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Comment by nradov | Hacker News Reader

The actual labor share of income is significantly higher when you include employer contributions to employee health insurance premiums. Healthcare costs have been rising faster than overall inflation for decades, and while many of those costs are passed on to employees the employers have also absorbed a significant chunk. If we want to increase the labor share then we'll drive down healthcare spending.

And no, there's no simple solution to this problem. The notion that something like "Medicare for All" would solve the problem is a total fantasy, disconnected from actual US healthcare economics. Any real solution will have to work on multiple angles including preventive care, PBMs, provider wages, rationing, drug prices, fraud, malpractice insurance, interoperability technology, etc.

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Why wouldn't a single-payer solution work? The margin that the insurance companies take for themselves seems like a good place to start. From there it would spiral out to the third to half of time that all of the clinical staff spend just dealing with insurance issues and insurance billing.

There are countries in Europe which have entirely privatized healthcare systems (not even medicare/medicaid equivalents). US tried adopting some of their practices with Obamacare and even that didn’t work out. Singlepayer isn’t really necessary to have a reasonably affordable and accessible healthcare system proper regulation is.

As successful as Obamacare has been it didn't really do much to lower the cost of healthcare or claw back the billions wasted to insurance company profits. There might be some kind of regulation just as effective as single payer, but we've never seen it anywhere in the US.

> but we've never seen it anywhere in the US.

Well just copy paste the Swiss system (of course that’s not feasible both the “free market” and pro “socialized” single payer supporters would hate it). However they have a heavily regulated, reasonably affordable fully private healthcare system.

> As successful as Obamacare has been it didn't really do much to lower the cost of healthcare

It dramatically lowered the cost to consumers. Further, conflating overall healthcare spend with the portion of spend tied to a significantly lower-cost population is apples and oranges at best and represents a fundamental misunderstanding of healthcare cost in general. It's ok to not have opinions about things you know you don't understand.

"lowered" hasn't made much difference. Before the affordable care act Americans spent more and got less for their money and that hasn't changed. Insurance companies are still stuffing their pockets with billions and denying coverage. Americans struggled to afford the care that they needed before the affordable care act, and they still struggle to afford the care that they need today. The affordable care act was a very small improvement, but it didn't move the needle compared to other nations

I'm not necessarily opposed to a single-payer system but the margin that for-profit insurance companies take is a tiny fraction of overall healthcare spending. You could zero it out and it would barely move the needle. And many of the largest commercial health plans such as most Blue Cross Blue Shield Association members are non-profit. There is literally no margin.

Provider organizations spend a huge amount of effort dealing with Medicare and Medicaid, which are pretty close to being a "single-payer solution" already in many cases. From an administrative overhead perspective they aren't always easier to work with than commercial health plans. Plus they have enormous problems with fraud, waste, and abuse.

The mandated low margin is part of the problem. When your margins are regulated, the only way to increase profits is to just make everything more expensive. More revenue, same margin, more profits. Humane health care is incompatible with free market economics.

Perhaps its not compatible. But that’s tangential to the situation in the US, at the very minimum you need to have price transparency in any ‘free market’ system.

I think the point is that we might as well just give up the pretense of a free market healthcare solution and just focus on what's humane.

Is it humane to leave a patient to die in an ambulance when a single-payer nationalized healthcare system is over capacity?

https://www.theguardian.com/society/2025/apr/06/englands-nhs...

I'm not trying to be snarky here, the point is that there is no easy solution and optimizing based on what politicians subjectively consider "humane" isn't going to get us anywhere. If we want to actually fix the problem then we need to focus on what's economically feasible rather than low-effort hot takes and sound bites. Free markets, with reasonable limits, can be part of that solution by revealing consumer preferences and allowing for efficient allocation of limited resources.

> Is it humane to leave a patient to die in an ambulance when a single-payer nationalized healthcare system is over capacity?

I think painting the inhumanity of that as a consequence of the structure of the healthcare system is disengenuous at best, especially as the implicit solution you're proposing is to artificially lower utilization rate and access. Deflecting patient deaths into "technically not our fault, they didn't try to get help" by exploiting economics is in no small terms extremely inhumane.

