Any given health provider has to deal with thousands of different insurers, and it's not uncommon for individual patients to have primary, secondary, tertiary, and even quaternary insurers the provider then has to deal with to get paid for a procedure.
To keep health care workers focused on providing health care, providers hire a bunch of administrative workers whose job is to offload the work of haggling with insurance onto cheaper workers, but because there's so many insurers, and patients have so many layers of insurance, you end up with something close to 10 administrators per doctor.
Alas, because there's so much money sloshing around in the system, and because the US government is so thoroughly corrupt with bribes from special interests, there's no movement to correct the problem. The system is unsustainable, though, so it will inevitably collapse in on itself at some point, causing a lot of misery and probably death before anything is fixed.
A thing that's always worth keeping in mind: retail clinical practice for non-geriatric adults is a very small fraction of all health care costs in the US, and end-of-life care is a very large fraction. Most of us only have exposure to the former, and we generalize from it, but that's not giving us an accurate picture.
Worse is the distortion of incentives for healthcare providers. The giant leaky insurance tit is there to be sucked on, creating corruption at every level.
When you are billed for a procedure you have no idea how much you are going to get charged or what you could get billed for. There could be gigantic opaque charges for things you have never heard of. Ticketmaster could only dream of such a rip-off.
Not to mention blatant over-billing for unnecessary diagnostics, etc. Every year new kickback schemes are discovered.
Price transparency is a real problem. Overbilling is a real problem, so is overprescription. Important to keep in mind that those are on the provider side, not the payer.
Here's JAMA for the BIR, based directly on cost breakdowns in specific real systems:
"Administrative costs have been estimated to represent 25% to 31% of total health care expenditures in the United States, a proportion twice that found in Canada and significantly greater than in all other Organization for Economic Co-operation and Development member nations for which such costs have been studied."
Imagine the profit margins where you don't have to pay salaries to them.
Phone and front desk stuff is just administrative burden, scheduling the appointment and making a paper trail.
(to improve US healthcare, laws will need to change; when those laws change is a function of election outcomes and cadence; those election outcomes are a function of the electorate, who they vote for, and the rate of cohort turnover; think in systems)
This timeline seems wildly optimistic
Congratulations, I think you just described the most ridiculous non-profit in existence.
It's actually been a fun exercise in building a gen AI solution to pour context into queries and get custom migration plans [eligible visas, employment connections at the destination, potential non traditional paths outside of work visas] out like an expat/migration plan vending machine. Output is verified by a human familiar with the problem space and away we go getting someone to where they want to go.
"Make something people want. Don't worry too much about making money." The demand, I argue, is proven. You should try to be more curious.
Record Numbers of Younger Women Want to Leave the U.S. - https://news.gallup.com/poll/697382/record-numbers-younger-w... - November 13th, 2025 ["In 2025, 40% of women aged 15 to 44 say they would move abroad permanently if they had the opportunity. The current figure is four times higher than the 10% who shared this desire in 2014, when it was generally in line with other age and gender groups."]
Americans are leaving the US at rates not seen since the Great Depression — and 5,000 even gave up citizenship last year - https://finance.yahoo.com/economy/articles/americans-leaving... - May 24th, 2026
Americans Are Leaving the U.S. in Record Numbers - https://news.ycombinator.com/item?id=47161219 - February 2026 (93 comments)
Those people would be better off under a more generous welfare state, but immigration policies in those nations are much less dysfunctional than our own. If you are able to offload some of these people onto another nation, I thank you, but it's a very odd focus for a charity.
If you want an example of how uninformed the people inside your TAM are, see the younger women polled in your citation. Based on other data, I strongly suspect they are motivated to leave due to actual and potential changes in abortion law and policy in the US (which I do not support for the record), and have absolutely no clue whatsoever what rights they would have in most of the rest of the world (spoiler alert, it's less than most Americans have).
What disposable income? There is very little, if any, middle class left ("K-shaped economy"). You say misinformed, but the economic ground truth is clear as day imho.
Americans Are Falling Behind on Their $1.25 Trillion Credit-Card Bill - https://news.ycombinator.com/item?id=48327518 - May 2026
‘It’s never enough’: young Americans struggle to build financial independence as cost of living spikes - https://www.theguardian.com/us-news/2026/may/31/young-adults... - May 31st, 2026
Brookings: States of Affordability: A series on where and why US households struggle to make ends meet - https://www.brookings.edu/articles/states-of-affordability-a... - May 27th, 2026
This is how close American households are to the financial edge - https://www.npr.org/2026/05/28/nx-s1-5836525/affordability-r... - May 26th, 2026
Urban Institute: The American Affordability Tracker - https://www.urban.org/data-tools/american-affordability-trac... - Last updated April 2nd, 2026
> Nearly half of people in American families cannot afford the true cost of living. Urban research finds 49 percent of people in American families don’t have the resources to cover essential expenses to live securely in their community.
> The cost of essential goods and services is rising faster than earnings. Since 2017, average earnings have grown about 43 percent nationwide. Over the same period, home sale prices have increased 81 percent and rents 54 percent. The lowest-cost Silver health plan on the Affordable Care Act Marketplace has risen 77 percent, and child care costs have grown dramatically.
> Rising everyday expenses, including energy and transportation, are adding new pressures on households. Residential electricity costs have increased faster than earnings across much of the country, leaving customers paying about $40 more in December 2025 on average than they did in December 2017. Gas prices have also risen sharply, with the national average growing by $1.00 per gallon since late February 2026.
> Affordability pressures are spreading beyond traditionally high-cost areas.
> Many previously low-cost regions, including parts of Atlanta, Chicago, Louisville, Winston-Salem, Columbus, Nashville, western New York, south-central Wisconsin, and central Florida, are seeing costs for housing, health care, and groceries rise faster than in other areas.
Brookings: In every corner of the country, the middle class struggles with affordability - https://www.brookings.edu/articles/in-every-corner-of-the-co... - December 2nd, 2025
Americans are losing spending power, say researchers: Most can no longer afford a ‘minimal quality of life’ - https://www.cnbc.com/2025/06/13/most-americans-cant-afford-a... - June 13th, 2025
US Dept of Labor: Childcare costs remain an almost prohibitive expense - https://blog.dol.gov/2024/11/19/new-data-childcare-costs-rem... - November 19th, 2024
Claiming there's "very little middle class left" is laughable, and then I can double over when I remember that the median household income is higher in Mississippi than it is in the UK.
Your wall of citations is basically just documenting the vibes I described. You missed the "(some scary percentage) of households are living paycheck to paycheck" one which is regularly discredited because people don't know how much they spend in general and consider things like optional 401k contributions to be "spending".
Please, please, please provide the name of this charity so I can donate to it.