Obamacare also has a huge positive impact besides just access to healthcare. For instance I couldn't have started a startup without it, and it's much easier to hire contract workers because of it.
SPY: about 4X
QQQ: about 6X
GOOGL: about 6X
CI: about 9X (Cigna health)
ELV: about 10x (formerly Anthem)
AAPL: about 19X
UNH: about 20X (united healthcare)
Health Insurance stocks in the US did better than tech stocks after Obamacare passed. Why?
Is this a genuine question or is it rhetorical? I can’t really tell these days.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145008/
Short answer is that insurance companies were “limited” to 20% profits and 80% expenses by ACA.
Smarter insurance companies realized quickly that they not only had zero incentives to cut costs, but they were actually incentivized to let costs increase to be as high as legally possible, thereby increasing their profit cap in absolute dollars.
I don’t know if this was the idea of one party, a bilateral backroom negotiation with the insurance companies, or a comprehensive lobbying victory, but it ended up being a massive boon for insurance companies and hospitals and a complete shitshow for consumers.
If this part of the ACA doesn’t change, it will break the US healthcare system.
It is a competitive business without a lot of pricing power. But what it will do is provide consistent, reliable returns. And since more people are getting more healthcare, the magnitude of the profits will obviously be higher, hence the increase in stock price.
Basically, the market caps now reflects what are essentially utilities that earn ~5% profit margin on huge revenues. This was not clear in the early ACA days, but investors have obviously warmed up to them.
It seems like you’re theory-crafting here rather that describing what is actually happening in the industry.
1. I somewhat sloppily used the term “profits” in my previous post, and I should have used “gross margins”. Specifically, 80% of premium payments have to be used on healthcare expenses. Their profit (~5% as you mentioned) comes after they pay their relatively consistent operating expenses out of their gross margins.
2. The increased number of people getting insured is not what has driven up the insurance companies profits. Those numbers don’t add up.
3. The prices of name brand insurance have increased fairly consistently. It’s not competitive at all, imho. It’s an oligopoly.
4. If you know people who work in medical billing and/or you’ve known a handful of people with substantial medical bills, you will know that hospitals have increased prices for many things to ridiculous levels, and they “nickel and dime” patients at ridiculous markups for anything possible. Why? Insurance companies don’t bat an eye at these expenses any more, and they are not incentivized to do so. As money out increases via payments to providers, money in can increase via premiums, and thereby absolute gross margin can increase proportionally. If you need further proof, check out the actual prices that people pay when insurance doesn’t cover something. Miraculously, charges come down and substantial portions of the bill will be forgiven/waived.
5. Investors have warmed up to the idea that health insurance is a government-supported racket that ultimately screws people who have to pay their own premiums in part or in whole.
Note that I am a fan of most parts of the ACA, but the 80/20 rule (and the misaligned incentives that it facilitated) needs to be fixed. That said, the hospitals and insurance companies are feeding at the trough, they have established a new excessive normal, and they will fight any change to the 80/20 rule by comically pleading poverty.
>Their profit (~5% as you mentioned) comes after they pay their relatively consistent operating expenses out of their gross margins.
Just like in any other business.
>The increased number of people getting insured is not what has driven up the insurance companies profits. Those numbers don’t add up.
Their profit margin has not been driven up [0].
>It’s not competitive at all, imho. It’s an oligopoly.
In an adjacent comment [0], I posted profit margins for 7 different publicly listed multi billion dollar health insurance businesses, which excludes Kaiser Permanente. If that is not a competitive business sector, I don’t know what is. If you are claiming collusion, I would need proof.
>That said, the hospitals and insurance companies are feeding at the trough, they have established a new excessive normal, and they will fight any change to the 80/20 rule by comically pleading poverty.
How are sub 5% profit margins feeding at the trough? If that is feeding at the trough, what is Apple, Microsoft, Visa, Alphabet, etc doing?
If insurance companies had the pricing power you are claiming they have, why would the shareholders accept anemic profit margins?
It really seems like you are arm-chair quarterbacking your comments based on some quick online searches. I strongly encourage you to talk to folks who have worked in hospital billing pre- and post-ACA and (if possible) actuaries who work in the health insurance industry who will speak to you frankly (rather than toeing the industry line). The misaligned incentives are a complete shit show.
> Why is gross margin relevant?
If you can increase gross margin number while maintaining operation costs at about the same proportional level, then you end up with more absolute profit. So 100 premium, 20 gm and 5 profit can become 150 premium, 30 gm, and 7.5 profit.
