The worst part, simultaneously soul crushing and apocalyptic rage inducing is that we get these outcomes after spending more per capita on healthcare than pretty much any country on the planet.
https://commons.wikimedia.org/wiki/File:OECD_health_expendit...
(And we’re middling in outcomes!)
Americans are not inherently three times as sick as Australians.
Side note: I'm an Australian citizen, living in the States.
An Australian hospital doesn't need a billing/collections department and the docs don't sit on appeals calls with insurance; when my wife broke her foot visiting, they basically didn't know how to bill her (for surgery and three days in a ward!). My son needed a badly ingrown toenail treated on a separate visit there last year; they just treated it and sent us on our way, no charge, despite his being a tourist.
I straight up don’t believe the drug use one, we have way more fentalyl deaths than you and it’s not even close.
You didn’t address crime. We have much more of it. More gun ownership and gun usage as well.
I’m not quite sure what this anecdote has to do with my comment.
Australians eat a substantially similar diet to Americans, and have similar health issues (obesity, heart disease, etc.) as a result. They are deeply related things.
> I straight up don’t believe the drug use one, we have way more fentalyl deaths than you and it’s not even close.
Gee, I wonder if not having healthcare (including access to things like therapy and rehab) might drive up drug death rates.
> You didn’t address crime.
Sure; you didn't address how it's responsible for 3x the healthcare costs.
Sorry I don't believe this
> Gee, I wonder if not having healthcare (including access to things like therapy and rehab) might drive up drug death rates
Lol, yeah that's why we have so many fentanyl addicts, the lack of therapy, I'm sure that's it
> Sure; you didn't address how it's responsible for 3x the healthcare costs.
Gunshot wounds obviously, we have way more guns and gun crime than Australia
Facts don’t require your belief. 30s in an Australian grocery store will have you feeling quite at home.
> Lol, yeah that's why we have so many fentanyl addicts, the lack of therapy, I'm sure that's it
Read again. You cited their deaths, not their drug use. Australia has plenty of drug users!
> Gunshot wounds obviously
You think the US spends 2/3 of its healthcare spend on gunshot wounds, accounting for the difference?
To quote you, “sorry, I don’t believe that”.
Deaths are pretty much 1:1 with drug use. Us having more fentanyl deaths mean we have more fentanyl users. Feel free to cite something that proves that Australia has the same amount of drug users as the United States.
It’s a contributing factor. Americans consume healthcare at much higher rates for many reasons, some of which I listed above. I’d fully expect Americans to pay more when they consume more.
https://www.abc.net.au/news/2010-04-14/australian-diet-worse...
https://www.nationalhogfarmer.com/market-news/study-finds-am...
https://www.youtube.com/watch?v=omT2ENVQziM
https://www.theguardian.com/australia-news/2025/nov/19/austr...
> I don’t believe claims made without evidence.
You're certainly making a few of them!
> Feel free to cite something that proves that Australia has the same amount of drug users as the United States.
https://www.aihw.gov.au/reports/illicit-use-of-drugs/illicit...
"According to the 2022–2023 National Drug Strategy Household Survey (NDSHS), an estimated 10.2 million (47%) people aged 14 and over in Australia had illicitly used a drug at some point in their lifetime (including the non-medical use of pharmaceuticals), and an estimated 3.9 million (18%) had used an illicit drug in the previous 12 months."
https://drugabusestatistics.org/
"Among Americans aged 12 years and older… 70.5 million or 24.9% of people 12 and over have used illegal drugs or misused prescription drugs within the last year."
That's broadly quite similar.
> Deaths are pretty much 1:1 with drug use.
You can absolutely reduce drug death rates with safe injection sites, needle programs, narcan distribution, safety education, substance abuse treatment, etc.
> Americans consume healthcare at much higher rates for many reasons, some of which I listed above.
Americans pay substantially more money for the same procedures and medications. Again: THE EXACT SAME THING; no difference in amount or quality consumed, just drastically more money going into corporate pockets.
https://nypost.com/2025/08/07/world-news/doctor-exposes-shoc...
"Atorvastatin, a medication to lower cholesterol and prevent cardiovascular disease, is priced as little as A$6.70 for 30 tablets in Australia, compared to US$2,628 for Americans."
"However, the biggest shock was Sofosbuvir, which treats hepatitis C, with a 12-week treatment roughly costing an eyewatering US$84,000 without insurance and discounts. Meanwhile, it costs about $31 for a packet of 28 in Australia on the Pharmaceutical Benefits Scheme (PBS)."
It "costs" much less--because in reality we end up footing the R&D bill. The drug companies tolerate sales to the UHC countries so long as it's above their marginal cost. If US customers were also paying $31 for that Sofosbuvir there's no way the company would recoup costs and they would not develop it.
Fixing this will cause big shakeups in the universal coverage systems and thus big political shakeups. It should be done, but gradually.
I will also say the comparison is false--my wife is on Atorvastatin, it's even less than what you are quoting for Australia. You're comparing the brand name with the generic.
