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Why does it cost 1 billion dollars a mile to build a subway in San Francisco? Where are all the costs coming from? It's the same with healthcare. Nobody know

Why does it cost 1 billion dollars a mile to build a subway in San Francisco? Where are all the costs coming from? It's the same with healthcare. Nobody knows why it's so ridiculously expensive. I wish they could hire some smart forensic accountants to figure out what is behind the ridiculous cost and then actually fix the problems by replacing the guys who are price gouging or work with the government to change regulations to make it cheaper.

pcurve 9y ago
Agreed, but the article does explain why it costs absurd amount cost per mile. Unnecessary roles that don't reflect modern construction techniques, high union labor costs, regulations, and concession to people to minimize quality of life disruptions, etc. I'm all for fair wages, but $110+/hour or $225,000/year? Give me a break. You'd have lines going out to NJ if they open up the job to everyone at $85,000/year. I work in healthcare and we all know WHY it costs outrageous amount here in the states, but nobody wants to fix it because EVERYBODY has his or her finger in the pie. Yes, price gouging is a problem, but it's only side effect of a bad system. Healthcare is expensive because there are too many damn fingers in the pie, and nobody wants to pull his or hers out first. Doctors, hospitals, private insurance, drug distributors, medical device makers, lawyers, pharma, pharmacists, physical therapy center. Guess what all these entities have? IT, HR, Sales & marketing, etc.
- shard972 9y ago
  I wish people could start with that premise in healthcare, that there isn't 1-2 big things causing the US healthcare system to be so expensive. So many people seem to always have a point about "Oh if we just moved everything to medicare" or "if we just repealed obamacare" as if there is a silver bullet. The only thing i think we can know for sure about why the US healthcare system is expensive, it's because of what you said, so many special interests groups that all work within the system and gouge each other every day to keep their heads above water.
  - jessaustin 9y ago
    I almost wish we could forget for a moment that health care in USA is expensive, and pay attention instead to how quickly it is getting so much more expensive. Let's just stop the worst of the bleeding, and worry about solving all the problems later.
    - mcny 9y ago
      Well it can't happen without price transparency. Transparency is good on it's own. Why does Google not want to make all salary and compensation information public? Why do insurance companies want to keep their contracts and payouts with hospitals secret? There is zero reason for these things to be secret. These things should be required to be public. We can't fix problems if we can't see them.
shard972 9y ago
What about if it's just government waste/corruption mostly? Who is going to be able to hire someone to say that with such authority that things change? EG: We find out that 30% of road costs are being wasted by nepotism/contracts given to mates. I just can't imagine how it would work that someone could point it out and anyone would even care. If the county hired him, he wouldn't get any coverage. If the state government did, they would probably just bury it to cover their own ass. The federal government maybe, but then you have issue of jurisdiction and dealing with 50+ audits at once and trying to explain to every state voter about what is happening in their state. Only other option is independent watchdogs or companies but it still like it would be almost impossible to be even get a proper view of the real corruption from that angle as the government would never let you close enough to the deal making process. In the end, I really don't know how you can overcome the losses due to government corruption unless voters make significant changes in their behaviour. That or just wait for a whistleblower to blow the lid off it all in some spectacular way.

pcurve 9y ago

Agreed, but the article does explain why it costs absurd amount cost per mile. Unnecessary roles that don't reflect modern construction techniques, high union labor costs, regulations, and concession to people to minimize quality of life disruptions, etc. I'm all for fair wages, but $110+/hour or $225,000/year? Give me a break. You'd have lines going out to NJ if they open up the job to everyone at $85,000/year. I work in healthcare and we all know WHY it costs outrageous amount here in the states, but nobody wants to fix it because EVERYBODY has his or her finger in the pie. Yes, price gouging is a problem, but it's only side effect of a bad system. Healthcare is expensive because there are too many damn fingers in the pie, and nobody wants to pull his or hers out first. Doctors, hospitals, private insurance, drug distributors, medical device makers, lawyers, pharma, pharmacists, physical therapy center. Guess what all these entities have? IT, HR, Sales & marketing, etc.

shard972 9y ago
I wish people could start with that premise in healthcare, that there isn't 1-2 big things causing the US healthcare system to be so expensive. So many people seem to always have a point about "Oh if we just moved everything to medicare" or "if we just repealed obamacare" as if there is a silver bullet. The only thing i think we can know for sure about why the US healthcare system is expensive, it's because of what you said, so many special interests groups that all work within the system and gouge each other every day to keep their heads above water.
- jessaustin 9y ago
  I almost wish we could forget for a moment that health care in USA is expensive, and pay attention instead to how quickly it is getting so much more expensive. Let's just stop the worst of the bleeding, and worry about solving all the problems later.
  - mcny 9y ago
    Well it can't happen without price transparency. Transparency is good on it's own. Why does Google not want to make all salary and compensation information public? Why do insurance companies want to keep their contracts and payouts with hospitals secret? There is zero reason for these things to be secret. These things should be required to be public. We can't fix problems if we can't see them.

shard972 9y ago

What about if it's just government waste/corruption mostly? Who is going to be able to hire someone to say that with such authority that things change? EG: We find out that 30% of road costs are being wasted by nepotism/contracts given to mates. I just can't imagine how it would work that someone could point it out and anyone would even care. If the county hired him, he wouldn't get any coverage. If the state government did, they would probably just bury it to cover their own ass. The federal government maybe, but then you have issue of jurisdiction and dealing with 50+ audits at once and trying to explain to every state voter about what is happening in their state. Only other option is independent watchdogs or companies but it still like it would be almost impossible to be even get a proper view of the real corruption from that angle as the government would never let you close enough to the deal making process. In the end, I really don't know how you can overcome the losses due to government corruption unless voters make significant changes in their behaviour. That or just wait for a whistleblower to blow the lid off it all in some spectacular way.