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The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to

by eric_b 7y ago

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... why? - I honestly don't know. But the current political climate in the US is incapable of dealing with any kind of multifaceted problem. One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur. (I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous)

otakucode 7y ago
No reason? Hey, let's assume you're running a business. Only it's a special business. The customers really need your service. And they don't pay for your service. Someone else pays the bill for them. And they are extremely interested in acquiring the absolute top quality possible when using the service. So when you charge $50, but the guy across town charges $500, the customer will fight tooth and nail to get in and use your competitor instead. Call it 'reverse capitalism.' That's insurance-supported medical care in the US. No one wants to go to the cut-rate bargain-basement doctor. And the majority of patients aren't paying their own medical bills. The insurance company is footing that bill. So when their kid gets sick, they're price-shopping in reverse. They only want the premium level, and offering a good deal actively stops people from using the service. And that doesn't even get into the price-fixing that insurance companies engage in, entirely legally, because insurance is determined to be "not commerce" and therefore exempt from all antitrust laws. There is definitely a reason why Americas sub-standard care is so expensive - insurance.
MuffinFlavored 7y ago
> so they need to charge a lot... why? - I honestly don't know. Does anybody else know the answer to this? > Doctor's are paid too much... why? Are US doctors paid too much when compared to say... Japanese doctors? European doctors?
- eric_b 7y ago
  In many cases US doctors make 2x (or more if you're a specialist) than their European counterparts. The outcomes are not materially better in most cases. (Also, I'm just picking on one small reason for healthcare costs, the point is that is just one of many)
  - MuffinFlavored 7y ago
    > In many cases US doctors make 2x (or more if you're a specialist) than their European counterparts. That sounds outrageous but isn't the same for software engineers as well? Senior level software engineers in (not San Francisco/New York/Los Angeles) can easily make $80k - $160k.
    - zanny 7y ago
      The salaries given relate back to expenses paid. Doctors in Europe broadly don't pay anything for medical school and thus don't have a mcmansion of debt to recoup after graduating. Developers throughout Europe find their salaries regularly pegged to cost of living wherever they are. In the US salaries are distorted for 2 reasons - most major global tech companies are here and thus there is higher demand for developers here than elsewhere - and two that those tech companes congregate in the most expensive cost of living places on Earth due to NIMBYism and Americas broken city planning culture. In general almost everyone in the US is paid, comparatively, more than their European counterparts because their raw income has to afford to cover potential medical expenses that nobody else abroad has to contend with. Americans also get much reduced food, utilities, and housing benefits compared to the broader first world.
      - 7y ago
th0ma5 7y ago
I don't think negotiating power is debunked.
kaibee 7y ago
> (I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous) It is illegal for Medicare to negotiate drug prices. That needs to be fixed.
- Andrex 7y ago
  I was going to comment the same thing. Pointing to Medicare/Medicaid as examples for why drug negotiation doesn't work is an impressively incorrect line of thought.
  - maxerickson 7y ago
    Medicaid mandates drug prices at a fixed percentage of what private buyers pay.
    - jacobush 7y ago
      So just raise prices.
      - maxerickson 7y ago
        Private buyers won't just automatically pay more, so they can't "just raise prices". Of course prices will still be raised, but the point is that Medicaid drug spending is rather directly linked to negotiated prices for drugs, not just based on whatever the manufacturer asks.
- maxerickson 7y ago
  The private companies that administer much of Medicare drug coverage in fact do negotiate prices. CMS can't step into those negotiations.
- hcknwscommenter 7y ago
  And Medicare costs are lower than private healthcare. OP just seems to be arguing that it's not low enough?
JMTQp8lwXL 7y ago
Software Engineers in the US often make 2x as much as our European counterparts, yet we don't have any artificial limits on the number of people able to study Software Engineering. I'm not disagreeing with you the point on the AMA, but even if they removed their limits -- would many more people want to enter the field? It seems extremely intensive, not only during your education and residency, but on the job too. 12+ hours days, multiple days per week? No thanks.
- robbrit 7y ago
  Speaking for Canada rather than Europe but I imagine the argument is mostly the same. The supply and demand ratios are different. Canada has very few pure software firms like Google or Amazon compared to the US, so there is significantly less competition for the engineers that work there. This drives prices down - or rather, prevents prices from being driven up.
