Why are Americans paying so much more for healthcare than they used to?

It's a pretty obvious answer, to be honest. Because it's a poorly regulated industry for the purposes of minimizing cost to individuals. Over time, industry participants will continue to expand rent seeking practices and because the demand for health is almost perfectly inelastic, they can continue to get away with it. Too many middlemen, too much needless complexity, not enough regulatory oversight.

I'm a rabid defender of the free market, but healthcare is not a regular market because nobody chooses to purchase healthcare services. You take them at whatever price they are offered whenever you need them. It's why we call users of these services "patients", not "consumers".

Consumers are best served by private companies competing against each other in a nearly perfectly free market to offer the best goods and services at the lowest prices. Patients are not.

Patients are best served by a well regulated industry in a nearly perfect not-free market in which their needs are prioritized over profit. Healthcare, just like education and security, are the foremost duties of the State.

The reason it costs less is because there are no administrative staff at all aside from the receptionist. interfacing with insurers requires an entire back office of non revenue employees that DCPs do not need to bother with.

You can also save a lot of money in HDHP by ordering your own tests from a reseller like ownyourlabs instead of having the hospital doing it, especially if you like doing annual preventative tests that may not be medically necessary. I bring the results to my dpc doctor for review and it's all very convenient.

* https://www.noahpinion.blog/p/insurance-companies-arent-the-...

The margins and ROE for health insurance companies aren't that big, health providers on the other hand…

Of course that doesn't necessarily mean the insurance companies are useful:

* https://paulkrugman.substack.com/p/health-insurance-is-a-rac...

But given the realpolitik of when Obamacare was passed, the current US system was probably the only way at the time to get to universal healthcare. The ACA barely managed to get passed after all (219–212 and 60–39):

* https://en.wikipedia.org/wiki/Affordable_Care_Act

“Politics is the art of the possible, the attainable — the art of the next best.” ― Otto von Bismarck

There's no downward pressure on these prices except what the insurance companies can negotiate, and people don't like the insurance companies doing that when their health is on the line.

ie, It's a total market failure, and single payer would fix things, at the expense of all the profits of the 3 largest factors.

The most ethical approach would be to separate care into health care and medical care. Health care should be strictly preventative and diagnostic and be free.

Healthcare as defined below is outrageously expensive to begin with. Going to hospital and seeing some resident for 5 minutes after having a nurse take your blood pressure and weight shouldn’t result in the insurance company being billed $1000.

Part of this resolution will be introducing far cheaper labor and automation. One point people never want to concede is that the actual cost of labor is increasing without commensurate productivity, aka cost disease. Free health and medical care will exacerbate this.

Medical care should be pay for yourself or purchase private insurance.

Medical care here is defined by actual treatment such as surgery, whereas health care includes diagnostics such as a yearly assessment, blood tests, etc.

Of course, it’s easy to want others to pay the bills.

Doctors can be sued for malpractice if they miss something, so they're incentivized to provide as much care as possible, regardless of cost.

Hospitals and other healthcare organizations are likewise incentivized to charge as much as they can, since the bills are passed on to insurance companies.

Insurance companies have every incentive to lower the bills they pay. They negotiate volume discounts with healthcare corporations, and the billing system that gets worked out between these large organizations has little connection to the actual cost of healthcare provided to consumers.

For most consumers, insurance coverage is connected to employment, so it's very difficult to shop around. It could mean leaving one job for another, just to get different health coverage.

Inefficiencies abound. We can do better, but there is not a simple solution to this.

You could probably eliminate a lot of these inefficiencies by eschewing any sense of morality or fairness and simply letting more people die. Society isn't quite ready for this level of dystopia, but it's the direction we're headed if we don't change course. Nationalizing the US healthcare system may be the best answer, but it is guaranteed to be enormously complicated, and not guaranteed to improve outcomes.

One can view standards that maintain a certain level of quality as privileging the well off, requiring an industry to cater to their preferences over those of other classes of consumers.

Which granted the companies guaranteed payment from every American when not nearly every American was paying before.

There's plenty more on top of that, it's only one fundamental.

Yes, price discrimination, lack of pricing transparency, excessive administration costs, etc all add to spending. But at the same time we know that a lot of chronic diseases are increasingly common, that we have a large number of aging boomers, and that new, effective but expensive drugs (e.g. semaglutide) are being prescribed to both people that need them and perhaps some that "need" them, so there are simultaneously good reasons to expect healthcare spending to go up.

If we can't track both the price and the care delivered, we can't really see if the efficiency of care delivery is getting worse (though it probably is). If we don't have metrics that compare care delivered to care required, we can't tell if we're failing to care for our population ("Bob needs X but can't get it because he can't afford it") or over-prescribing and testing ("Alice may not need Y but her GP put her on it to cover bases").

The system is broken. The players are corrupt. But measuring spending only does not really illuminate the issues.

The cynic in me thinks “they” will make it illegal or lucrative to not talk about the problems. May be they will spin up yarn like they do for school shootings and made half the country be fully ok with school shootings.

Brief list of problems:

1. It's too expensive to become a doctor. Unless you come from a relatively affluent background, a freshly-minted doctor will graduate with $300k+ in student loan debt. After 3-10 years of working minimum wage (ie residency) that debt will be $500k+. Salaries need to be high to cover that. Everyone pays for that input cost, a lesson we're also failing to learn from increased housing costs too.

If anyone complains about physician salaries and points to other countries, particularly in the EU, ask them about the debt required to become a doctor in the US vs whatever country they bring up;

2. For-profit healthcare incentivizes taking money and then not paying for medical care to increase profits. The industry calls any payout they have to make a "medical loss";

3. The ban on importing medicines and Medicare negotiating drug prices needs to go. All it does is make drugs WAY more expensive in the US than any developed nation, often by orders of magnitude;

4. Even so-called not-for-profit foundations that own hosptials and medical providers are little better because, for example, the executives can be incentivized to icnrease assets under administration, just like a mutual fund. And any such money put into assets isn't being spent on healthcare. This needs to stop.

5. More artifical barriers. As just one example, physicians are legally forbidden from owning hospitals. This provision was snuck into the ACA;

6. Standardize electronic health records. EPYC is a scam and more rent-seeking;

7. Federal research dollars should come with equity in any drugs commercialized from that research. Drug companies don't do research, much as they claim to. They spend their money on marketing, lobbying and patent extension;

8. Patent reform. Drug companies make pointless changes to molecules and stop making the version that goes out-of-patent. No one else can produce it because parts of the manufacturing process are hidden (eg trade secrets) and, even if you can, you can't verify what you've produced is compliant with the approved version;

9. The state should produce generics. Insulin, epi pens, that sort of thing. Price gouging on these should be a crime. Some states are or will be producing insulin.

Capitalism is great, as long as there is some amount of regulation. And healthcare is an area where this is definitely needed.

So the good part of capitalism don't work, but the bad parts do, like concentration of power and ignorance of externalities.

And today, we have reached a tipping point in those, with abuses overcoming people's tolerance for them.

The reason is simple, for profit healthcare, simple as that.

In my area I am old enough to remember when all hospitals where I live where run by various charities. My small city of 100,000 people we had 3 hospitals. 2 run by Roman Catholics and a third was non-profit. Back then things were kind of cheap when compared to what people's salaries were.

Now there is only 1, owned by Tufts. The non-profits were pretty much eliminated in the late 80s or early 90s, and no one can pay their hospital bill without insurance. Even with insurance it is very hard to pay up.

So there is your answer :)

Is this really a mystery. I would guess < 5% american adults know how to use a knife or boil an egg.