins and insurance execs?

Those yachts and 2nd vacation homes won't buy themselves.

That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree.

My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged.

The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.

https://www.kff.org/health-costs/issue-brief/hospital-margin...

The entire point is most of the surplus from the hospital is being extracted as real estate rent. The hospital itself doesn't need to post a profit in order for the overall scheme to be profitable for the perpetrators.

Furthermore as far as getting into this situation, administrators of a non-profit are just as capable of asset stripping to post good numbers in short term, and self-dealing to enrich themselves long term.

I think that every market needs regulation to work well. Different rules for different markets, but they need regulation to keep participants on relatively equal footing, for example to avoid cartels.

In current day America it doesn't seem like anything useful is compatible with making money. From the outside, it looks like you've entirely divorced money from common good.

It is possible to make hospitals profitable, but it requires you to take control over what sorts of things you wish to make a profit.