> How are sub 5% profit margins feeding at the trough?
The percentage is not the issue. The absolute amount is.
Some examples:
- My premiums pre-ACA to now have almost quintupled. There are some good reasons to explain a small part of that increase (e.g., I’m older), but 4-5x is absurd. Way higher than inflation, and way higher than the quality of care has improved (for me specially, but also in general).
- This link (https://khn.org/news/article/surprise-bill-iv-push-hospital-...) is an example of hospitals feeding at the trough. Imagine this happening hundreds or thousands of times a day at every hospital. It’s absurd. I realize that this is basically a marketing piece by Kaiser, but the article is directionally correct based on folks I know who work in medicine, health insurance, and hospital billing. Their stories are all very consistent.
- There are many other countries with functional healthcare systems that do not charge anywhere near this much (for most people). Japan comes to mind. I have lived there. Premiums are based on a percentage of your salary, and the cost is much less than the US for 95%+ of the population. If you have no salary, it’s about $100 a year. When the US system reforms, I hope that the reformers take lessons from Japan since the transition from our current system to something like theirs will be relatively easier than many/most other options.
> If you are claiming collusion, I would need proof.
This isn’t CSI, and collusion doesn’t have to be explicit, especially with oligopolies.
Once the major players in any market in the US realize that they can take a win-win game theory approach to their pricing, they pretty much do so. They don’t have to have surreptitious back room meetings in order to realize that increasing prices more or less in step is mutually beneficial, especially in health insurance, which has a wide moat.
Do you expect profit margins to approach 0% over time?
> If you can increase gross margin number while maintaining operation costs at about the same proportional level, then you end up with more absolute profit. So 100 premium, 20 gm and 5 profit can become 150 premium, 30 gm, and 7.5 profit.
Sure, but because of competition, this is not happening. The premium payer will shop around and choose a different insurer offering 130 premium. If this is happening, there would be clear evidence, since all of these publicly listed companies have public financials.
> is an example of hospitals feeding at the trough.
This discussion is about insurance companies, not hospitals.
In any case, I will simply rest my case that a business with low single digit profit margins is, by definition, not “feeding at the trough”. Lots of competition, low profit margins, all lead to a pretty cutthroat business environment.
I suggest people direct their ire at drug manufacturers, healthcare providers, software providers, and others in the healthcare business with 20%+ profit margins. And increasing the supply of healthcare in general.
Or people can keep wasting energy on blaming the 3% middleman, which is beneficial for the 20%+ profit margin businesses.
Edit: final note:
> - My premiums pre-ACA to now have almost quintupled. There are some good reasons to explain a small part of that increase (e.g., I’m older), but 4-5x is absurd. Way higher than inflation, and way higher than the quality of care has improved (for me specially, but also in general).
Premiums pre ACA and post ACA cannot be compared due to drastic changes in laws about the terms is the insurance. Namely, the limitation of pricing insurance on only age/location/smoking status, and the implementation of out of pocket maximums. In addition, as of 2022, the no surprises act bill means out of network emergency costs are included in the out of pocket maximums.
Effectively, even though you feel you are getting less quality of care (and you very well might be), the insurance product is much different than before with much higher (nominal) coverage, much more expensive treatment options, and more subsidies for others in the insurance pool.
Based on aging demographics and declining labor force participation rates, I would not expect the situation to get any better. Healthcare, especially labor intensive, will cost more and more.
This analysis shows the majority of health insurers becoming less profitable after Obamacare?
https://www.commonwealthfund.org/publications/issue-briefs/2...
Considering that an out of pocket maximum did not exist prior to affordable care act, and insurers were allowed to deny people with pre existing conditions, I would expect drastically higher spending on new insureds because they would finally start getting healthcare.
Now the insurance company has to pay the hundreds of thousands and millions per NICU/hemophiliacs/cancer patients etc, so why wouldn’t their expenses go drastically higher?
I'm asking why their revenue for increased exponentially for having 10% more clients.
Not to mention that the ACA forced insurers to subsidize old people from the young (maximum age rating factor), health to sick (can only price based on age, location, and tobacco status), and imposed out of pocket maximums. All of these mean the insurance company is spending a lot more after ACA than before ACA, and all of that had to be recouped as revenue from premiums, otherwise you have bankruptcy.
Also, all the US health insurance company financials are public. You can see their profit margin is a steady ~5% for over a decade. They are spending $95 for every $100 in premiums they take in.