The answer to that is that near universally in the world, our labor pool of medical personnel is too small, and almost all of it has to deal with an arbitrary restriction of labor supply. Stupidly, I have felt this many times in America, so trivially it's a problem no matter the structure of the healthcare system. Optimizing towards maximizing the number of nurses, doctors, pharmacists, the whole spread, in a society is underdiscussed but obviously beneficial (for everybody but those who profit off of the labor scarcity)

is it humane to solve that problem by excluding people based on income? that's what your proposing, as that's how markets solve problems like this: if more people need a product/service than the market can provide prices go up and the poor are excluded. also not trying to be snarky but that's the choice in front of us. part of the problem with free market solutions to healthcare is the feasibility of walking away from a bad deal. in every other space prices are regulated downward by the buyers' ability to either buy something else or do without but there is no doing without emergency care and doing without preventive care is just deferring the cost until it's emergency care at punitive interest.

Stop lying, I haven't proposed anything of the kind. Free market solutions often include giving cash subsidies to certain participants (and you would be aware of this if you had bothered to do even basic research on serious healthcare system reform proposals before commenting). I'm simply pointing out that it's a complex problem with multiple causes and there is no simple solution.

Even cash subsidies can be a kind of chain. Why wouldn't we just subsidize the whole thing for everyone then? And if the purpose of a health insurance plan is to collect groups of people into "risk pools," then why wouldn't we just put everyone in a global risk pool? And if the purpose of a health insurance plan is to negotiate rates on behalf of a bunch of people, why wouldn't we have someone like CMS determine those rates? And if the purpose of a health insurance plan is to make sure everyone has health care, why would we create a system where people are excluded by means-testing?

Free market solutions, by definition, exclude external interference. Subsidies, by definition, are market interference by an external actor.

They're not lying any more than you were when you responded to my suggestion that we should prioritize what's humane with some sort of interpretation that I was saying something about politicians.

> I'm not trying to be snarky here, the point is that there is no easy solution and optimizing based on what politicians subjectively consider "humane" isn't going to get us anywhere.

On the contrary, most politicians seem very adamantly against what I'm proposing. I don't know why you think I'm suggesting that we delegate how we determine what's humane to politicans.

That is the inevitable consequence of your suggestion. In any national healthcare system, it's ultimately the politicians who have to make choices about the incentives that drive the behavior of every other participant.

Is it humane to spend $100K of public funds to extend the life of a terminal cancer patient by 6 weeks? Some would say yes, others no. Those are real choices that have to be made and in the most expensive parts of the healthcare system there is no clear consensus on what is "humane".

I don't think the core issue is the health insurance companies stealing money, it's the deep inefficiencies that come from the position the insurance companies hold.

How many man-hours are spent dealing with insurance paperwork? How much do hospitals and doctors spend each year just dealing with that interaction, rather than treating patients?

> Plus they have enormous problems with fraud, waste, and abuse.

I'd say "enormous" requires some evidentiary proof. Obviously there is fraud and waste. But almost all large scale systems have that. We should certainly try to minimize it wherever we can but I don't think "waste and fraud exist" are a reason to not pursue a path.

>I'd say "enormous" requires some evidentiary proof. Obviously there is fraud and waste. But almost all large scale systems have that. We should certainly try to minimize it wherever we can but I don't think "waste and fraud exist" are a reason to not pursue a path.

Are you living in the same country as the rest of us? There is plentiful evidence of the enormous fraud and waste. It’s not even a point of debate anymore.

For what it's worth I know you've worked on FHIR and probably know a lot of details I don't. Actually I'd be interested in talking to you about FHIR.

That said!

1) In the big picture isn't the US clearly paying more than other countries? I'm sure some of this is eg a janitor in the US costs more than a janitor elsewhere, but still...

2) Isn't the cap for the margin that insurance companies can take 20%? That is, they have to pay out 80% as claims take 20% for overhead

3) Doesn't insurance also induce more work done by everyone else who has to deal with them? So the margin the insurance company itself takes is not the only cost they add. Maybe they make providers do more paperwork, or let patients order tests etc that they would not if they were not spending other people's money, or some other reason. Say insurance pays out 80%, but 30% of documentation or actual work is not done by insurance but only exists because of them, now we're down to 56%.

