Brutal.
Meanwhile the White House calls it all "fake news".
I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper.
B) Biden papered over A) with "temporary" covid subsidies in 2021 and those are going away, revealing A) again
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.
Unsubsidized bronze plans were in the $250-350 range in 2016/2017. That's nowhere near rent.
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
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.)
These are legitimate complaints. Trashing the system because it's overly generous in some respects is insane.
> 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.
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.
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.
(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.
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.
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.
Wait, what changed in 1985?
Before this I recall seeing $7 taken out of my paycheck and there were no deductibles or copays. Meds were $5.
[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.
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.
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.
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.
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.
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.
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.
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.
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.
This statement is at odds with itself.
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).
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.'
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.
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.
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.
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.
(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.
> 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.
The truth is a lie and only government lies are the truth. Orwell would be so proud.
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 :(
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.
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.
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.
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)
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.
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.
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.
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.
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.
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.
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.
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.
(It's getting late, Jeff. I'm heading to bed myself.)
https://www.jeffgeerling.com/about
He is impressive.
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.
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 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 :("
the networks in the illinois aca suck if you live in the chicago area.
blink
Top cover in Australia for a family is about USD$400 per month.
Health insurance premiums cost about as much as buying a new car every year. Healthcare is generally on top of those premium payments.
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.
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...
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.
https://www.kff.org/state-health-policy-data/state-indicator...
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.
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...
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.
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?
Highest 20 occupations by median annual income, the bottom is pilots, everyone else is a medical specialty.
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.
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?
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.
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?
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).
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.
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.
"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.
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.
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.
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.
If you're talking about RealPage, the actual effect it had was putting more units on the market and lowering rents, not raising them.
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.
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.
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.
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.
What could go wrong putting a bunch of finance bros at the wheel of a "Pay this amount or suffer/die" industry?
Can you be health insured outside of the country you live?
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.
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.
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
Your point still stands, but it’s still a bit more than $100
Source: I’m a MD
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...
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 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.
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.
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.
https://www.cms.gov/priorities/burden-reduction/overview/int...
Think I hung a lantern on that
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.
I actually think the 700 USD price is very reasonable. But I dont care how rich you are thats a terrible consumer experience.
I am also convinced likewise that a more public system would also work better than the weird situation in the US.
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.
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...
and you never find a real doctor anymore anyway
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.
This is insane.
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.
mmarian•2mo ago