> Today, many of those practices have been bought up by large corporations, including hospitals, private-equity firms and even health-insurance companies. It’s a shift that not only has changed how money moves through the health care system, but may also be helping some insurers boost their profits, according to new research published in Health Affairs.
> A study from researchers at Brown University’s Center for Advancing Health Policy through Research and the University of California Berkeley found that UnitedHealthcare, the nation’s largest health insurer, pays doctors who work for its own physician network, Optum, more than it pays independent practices for the same care.
(And the independent practicioners are having to use a significant portion of the money they take in to… fight the insurers!)
The idea that the problem with our system is health insurers is just slopulism. We have grave problems with our system! But they start with the providers, where the majority of all the funding in our system goes, not to the scapegoats they've stoop up in our insurers. The distinction is vitally important, because the most popular answer to this problem is to extend Medicare to everybody, and Medicare is just as victimized by this as everything else is!
We pay doctors too much, and we artificially restrict the supply of practitioners. Those doctors routinely overprescribe. Every other problem in the system is marginal.
And by inflating that amount...
> Using newly available federal price transparency data, the researchers found that UnitedHealthcare pays Optum physician practices about 17% more than non-Optum practices in the same region. In markets where UnitedHealthcare holds a large share of the insurance business, that difference was even larger, up to 61%.
their capped-by-law 20% cut of premiums goes up, too. "Oh, those mean old providers we own charge so much! We have to raise premiums again!"
Fun thing about the NHE: you can project it as far back as you want. The data is there.
What? Insurers have been playing this game far further back than 2023.
If an insurer doubles the time a doc has to fight over denials and has to hire extra billing staff to assist, where do you imagine that cost shows up?
Again: how will the “insurers force provider costs up” show up in said tables?
It’s caused by the insurer. It shows as a provider’s cost. But it doesn’t mean said doc is making any more money at the end of the day.
The insurer does, though! Their 20% cut got bigger, and the "computer says no" denials are cheap!
TL;DR: Where in your link does "doc spends needless hours on phone fighting insurer" show up as a cost?
But it's not a "Cost of Health Insurance" item. It's an expense at the practicioner level! They have to factor that non-billable time into what they charge for the procedure!
Read their definitions: https://www.cms.gov/files/document/quick-definitions-nationa...
"Administration" is the insurer's side of it.
If an insurer manages to double a doctor's administrative costs for billing/appeals/etc., where does it show up in your tables, per your link's PDF of definitions?
> Insurers are almost literally a rounding error.
Again, the argument is that the raw cost of health insurance does not reflect its externalities imposed on the other items in your list; that insurers drive up hospital and practice costs, as they have to staff up enormous amounts of staff and expensive physician time to deal with the insurer.
Some of which is those practicioners' admin cost from dealing with the insurers. (And, you know, doing the actual work.)
Denials are nice and cheap. Fighting them is not.
And as noted in that other conversation, this is one aspect of many. UHC isn’t pursuing vertical integration for funsies.
Again, I want to be clear: I'm not here to defend the American health system. It's a disaster. It's just clear to me you don't have a bead on why that is. (The answer is artificial scarcity of practitioners, overprescription, and lack of price transparency).
So is “insurance doesn’t have any externalities that might hide in my very broadly categorized numbers”.
It doesn't help that our healthcare billing systems are so outdated and broken. I once had a doctor visit denied with the reason code that it should charge the other insurance (for people on multiple plans). I was only on one plan, but my wife was on two. The doctor and I went through all the paperwork - my name was right, my birthday was right, my policy number was right and when I got notice of the rejection it had my name on it. Eventually we traced it to an error - not in my insurance company, not in the company that handles claims in this areas for my insurance, but instead in some middle-man company that was responsible for transferring claims between the two. Nevermind that all three companies claimed to be BlueCross BlueShield. This took over a year to resolve.
The numbers here are not close. They're stark.
> A new study finds that the extra time and labor physician practices spend on interacting with insurance companies and government entities cost U.S. physicians $82,975 each per year, while doctors in Ontario spent $22,205.
> Canadian physicians follow a single set of rules, but U.S. doctors grapple with different sets of regulations, procedures, requirements, formularies and forms mandated by each health insurance plan or payer. The average U.S. doctor spent 3.4 hours per week interacting with health plans; Ontario doctors spent 2.2 hours. The bureaucratic burden falls heavily on U.S. nurses and medical practice staff, who spent 20.6 hours per physician per week on administrative duties; their Canadian counterparts spent only 2.5 hours on paperwork.
All that falls in your $2.5T bucket. And their cleaners, HR, etc. And insurers have had 15 years of innovation since that study.
My local grocery store wouldn't even bother issuing a coupon for that small a discount.
This isn’t seventh grade math. This is kindergarten level cause and effect.
I said earlier we'd gone round-and-round on this topic before, and I was a little burned out on it, but I didn't expect you to refute your own argument like this. I'm glad we gave it another run this time! This is a great statistic; I'll be using it elsewhere. Thank you.
> I was a little burned out on it
I just did my taxes and am a little burned out by the $49k in healthcare expenses I got to deduct on them.
Even surgeons. Ask a surgeon how much time they spend in the OR. It's less than you think.