I say this because literally yesterday, my wife, a pediatrician, after she spent the day seeing patients and got home to go through notes, had to leave a message with an insurance company: she saw they faxed her clinic on Saturday, when the clinic was closed, to cancel care for a patient with an ongoing chronic condition with no changes unless the insurance company got a reply in 48 hours (again, while the clinic was closed!). Now she has to schedule some kind of I don't even know what with them, to confirm the condition is the exact same, except she sees patients all day so it's a pain to schedule...

idk the fact that BCBS is a non profit and has no margin in some technical sense does not seem like a big consolation, something is rotten no?

(edit - the insurance company in the anecdote is not BCBS)

I've worked on a lot of healthcare interoperability standards, including HL7 FHIR. Those can be part of the solution in terms of making the system operate more efficiently and cutting administrative overhead. In many cases payer and provider organizations are still doing things manually that could be automated using existing standards. But they fail to do so due to lack of vision and insufficient technical resources. Literally everything that can be done with a fax can be done faster and better with X12 / NCPCP / DirectTrust standards that have been around for years and are widely supported by commercial EHRs.

It's true that no matter how you look at it, the USA spends a lot more per capita on healthcare relative to outcomes. But you have to be careful what outcome metric you look at. Like we're not doing great on life expectancy, but much of that is due to factors largely outside the healthcare system like violence, vehicle crashes, and lifestyle choices. And in other areas like 5-year cancer survival rates or new drug development we're at or near the top. Part of the problem in the USA is that we seem to be culturally incapable of admitting that rationing is needed, and that it simply isn't feasible to deliver excellent care to everyone, so political reform debates devolve into sound bites about "death panels".

The Affordable Care Act (Obamacare) set a minimum health plan medical loss ratio of 80%, or actually 85% for larger plans. And in practice most come in higher than that due to competitive pressures.

https://www.cms.gov/marketplace/private-health-insurance/med...

There's a huge amount of administrative overhead in dealing with health plans for things like claims and prior authorization. Much of that is imposed not so much by insurers themselves but by employers who want to hold down costs. Like a commercial insurer would be happy to sell a plan that would pay every claim immediately at 100% with no questions asked. It would be less work for them. But no one would buy it because costs would explode. Medicare and Medicaid plans also have prior authorization and peer review processes. Something like a quarter of all healthcare services are "low value care" which doesn't align with evidence-based clinical practice guidelines and may even harm the patient, so when health plans apply review processes the right way then ideally it's better for patients and holds down costs for everyone.

To be clear, I'm not here to defend commercial health insurance companies. They are part of the problem and some reforms in that area are sorely needed. But let's have an honest debate about it and stop pretending that eliminating them would solve the deeper systemic problems.

Admin inefficiencies between orgs definitely exist and maybe better interoperability and standards is the solution, but wouldn't there also be less of a problem in the first place if there were fewer different orgs all complicating workflows?

Also not saying you're wrong about many healthcare services being unnecessary or even harmful, and someone has to be the one to say no to patients asking for low value care which is definitely a real hard position to be in and a real problem. At the same time insurance companies aren't making a great case for themselves as the solution imo bring on the government death panels.

Yes, provider organizations waste a lot of resources dealing with differences between health plans. Reducing the number of different payers would certainly reduce that overhead, at least in the short term. Mandating increased health plan transparency and use of open interoperability standards can also help by allowing providers to deal with those health plans in a more consistent way and automating much of the current manual work.

In general though I'm just skeptical that a single payer solution is the best possible long-term approach. US federal and state governments are already under tremendous fiscal pressure. So if we forcibly route all healthcare payments through governments then there's going to be constant pressure to hold down costs through blunt measures. And decisions will inevitably become even more politicized with special favors or punishments given out based on party loyalty. Do we really want to put someone like Xavier Becerra or Robert F. Kennedy Jr. in charge of centrally planning something like a fifth of the US economy?

The current US healthcare system is unnecessarily wasteful and cruel. But on the positive side we produce far more innovation per capita than any other country. Let's find a way to incrementally fix the worst problems without killing the golden goose.

insurance issues are provider and insurer going back and forth detrmining if doctors assessment of necessity is agreed upon.

i am not familiar with universal system. In that system if your doctor thinks something is medically necessary then thats the end of it and its gets done?

All healthcare systems have some form of rationing. Even if your doctor thinks something is medically necessary it can only get done if the system actually has capacity.