> Also, all the US health insurance company financials are public. You can see their profit margin is a steady ~5% for over a decade.
https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...
https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...
https://www.macrotrends.net/stocks/charts/CVS/cvs-health/pro...
https://www.macrotrends.net/stocks/charts/CI/cigna/profit-ma...
https://www.macrotrends.net/stocks/charts/HUM/humana/profit-...
https://www.macrotrends.net/stocks/charts/CNC/centene/profit...
https://www.macrotrends.net/stocks/charts/MOH/molina-healthc...
Going back to testfoobar’s comment comparing tech companies and health insurers, I do not think any investors will be impressed by health insurance companies’ low single digit profit margins compared to tech’s 20%+ profit margins.
What about between 35 and 50?
I mean I know only two interesting facts about you, the difference in time, and I already know a common sense reason why your price today is much higher than it would be when you were 15 years younger, in “literally” any time in history, and perhaps it was always about 3x more expensive premiums.
https://www.healthcare.gov/how-plans-set-your-premiums
> Age: Premiums can be up to 3 times higher for older people than for younger ones.
It is actually very available information. See age rating factors in these pdfs:
https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...
For example, in New Jersey, a gold metal level plan would cost a 64 year old 3 * $730.86 ~ $2,200 per month, which legally has to cover 80% of a person’s expected healthcare costs.
For a silver level plan, ~$1,300 per month will cover 70% of the healthcare costs.
That just shows how much more healthcare people need as they get older.
Still, the supply side support necessary would also be an issue. For markets where the local going rate is expensive enough it would make a ton of sense to allocate military medical units to supplant the local market until more doctors of that type were in the area. If it takes long enough the military supply might even retire from the forces to open practices in that area.
<rant-on>
Sure. On my back, and that of countless others. It's fucking highway robbery.
Before Obamacare we had excellent health insurance with excellent coverage, doctors and low deductibles for $650 per month.
When we were shoved into Obamacare, our rate TRIPLED to $1,800 per month. Today we are paying nearly $2,300 per month. This is equivalent to a mortgage payment or non-trivial savings either for personal use or to help your kids with college.
There is no other way to put it: We are being robbed.
Put some numbers to it for context:
Over ten years the increase amounts to about TWO HUNDRED THOUSAND DOLLARS. Money taken from us, by law. This doesn't even include a calculation of what this would be if invested in a low risk mutual fund or real estate.
The concept that a family has to pay so much PER MONTH for health insurance should make everyone take pause. This kind of thing is why I have always had a strong negative reaction to anything government-driven. It never ends well.
Even worse, Obama lied to all of us. His promise to the nation, easily found on countless videos, was that families would save in the order of $2,500 per year on health insurance. Right.
How do these people get a free pass on shit like that? Why?
I don't know if this is even possible. I wish someone could organize a massive class action lawsuit against all who forced this on us. I am happy for those for whom things improved. I truly am. However, doing it by causing serious financial harm to likely millions of families is not right, at all.
We (my family) are burning --quite literally-- tens of thousands of dollars per year on healthcare because of Obamacare. The other part people don't understand is that deductibles have gone up and insurance does not trigger until you spent a certain amount per person per year. In our case my entire family would have to be run over by a semi truck before we actually start to see significant benefits. In other words, the cost isn't just the premiums, but the expenses we have to incur before benefits actually kick in.
Here's an example: One of my kids ended-up in the hospital with myocarditis due to the Covid vaccine. That cost us over TEN THOUSAND DOLLARS, cash.
Needless to say, every time I see Obama, Pelosi and the bunch I have to try very hard not to launch into projectile vomiting. I know many people idolize them. Sorry, you have chosen to admire liars and criminals.
<rant-off>
Yes, that was the point. People who could not afford healthcare, are now receiving it. Hence people who can afford to pay for others to get healthcare, have to pay for others to get healthcare.
>However, doing it by causing serious financial harm to likely millions of families is not right, at all.
There was never going to be a way to redistribute wealth without taking to from those who have it or to give it to those who do not.
>Here's an example: One of my kids ended-up in the hospital with myocarditis due to the Covid vaccine. That cost us over TEN THOUSAND DOLLARS, cash.
And you are insured for amounts that go over the out of pocket maximum, which is legally around $17k for families. So if you need a $500k heart surgery tomorrow, you only have to spend a maximum of $17k.
Obviously, the price of healthcare is a problem, and the only way to fix that is to lower demand (let people die) and increase supply (more doctors, more taxpayer funded R&D into medicines that go into public domain, and tort reform).