- oarabbus_ 7y ago
  >In 2011, 43,919 students applied to medical schools. However, only 20,176 of those applicants were accepted into at least one medical school. In other words, 54% of applicants got rejected to every medical school they applied to. Even if we remove the bottom 10% or even 20% of un-accepted individuals (who we might assume, unfairly or not, are not cut out to be doctors) an absolutely significant number of people would enter the field.
  - madengr 7y ago
    I wonder what’s the graduation rate for medical school? You’d think it should be difficult enough to flunk out 2/3 of the students (like engineering), but I’m guessing that is not the case.
    - realitygrill 7y ago
      It's practically 100%. Once you're in, they'll do everything in their power to graduate you (legitly). Every incentive they have points at a perfect graduation rate. EDIT: In the US, anyway. Things are different in, say, Caribbean medical schools.
geddy 7y ago
> Doctor's are paid too much... why? You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures. If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.
- baq 7y ago
  they sue and get awarded insane damages, which is probably something that could be regulated more strictly, but then what do i know.
  - notadoc 7y ago
    You think the government should cap the price of suffering? What do you think should happen with malpractice or medical errors? For example, take this recent news story and pretend this was in the USA, where a woman goes in for a routine procedure and ends up with an abortion. https://nypost.com/2019/09/24/doctor-performed-abortion-on-wrong-woman-because-of-hospital-mixup/ https://nypost.com/2019/09/24/doctor-performed-abortion-on-w... How would you like to strictly regulate damages for that? What do you think is reasonable for that situation? How about if someone is rendered disabled or impaired? Marred? Dead?
    - hcknwscommenter 7y ago
      People like to point to malpractice and lawyers and blame it all on that. Every actual study I've read totals the cost of tort liability (insurance, law suits, damages, etc.) at about 5% of total health care spending. Significant to be sure, but not the bogey man people like to make it out to be.
      - notadoc 7y ago
        It sounds like an industry argument that would be introduced by insurers to benefit insurers, since it would obviously benefit them. I see no benefit to the patient to limiting medical error liability, but I'd be interested to hear the arguments in favor.
ergothus 7y ago
> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or more (though I'm sure if the median price differences are less dramatic than the extreme examples, the results I vaguely recall said there was still a noteworthy difference) How does this not indicate some fundamental difference between the US and other "developed" nations outside of the factors you list above? (Honest question)
- eric_b 7y ago
  I think we agree. I'm just saying it's not a single fundamental difference between the US system and other systems, it's myriad differences that combine to make things way more expensive in the US.
  - ergothus 7y ago
    But you eliminate negotiation as one of those factors using other countries as a reasoning. I've never heard that this is debunked (though I don't expect that it is the sole factor). Do you have sources? Or did I misunderstand and you are just saying that negotiation (or lack thereof) alone isn't responsible for all the cost headaches?
- bluecalm 7y ago
  MRI is like 5x cheaper here (I paid less than 300$ for both knees) without any insurance just doing it privately. The reason I think is that it's easier to open a medical business here, people can't sue for damages (or they can but will never be awarded anything substantial), there is less regulation you need to comply with and the doctors and technicians make less money. All this makes it possible to provide medical services at reasonable price. We have public single payer healthcare. The quality is low and lines are long (it's several months at least if you would like to get free MRI using that option and then like a year or more to get actual arthroscopy). Still I think shitty but somehow working public option keeps private providers in check because they can't charge arbitrary amount as there is always shitty option to fall back on. To give you an idea about prices here if you go private: typical doctor visit: 40$, dentist (one tooth filling): 60$, arthroscopy: 1000$, full blood panel with about everything under the sun included (hormones, vitamins, minerals, insulin response etc.): 200$. The quality of service is low but higher than in major metro areas in US (according to my sister who lives in NYC). This is Poland so low wages are surely one component that makes cheap services possible but I think not the only nor the most important one.
nemothekid 7y ago
>- Doctor's are paid too much... why? Haven't doctor's historically had high salaries? Becoming a doctor requires years of training which leads to a low supply of doctors for a field that has always had high demand. Likewise, Doctors seem to be overworked so I'm not sure I can say they are being overpaid. I don't think all the money that is being spent on healthcare is actually being funneled into doctors pockets. You did say there are a top 15 reasons, but I think doctor salaries are a bad example.