In most countries where there is universal coverage with a single payer, certain expensive treatments have long waiting lists or are simply unavailable at any price. Thus we see wealthy Canadians coming to the USA as medical tourists and paying cash for procedures like MRI scans or joint replacements in order to avoid the queue back home. There are always trade-offs, it's just a matter of what we want to prioritize.

yea queue is fine . i was wondering about gp's claim that universal would be more efficient because there is no more back and forth about approving.

i wasnt sure if it simply takes a different form or gets eliminated completly.

In my experience, insurance issues are usually insurer and patient going back and forth and then patient getting 6 different answers from 6 different representatives, then reviewing the 3000 page plan document, finding the single line that properly describes what should have happened, calling the insurance company, explaining to the rep how your plan works, and demanding that it be reprocessed. Like my wife has to do this frequently and spends several hours per month dealing with this but she has saved us probably tens of thousands of dollars in mis-processed claims that the insurance companies can't even properly handle. I usually am the person carefully reading plan docs, finding the proper billing codes, and explaining things like that to the insurance company. Sometimes we have to get the doctor's billing people to code things, like once they coded something that was an outpatient appointment as a minor surgery which could have cost us a lot of money.

So in my book since we get to speculate about what the system should look like, it should absolutely result in people getting care without all of this run-around. It's about eliminating as much misery as possible from the system and letting people just get treated and providers just get paid. We can talk about efficiency once the misery is gone.

Yes, part of the overall solution needs to be health plan transparency on clinical guidelines and coverage rules. Currently much of that is concealed, or applied unevenly.

But we're not going to eliminate misery from the healthcare system. Demand is effectively infinite, mainly from patients with complex conditions, and supply is finite. Developed countries with more socialized healthcare systems typically do a pretty good job of delivering basic primary care but things often fall apart when more complex or specialized care is needed. Those systems also ration and deny care but it tends to be through forcing patients to wait in long queues, or simply not offering expensive treatments at all. Like under the UK NHS, some prescription cancer drugs just aren't available. So that's a different form of misery.

you think there is scope for a non profit here that can advocate on behalf of patients and read the contracts. perhaps with ais help.

> If we want to increase the labor share then we'll drive down healthcare spending.

It may not be simple but it's clear the United States is doing something catastrophically wrong. All the other healthcare systems on the planet in developed countries have problems, sure. But we spend magnitudes more money to receive middling-to-shit healthcare. Medical debt and bankruptcy is a unique American problem that also happens to be the most reliable way for otherwise productive and prosperous members of our society to end up fucking homeless. Because they got SICK. I rarely use the word "evil" but that really fits IMO.

Like you cannot tell me with a straight face that the insurance industry couldn't be blown the fuck off the map tomorrow and literally everyone who doesn't own an insurance company isn't instantly better off.

If the insurance companies disappeared tomorrow, presumably all medical care is paid for at point of use by patients? That would mean stochastically facing catastrophic bills from providers. I am sympathetic to the idea that healthcare providers and systems here should be making no more than in, say, Europe, but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.

> but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.

I'm sure he'll manage.

Sure, but the rare type of person capable of becoming an orthopedic surgeon has other career options. There are some who are drawn to it as a calling because they love caring for patients and would do it regardless of wages. But most respond to economic incentives, so at the margins some will choose to go into technology or finance or something and make more money there.

When we fix the price of something below the market clearing price then there will always be a shortage. This is inevitable. We might decide that having a shortage of orthopedic surgeons is acceptable but let's not pretend that there are no trade-offs.

Germany has a stagnant economy so it's easy for their healthcare system to pay doctors lower wages because they have few other options. Baumol's cost disease is a real factor in healthcare, and it impacts the USA more than most other countries precisely because our overall economic growth has been so robust.

If you as a person are turned off of a career because you can only make a mere, paltry peasant wage of $300k per year, then I think that's really a you problem there.

And as to your comments about shortages, we already have shortages.

Feel free to moralize all you like about the maximum wages other people should earn if that makes you feel better but that won't solve any of the actual problems. In the real world, most people respond to economic incentives. Shortages can always get worse. (I am not a physician.)

> In the real world, most people respond to economic incentives.

Then why is there a shortage? Are you telling me the $750,000 yearly compensation still isn't enough?

Are you telling me that $750K yearly compensation still isn't enough for an NBA player? Maybe they should be nice and agree to play for less because they love the game and want to entertain people.