No, the point was to use healthcare to buy votes.
> People who could not afford healthcare, are now receiving it.
Nobody I know has a problem with the concept of helping others. Nobody. Helping others might be to tack-on $100 per month to help cover the under-insured. We do this with auto insurance already, everyone pays a little more for uninsured motorists. A QUADRUPLING of health insurance costs is theft. It isn't equitable by any stretch of the imagination.
And then there's the fact that the US President and everyone from his party who supported this told us, promised us, families would save $2,500 per year. Instead of that, we were forced --FORCED-- by law to buy a product that today costs four times what we used to pay for a better product.
We have a situation where the US government is forcing us to pay an exorbitant amount of money for a substandard product. Forced. So much for the land of the free.
> Hence people who can afford to pay for others to get healthcare, have to pay for others to get healthcare.
What's next? Pay for those who can't afford to buy a house? By that logic one can justify just-about anything.
Sorry, that's not justification for any government to force people to buy a bad product that financially brutalizes them.
Yes, we need solutions for healthcare. Obamacare isn't even close to a solution. It's a travesty. In the long term it has actually degraded our healthcare system. The problem is it will take years for the less informed and easily impressed among us to understand this.
Apparently you do, if the help costs more than $100 per month.
>We do this with auto insurance already, everyone pays a little more for uninsured motorists.
Uninsured and underinsured auto insurance does not help anyone else, it only helps the premium payer.
>what we used to pay for a better product.
I do not see how this can be true when there were benefit maximums, as opposed to out of pocket maximums, and pre existing health condition exclusions existed.
>What's next? Pay for those who can't afford to buy a house? By that logic one can justify just-about anything.
Yes, that is the crux of politics today. How much wealth redistribution should the government perform?
Previously, a few tribes in society had it made in the shade. Old people, government employees, employees of large businesses, especially white collar or ones with large union presence. Then sufficient amount of Americans no longer belonged to those tribes, hence the political will to pass reform. Which I guess you characterize as “buying votes”.
>Sorry, that's not justification for any government to force people to buy a bad product that financially brutalizes them.
You are not buying a bad product, you are paying a tax since your premiums explicitly subsidize others, just not paid directly to the government. Also, there is no penalty for not purchasing health insurance since 2018, so the government has not been forcing anyone to pay the “tax”.
BTW, and because the accusation is always made, implicitly or explicitly: I am not a right-winger/conservative. Not even close. I am driven by data and facts, not fantasies. Pure and simple. If I had to classify myself politically I would be a classical liberal. In other words, socially liberal and fiscally conservative. That, I believe, is, for the most part, the balanced formula that lifts all boats, not the madness both political parties force upon us.
https://en.wikipedia.org/wiki/Classical_liberalism
Live long and prosper.
Yeah, that’s why they had to resort to blatant lying to get it passed. But hey, it was for the greater good! Take one for the team and be a good sport about it. “We have to pass the bill to see what’s in it,” and all that.
> And you are insured
You are intentionally missing his point. The cost of that insurance has gone up massively the past 15 years. The same level of insurance cost at least an order of magnitude less 15 years ago.
again, because,
>There was never going to be a way to redistribute wealth without taking to from those who have it or to give it to those who do not.
Health insurance premiums are an explicit wealth transfer, from young to old, and sick to healthy. For all intents and purposes, you can consider them a tax (hence the individual mandate that was later removed).
https://www.healthcare.gov/how-plans-set-your-premiums
> Five factors can affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents.
>Notice: FYI Your health, medical history, or gender can’t affect your premium.
You have more poor and more sick people getting healthcare, without commensurate increase in the supply of healthcare, so obviously costs are going to go up.
I cant fathom why the majority of Americans are ok with their weird sociopathic Job = Health Insurance based system. While not as nearly unanimous as the metric system, well funded Public Health Care to a level where most people don't need health insurance to cover an emergency hospital visit for say a broken leg... is basically what everyone else around the world in other countries considers a normal and good thing...
In essence... You were already getting ripped off, now you're getting ripped off even more.
In England, Australia, Germany, France, Canada, etc, etc, etc... The treatment for your child would likely have cost you nothing, or nearly nothing. The fact it cost you over $10,000 is not entirely the Obama's fault, it's the collective fault of nearly a century of American citizens who have accepted the status quo and not pressed for any sort of change prior to Obama promising to change it single handedly, since that worked about as well as most people watching from other developed countries with modern socially supported public health care expected it to... it was a best case train wreck because of health care industry self interested lobbying efforts from pharmaceutical companies, insurance companies, hospital management companies, all the companies... not because it was a bad idea to stop the fright train that is employer provided health care in the USA. They just managed to convince them to stop the metaphorical train in such a way they could profit even more, and thus cost everyone including the government even more money...
