What's driving rising business costs?

The core issue is it suddenly destroys a large number of companies and removes millions of unnecessary jobs from the economy. That’s a great deal of wealth and a great number of voters who don’t want you to save hundreds per month by making them redundant.

Odd how the most popular programs in the US, social security + medicare, are the ones with zero means testing.

Maybe let's not blame one of the few only noble professions left in our greed fueled world.

Blame the hospital administrators or pharmaceutical reps before you start blaming doctors.

https://savegme.org/

I agree that certificate of need laws should be repealed to increase competition between healthcare facilities. That only impacts some states, not the whole country.

https://nashp.org/state-tracker/50-state-scan-of-state-certi...

Physician pay depends on specialty, but it can range from the low $100kish mark for pediatricians to $500-750k for certain kinds of surgeons. Family medicine tends to be around $200k. However, this amount ranges vastly by market and top pay often goes to those willing to work in more rural hospitals because no one wants to. For example, pay in NYC for physicians is appalling low compared to the rest of the U.S. market. In addition, certain systems have hard caps. For example, the VA hospitals cap physician pay inclusive of bonus at $400k. This is documented and you can in fact just look up a random doc at the VA with one of the many federal pay search tools.

While some doctors can make more, it typically because they own a practice and that increased pay comes from good old fashioned capitalism. Meaning, they tax the amount their nurses, NPs, medical assistants, etc. make just like all businesses make money per head on their employees. Whether you believe this is right or wrong is up to you. However, this is not any different that someone who runs, for example, a yard care business. More accurate pay can be found by those who work directly for large hospitals.

Next, the cost of medical education in the United States is vastly higher than other countries. Right now, medical school will cost you somewhere from $400-600k. This is in addition to whatever debt accrued during undergraduate. Further, medical school applications are highly competitive, so students often accrue additional debt by completing a masters in something like public health prior to entry to medical school. This means that someone may have upwards of $750k of debt when they finish medical school, but they still have somewhere between 3-10 years of residency and fellowship before they make attending money. During this time, the debt accrues interest and balloons.

Now, once you become an attending, you're still not good and expenses are vast. Shift work can vary from something like 7 12-hour shifts in a row for intensivists to 14 shifts in a row for hospitalists. Note, just because it says its a 12-hour shift doesn't mean you work 12 hours. They still need to chart and bill and if it's busy, that may be another few hours after the shift is over. In some remote clinics, an ER physican may work 7 24-hour shifts in a row. That may sound absurd and unsafe and it likely is, but it's the reality of the work. If someone is working that schedule, they have increased expenses to just, frankly, live. On the low end, it's very difficult to cook in that environment, so you have to buy a lot of premade food. On a more expensive end, having children on this schedule is extremely difficult. You either require a spouse that doesn't work or you need something like a night nanny. If you're working 12 hour shifts, you must sleep at night and you can't be up to take care of a baby otherwise you run the risk of killing someone the next day. Unless you're paying someone under the table, current nanny rates in large markets are about $20-25/hour. Insurance rates are also high. I don't mean malpractice either. Generally speaking, one needs to carry disability insurance because if one gets into a car accident and breaks their magic hands, there's no way to pay back that debt otherwise. These policies are thousands a year. That's just the start. They pay a large amount of money to buy their time back because they don't have it.

Next, there's a myth about limiting residency slots in order to increase pay, at least recently. I will not defend the AMA and some of they took, especially in the 1990s. Here's the 2025 residency match data:

https://www.nrmp.org/match-data/2025/05/results-and-data-202...

The number of offered and filled slots is on page 2 (or 13 depending on how you count). Some specialties filled all of their slots. Where the U.S. vastly lacks is pediatricians, family medicine, internal medicine (who can work like family medicine if need be.) Pediatricians had 147 unfilled slots. Family medicine had 805 unfilled spots. Internal medicine had 357 unfilled spots. These spots can be filled by people who graduated from U.S. medical schools, island medical schools, Mexican medical schools, or a vast array of other foreign medical schools. However, they're not filled because they don't have the applicants. That's not medical school collusion. That's the hard reality that medical school is extremely expensive and the training is extremely long.

Now, how do other countries handle things? One, their medical school is not as crushingly expensive. Two, places like Europe cap the number of hours a physican can work. If you want to pay American physicians less, you'd need to blow out their medical school debt, reduce their hours, and offer better benefits. Until then, no, really, they're not overpaid.

If you want to start pointing fingers, try the vertical integration of insurance companies, pharmacy benefit managers, and hospitals. I don't have the numbers readily available, so I'll stop here. But, really, it's not the docs.

Doubt.

> That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created each year).

Now explain this trend[1].

[1] https://fred.stlouisfed.org/graph/?g=1T22Y

I'm also skeptical about putting the federal government in charge of establishing standards of care. We already see that some medical conditions have been heavily politicized by certain patient interest groups. And while evidence-based medicine is great, we still have nowhere near enough data to establish clear clinical practice guidelines for medically complex patients.

Between ghost networks, death panels that deny you treatment, and the nature of deductibles, you have no fucking idea what you're buying, and whether or not you're getting ripped off.

[0] - https://oui.doleta.gov/unemploy/docs/trustFundSolvReport2025...

What you said, fee free banking + KYC + free instant transacting is something we definitely need, even if it hurts JP Morgan Chase a little bit.