If we're talking about orthopedic surgeons specifically, a good one is essentially an elite athlete. A single tiny error can leave a patient dead or crippled. It takes a rare combination of intelligence, ability to focus for hours, physical strength, and fine motor control. So only a minuscule fraction of people even have the necessary potential. And the training pipeline is necessarily long because they need a lot of reps to build up the mental and physical skills, and to weed out those who aren't suited. Sure, you can find some people who are willing to do the work for lower wages but will they be the right people?

Beyond the wage issue, supply for all physicians is artificially constrained by training system capacity limits, as I already explained above. There are things that could be done to make training a bit cheaper and maybe two years shorter. But the easiest win would be to make more efficient use of the existing supply by optimizing workflows, and automating or eliminating administrative tasks.

> would be very unhappy.

Significantly increasing the supply of doctors would solve that, though.

There are certainly some things that we could do to increase the supply of physicians by reducing the cost of education, expanding access to combined BS/MD programs, and increasing the number of residency slots. But those measures will have marginal effects, and take years to show up in supply numbers. There just aren't a lot more people who are mentally and physically capable of doing this work.

Part of the problem is that we force physicians to waste too much time on administrative work. Some of this could be delegated to cheaper employees or not done at all, thus effectively increasing supply. Administrative overhead is also one of the factors driving physicians to quit and pivot to other careers or retire early, which further constrains supply.

This part is controversial but we'll also have to shift a lot of primary care to Physician Assistants and Nurse Practitioners. Care quality might be lower in some cases but for routine conditions it's probably better to see a PA/NP today instead of waiting weeks for a physician.

What the US is doing is nonsensical. Modern Healthcare is an industrial system designed to handle large populations in bulk. But it only works if everyone can get timely access. This is true for things like mass screenings and medication.

The insane thing is denying it to half of the population doesn't really mean the other half gets to save that much money in real terms.

You're citing some of the results of a runaway healthcare industrial complex, such as drug prices, as reasons why the thing that would keep such a complex from emerging won't work.

Employers might be contributing more to healthcare costs, but that's because they have to in order to keep coverage for their employees at all as premiums increase, and individual out-of-pocket costs are still rising as a result of coverage denial and high deductibles.

While healthcare spending isn’t included in some economic measures like wages (which has contributed to the distorted productivity-pay gap discourse), labor share as discussed in this article is actually calculated using total compensation, the “total of payments to labor to produce output, including wages, benefits, and other monetary or nonmonetary payments,” which includes employer contributions to medical care not just wages and salaries.[0] They do discuss payroll share later on though, which doesn’t include non-wage compensation.

[0] https://www.bls.gov/opub/hom/opt/calculation.htm

I've built and audited medical billing systems and billing practices. It isn't an economics issue in a traditional sense. Infact it would drastically reduce complexity of these systems and payments over time, even allowing private insurers to exist but have to compete with a base general coverage. (many smarter people than me at princeton did economics showing this worked out as a net less expensive than what we are doing now) The biggest reason why its not the simplistic solution, is politics of all the middle men (me) making exponential returns from solutions to these systemic issues.

Too much money in the system being flawed, look at pricing for any HIPAA safe products and thats just technology. Money is so hard to get for healthcare providers it is its own industry of revenue cycle management and thrid party billers. Most of these physician lead practices charge more is because planning your account around reemburcement cycles from insurance companies are 30-120 days if your lucky is an advanced accounting problem. (Thats excluding complexities of audits, LOPs, network rates etc.) Medicare/medicaid the fraud side has lots of tiny wins through leaning on tax information more, taking the model from the successful basic income studies and trials worked out.

I'm not sure what you mean by pricing for "HIPAA safe products"? It's not particularly expensive to comply with the HIPAA Privacy Rule, and honestly that level of privacy and security is the minimum we ought to expect in any industry that deals with sensitive consumer data.

There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale and increase negotiating power with commercial health plans. Which is one of the factors driving up overall healthcare system costs.

The ops is crazy expensive, any service you get or buy into also instantly gets at least a 30% mark up. Look at the price of transport EDI clearinghouses vs healthcare! Yeah, it is stuff we should be doing for all data, but one mistake will leave you(business owner or contractor) with intergenerational debt or leave you criminal liable.

> There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale

There are plenty, in name at least many states have regulations to force this. Those larger roll ups are still clusters of smb doing 1-10m revenue monthly. They constantly fail and change hands behind the scenes, and are usually only protected by government regulations that reduce risk room to investors normally don’t have in other industries businesses. Their margins are like gambling almost and it’s a key driver of the service issues Americans face.