Americans were simply going without healthcare, so it was unavoidable that it was going to cost the whole country more money.
>I cant fathom why the majority of Americans are ok with their weird sociopathic Job = Health Insurance based system.
Because once the government gives a subsidy to a certain tribe, that tribe no longer has an incentive to vote to increase that subsidy to members of other tribes.
For example, in the US, old people have had healthcare for many decades. And they have the highest voting rates. But as a politician, you are not going to get far advertising that you will increase their taxes so that non old people can receive healthcare, especially if many of those non old people do not look like the old people.
But, completely screwing people is also politically unpopular, so what can pass is a half measure, like Medicaid, where politicians can say they helped people get healthcare, but also keep taxes low. How? Well, you simply pay the doctors and drug makers and dentists less for people covered by Medicaid. And you pay more for people covered by Medicare.
And as the tribes get more and more politically influential, you can keep adding various tiers of subsidy recipients. And that is the beauty of “health insurance companies”, or rather, “managed care organizations”.
Businesses with young, healthy, office workers can pool their health risks into less risky pools and pay much higher reimbursements so they get premium healthcare.
Poor people get directed to Medicaid, which will have a network of fewer and overburden doctors so they get less care, and less quality care.
Medicare will provide old people with enough healthcare to keep their votes coming.
Federal and military employees get decent healthcare because their coverage pays more.
Others get dumped onto the statewide exchanges that are you get what you pay for type deals.
And all of this is funneled through the managed care organizations so that people cannot easily measure who is getting what and who is getting more from the system versus less.
So tl:dr is that as a country, we do not actually want to help everyone equally. Just enough to say they were helped, but at the same time, make sure we get as much of the pie for ourselves as possible, and give up as little as possible.
Our medical establishment is very inefficient, pays for lots of useless shit, and subsidizes the world's medical research. All those things cost money.
> I cant fathom why the majority of Americans are ok with their weird sociopathic Job = Health Insurance based system.
Agree with everything in your comment. I think I can say everyone in the US wants a solution for this, including the idea of healthcare not being financially crippling for anyone.
It is easy to wrongly reduce any issue to a single variable. Politicians love doing this because they can then identify good and bad and use that to divide the population for votes. The truth is that everything in life is a complex multivariate problem. Few take the time to take a deep dive into the tree of variables in order to understand.
While not a comprehensive explanation, I'll attempt to at least provide some perspective, particularly for those not living in the US and likely, because of that, not having direct visibility into the web of issues. From my perspective, there are four macro issues that drive our cost structures. I'll keep it short. Happy to expand on any of these if interested.
1: Education: K-12
2: Education: University
3: Student loans
4: Laws, lawyers, lawsuits, liability
Primary and Secondary Education
They are sold the idea that minimum wage should be a living wage because we are training people who can only qualify for minimum wage jobs. Except that faulty economic ideologies is constantly eroding living standards at every level. Politicians pushed the $15/hr minimum wage as a solution for all the problems. Today, with inflation and rising cost structures (some of it driven by the doubling of the minimum wage), earning $15 per hour is likely less --in terms of purchasing power-- than it was before selling people that fantasy.
Education is at the core of a number of problems in this country. How does that affect healthcare? You are creating generations of poor people with no or low skills. This means they have trouble financially contributing to the greater good.
University Education
The fact that K-12 schools do not prepare students well means a significant number of them have to either take (and pay for) remedial coursework or eventually drop out. Most drop out.
In addition to this, our university programs waste student time by forcing them to take irrelevant coursework. This is particularly visible in the STEM fields. Students have to engage in about a years' worth of irrelevant non-STEM coursework. I define "irrelevant" to mean: Coursework that no employer cares about at all and will have no effect in advancing anyone professionally. We could graduate people 25% faster and with 25% lower student debt if we just excised irrelevant coursework.
What's ironic about this is that anyone would agree that someone pursuing a degree in art would be wasting their time and money if forced to take a year filled with mathematics, physics, chemistry and other STEM topics. And yet, for some strange reason, we force our STEM students to spend tens of thousands of dollars and waste an entire year taking courses like "Young Karl Marx". No bullshit, my son was forced to take this course at a major university while pursuing his degree in CS. Forced? Yes. A sociology module was required for graduation. Magically, this was the only available class for something like two quarters. In other words, he would have had to delay his graduation by half a year or "choose" to take this irrelevant and utterly useless class. And pay for it, of course.