Do other countries' state healthcare system costs count towards their labor share of income? If not, it seems sensible not to account for them that way in the US, or you're creating a much more serious apples and oranges problem for international statistics (which are often cited/compared for these figures)...

I strongly agree that socializing the healthcare industry will not help in any way. To the extent that healthcare costs have skyrocketed, it's precisely because of government intervention in the U.S. Healthcare industry has massively increased over the last 50 years, especially in the form of tax incentives for employers to compensate employees by way of health insurance. Anyway, with respect to the labor share of income, that is not correct. Employer contributions to employee health insurance premiums are included in the labor share.

> To the extent that healthcare costs have skyrocketed, it's precisely because of government intervention in the U.S. Healthcare industry has massively increased over the last 50 years, especially in the form of tax incentives for employers to compensate employees by way of health insurance.

It fails to follow logically that one specific way the government got involved that drove costs up means that any possible intervention is worse than completely being hands-off. How do you explain pretty much every other developed country in the world having more government involvement but lower costs than the US?

Health care costs across the developed world have skyrocketed for exactly the same structural reasons. Yes, implementations have been different in their details, but the larger structure is the same no matter where you look in the developed world. Government intervention has increased. That means more top-down management and less bottom-up self-organization based on private property and individual incentives.

This is not some spurious speculation. That market-based systems drive down costs enormously is replicated across dozens upon dozens of industries. It's one of the most replicable results in economics to the extent that economics can be replicable. As for why the costs in other countries are not quite as high as the U.S., it's because health care costs also increase as per capita GDP increases and the U.S. has higher per capita GDP. Moreover, because the U.S. has some aspects of its health care system still living more in the private sector, there is less top-down rationing. Other countries see very clear examples of rationing, so people spend less on end-of-life care.

> This is not some spurious speculation. That market-based systems drive down costs enormously is replicated across dozens upon dozens of industries. It's one of the most replicable results in economics to the extent that economics can be replicable. As for why the costs in other countries are not quite as high as the U.S., it's because health care costs also increase as per capita GDP increases and the U.S. has higher per capita GDP. Moreover, because the U.S. has some aspects of its health care system still living more in the private sector, there is less top-down rationing. Other countries see very clear examples of rationing, so people spend less on end-of-life care.

That actually sounds a lot like speculation. You're claiming that the most largest structural difference in the healthcare system in the US compared to other countries is unrelated to the difference in costs, and that other factors explain it, based on inferences from things not related to healthcare. I don't understand how you can have any degree of confidence that single payer versus private insurance has no effect at all based on what you're saying.

What I'm saying is not spurious speculation is the idea that the healthcare industry across the developed world has gotten more expensive because it has become less market-based and more top-down controlled. That's an extrapolation from the observed patterns across dozens upon dozens of industries.

As for the difference between the U.S. healthcare system and healthcare systems in other developed countries, if they had the same output of health care services, I would agree, but the US has far more diagnostic equipment per capita and more advanced treatments. It has the best neonatal facilities in the world. These are extremely costly and some of this expenditure doesn't actually produce that big of a difference in outcomes because it's really just dealing with end of life care, or a relatively small number of patients (e.g. premature infants). But when people are free to spend their money as they wish, this is what they prioritize. I'm also not ruling out that the U.S. healthcare system has less efficient government intervention than the healthcare systems of other developed countries. This is not mutually exclusive with the idea that, more broadly speaking, the structural change towards more government intervention has raised costs across developed world healthcare systems.

The more important question in my opinion is why health care spending across the entire developed world has skyrocketed over the last 40 years. It can be fairly inferred that the cost increase is directly related to increased administration and a lack of the kind of cost-cutting innovation seen in every industry that is substantially more market-based / consumer-driven, i.e. less top-down regimented, than healthcare.

Even cosmetic and laser eye surgery has seen costs come down over the last 40 years. That's what we should be seeing in the rest of the healthcare industry. And the reason we're not is because they operate under very different economic forces than cosmetic and laser eye surgeries, on account of government encouraging people to be covered by either public insurance or private insurance.

The problem is, quite simply, insurance.