What does this have to do with healthcare?
Hang on, we are getting there.
<continued>
Student Loans
One particularly sad example I have of this is a young lady who was a member of the FRC robotics team I mentored for many years. She was duped --I have to use the word, no other way to describe it-- into accepting admission into a university that was going to charge her $300K for a degree in mechanical engineering. I and other professionals mentoring the team advised her against doing this. We explained what $300K in debt for a degree in mechanical engineering was a formula for financial slavery for three decades, or more. Well, we could not beat the marketing machine. She graduated with a little over $300K in debt and is absolutely hating life today.
This is where we make a connection that starts with K-12 and culminates with university outcomes and the healthcare systems.
An MD, depending on specialty, graduates with about $300K in debt. That's actually a bad number because it is an average, and averages are horrible metrics to apply to a population. The number can easily reach $500K, particularly when you include all elements, not just tuition.
Here's the connection: There's an ecosystem of professionals, all of whom participate in delivering healthcare through their own specialties. The MD, nurses, PA's, radiologists, etc. are the most visible layer. The next layer is likely an array of engineers, biologists, chemists and other university-degreed professionals working either directly for the hospitals or for tech and pharmaceutical companies that are an integral part of the healthcare dependency tree.
When you are on the table in an operating room, the team surrounding you likely has a collective student loan debt in the order of two million dollars, if not more. One layer removed are other nurses and support personnel at the hospital. That is also likely debt that must be serviced in the millions of dollars. The people who build the equipment in that operating room, conduct research and develop drugs and other tools represent hundreds of millions of dollars in student debt.
One can follow that cost structure tree as far as one might wish.
This means that healthcare in the US has a non-trivial baseline cost of doing business that is inextricably linked to the quality and cost of our education. That's an important baseline to understand. You cannot fix healthcare costs in the US without fixing this complex element of a complex equation. At a minimum, the government should have nothing to do with student loans. University costs should not be subsidized. Students should pay fair market value for what their degrees can actually deliver. Curriculum would also be fine-tuned as part of this process. Nobody wants to spend thousands of dollars for a course on "Underwater Basket Weaving" when it is irrelevant and has no value. Let the student decide, do not force irrelevant material on them and charge inflated rates for it.
The journey to this point includes additional variables that have not been accounted for. One example of this is the fact that K-12 education is dominated and ruled by regional teacher unions, none of which truly exists as real advocates for excellence in education. The effects of such a structure ripple all the way up into university, graduation rates and the cost of remedial education. These result also dominate life outcomes for those who either don't attend university or drop out. They leave K-12 without marketable skills that could seriously improve their lives and improve society.
BTW, my wife is a doctor; we actually live the above realities. We is over 50 years old and we still have somewhere around $80K in student debt to pay for her degree.
Lawyers
The baseline costs I mentioned above are, in fact, just the tip of the iceberg. Every single element of the healthcare story in the US, be it people, supplies, equipment or drugs, has massive legal and liability costs associated with them. If your medical practice has to protect against a potential hundred-million-dollar lawsuit, there will be a non-trivial cost associated with this. Same with hospitals, the EKG machine manufacturer and even the company making the pillows you put on the beds at the hospital.
One turn of the crank and all of these baseline costs add-up to a situation where the "system" has to charge insane amounts of money for everything or it will collapse under its own weight. Doctors have to order two, three, ten times as many tests for everything, just to cover their ass in case there's a lawsuit. Companies have to spend tens, hundreds, billions of dollars for similar reasons.
When your baseline costs are driven by such cost structures, there is no amount of income redistribution that is going to fix any of it. Making me pay four times what I was paying before Obamacare does absolutely nothing --not one thing-- to fix the fundamental issue of a seriously fucked cost structure to deliver healthcare.
I'll stop here. The topic tends to be emotional for some because it is human nature to pretty much just care for self rather than to take a higher level view, explore root causes and take the pain required to actually solve problems for everyone.
Objectively speaking, in the US, we need to fix education at every level, stop subsidizing ridiculous university cost structures and curriculum, fix our laws to reduce and mitigate the horrendous costs of doing business and focus on delivery quality care for everyone at a reasonable price. At this juncture, if we fired all politicians and did the right things, it could take 25 to 50 years to see the results. That's part of the problem and an indication of just how messed-up things have become.