When something is paid for from a big nebulous ball of money rather than straight out of people's pockets, the downward pressure on prices just isn't there in the same way. The conversations between practitioners and insurers are about whether something is necessary, not about whether or not the practitioner is charging too much for it.

Here in the UK we see it, too - not so much in human healthcare since we have the NHS - but very definitely in animal healthcare; vets' bills have skyrocketed over the last couple of decades, in a mutually-reinforcing feedback loop with the rise in pet health insurance.

> Here in the UK we see it, too - not so much in human healthcare since we have the NHS - but very definitely in animal healthcare; vets' bills have skyrocketed over the last couple of decades, in a mutually-reinforcing feedback loop with the rise in pet health insurance.

Kind of amazing how perfectly this illustrates that in the exact same economy, the system with single payer mostly works to keep prices sane, and the private insurance model goes off the rails

This is true in the sense that if I sell water in the desert at $100 a bottle, at 900% profit margin, doesn't mean that if the government steps in and pays half of it, that the resulting system is somehow good, just because less people are dying of thirst.

> I strongly agree that socializing the healthcare industry will not help in any way.

It would eliminate the tens of billions that are wasted on insurance company profits.

The data here would already include healthcare contributions.

Removing a useless middleman party that needs a profit margin, and removing the perverse incentives of them having to prove their value thus having inflated prices with fake discounts, and centralising all healthcare purchasing power in a single entity, is absolutely going to solve a lot of challenges US healthcare faces

Yeah, I guess the rest of the developed world doesn’t really ‘get it’ - fools!

Could America be wrong? No, no, it's the other countries!

they get subsidized by usa pharma industry. Their costs will rise if pharma prices are negotiated by govt here too.

That sounds good to me. Why should millions of Americans die every year because they can't afford their medications just so that other countries can get their meds at extremely low prices? Let's also have the US government negotiate our prices and let things even out across the board.

Is there a reference you can cite with corrected numbers? Honestly this sounds like excuse-making, especially when used as a jumping point into a decidedly partisan take (complete with scare quotes!) on the essentially unrelated subject of public health care financing.

The idea seems to have merit, but it's unconvincing to people outside your bubble and I'm dubious.

You misinterpreted by comment. It was not partisan, and was based on reality and cold economics rather than ideology. None of the major US political parties have workable reform proposals that could actually be implemented and achieve net positive results.

This is a complex topic with no tl;dr possible. If you want to be able to participate in discussions on a rational, quantitative basis then a good starting point is "The Price We Pay: What Broke American Health Care--and How to Fix It" by Marty Makary, MD. It goes into the numbers far better than I can cover in a short HN comment.

https://www.bloomsbury.com/us/price-we-pay-9781635574128/

> [my comment] was not partisan, and was based on reality and cold economics rather than ideology

That's what all partisans think. Nonetheless you put needless scare quotes around Medicare for All, dismissed it as a "total fantasy", and, I guess, helpfully suggested I read a book by (literally!) the head of the Trump administration's FDA as a reference for "What Broke American Health Care".

If that was all done in good faith, then you're in an echo chamber and need to escape.

Is there anything in that book that is factually incorrect, or are you going to stick with a lazy, low-effort dismissal? If you had actually read it you would know that it's refreshingly free of partisan ideology.

The quotes around "Medicare For All" were intended not to scare anyone but to identify a general set of policy proposals that have been floating around lately.

Again, we're not having an argument about health care, and I'm not trying to dismiss the book you cited that pertains to the argument we're not having. I'm saying that book is clearly partisan, as is your argument.

And I'm using that observation (which you keep reinforcing!) to justify my suspicion around the economic point you tried to make upthread (that, I guess, "hidden" health care "income" would increase labor's share if measured).

It's 100% clear to me that the labor/income point is spin, and to be blunt I don't believe it for an instant.

> And no, there's no simple solution to this problem. The notion that something like "Medicare for All" would solve the problem is a total fantasy, disconnected from actual US healthcare economics. Any real solution will have to work on multiple angles including preventive care, PBMs, provider wages, rationing, drug prices, fraud, malpractice insurance, interoperability technology, etc.

I have been saying this for years. I'm so tired of social media memes turning into sage wisdom for an entire generation who can barely spell healthcare, let alone have any vague understanding of it.

I'm and-then'ing, not disagreeing, but the big healthcare cost fix, IMO, still centers around education cost reform, and fixing the supply of mid-levels+ across the country.

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