- kelnos 7y ago
  No, the low supply of doctors is caused by the AMA, which keeps the number of accredited medical schools low. In the 90s, they were instrumental in getting Congress to pass laws that cap the number of residencies permitted per year. Medicare pays much of residents' salaries, and the law stipulates a maximum number it will pay for, a number that was fixed in 1997, and only changed once, in 1999 (and then only for teaching hospitals in rural areas). The US population has grown by around 25% since then, but we're still getting the same number of new practicing doctors per year that we got over 20 years ago. Doctors are overworked because we have a shortage, not for any reason inherent to their profession.
ambernightcruse 7y ago
Part of the problem is that Medicare/Medicaid pays market prices. Its a pricetaker not a pricesetter, because of poor regulation, in spite of its larger position. If you pay market prices, expect inflation every year on top.
- maxerickson 7y ago
  No they do not.
evantahler 7y ago
This episode of planet money talks about this https://www.npr.org/2019/09/04/757645741/what-medicare-for-all-might-mean-for-jobs https://www.npr.org/2019/09/04/757645741/what-medicare-for-a... Because of redundancies in the US system, there are like 5:1 administrators for each doctor. That’s a huge source of the costs. Medicare for all will likely cut a lot of those jobs to gain the savings. This show talks about if that’s good or bad for society.
- eric_b 7y ago
  It amuses me when people think that letting the government run something will make it more efficient. I do not disagree there is tremendous waste in the current system. I strongly believe that expanding the government's role will only make it worse.
  - romwell 7y ago
    If only we had examples where the government running something like healthcare resulted in a better outcome for citizens. Perhaps a country in Europe, as developed as the US is. I mean, a country that we literally border with would be too much to ask for. Perhaps some of us would be less amused by the concept of government-run healthcare. Too bad we don't have the example of literally all of Europe, Australia, and Canada to kill that amusement vibe.
    - ch4s3 7y ago
      To play devil’s advocate, those nations are also good at providing other services that the US provides poorly.
    - ytNumbers 7y ago
      In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer. By that yardstick, countries like Canada and England stack up quite poorly when compared to the USA. Canadians don't come to the US to save money on health care. They come to the US because they have an expensive potentially fatal medical condition, and they might not survive a six month waiting period for treatment.
belltaco 7y ago
>One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur. Isn't the NHS or Canada's system better? How are they different from 'Medicare for all' ?
- GreenJelloShot 7y ago
  Define "better".
  - ceejayoz 7y ago
    Substantially cheaper, with similar patient outcomes.
mullen 7y ago
> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur. Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Don't want to pay what the government says it is going to pay? Good luck finding customers then, because the government is bargaining on behalf of all of the customers in the US. People who say this stuff are the same people who proclaim there is no solution to a problem that the only occurs in the US. Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.
- simonsarris 7y ago
  > Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Why do you think this would be true? Why do you think the bargaining power would work the way you think it would? If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case? What about other goods? Laptops? Cruise missiles? etc. Actually is it true for any good which the US Gov is the sole buyer? Can you think of even a single good where your supposition is true?
  - romwell 7y ago
    Perhaps this is a good reason: >Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.
    - deleted 7y ago
      [deleted]
    - GreenJelloShot 7y ago
      Really? So there are zero people from other industrial nations that come into the US for health care?
notadoc 7y ago
> Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... That sounds like a strange conspiracy, do you have evidence to support that? Keep in mind 20+ years ago that insurance was much cheaper, deductibles were almost nonexistent, and care networks were giant. Talk to your US parents or grandparents about their costs of health care, you'll still be stunned at how much cheaper it was. Medical schools and the AMA still existed then too BTW.
- evancich 7y ago
  Look up what "match day" and the NRMP is.
- oarabbus_ 7y ago
  The AMA quite literally fits the definition of a cartel. It's quite absurd to use the term "conspiracy". Academic papers going back to (at least) 1977 have suggested this: https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_contents https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_con... Here are some other reading links. http://www.jparksmd.com/blog/a-massively-overpaid-cartel http://www.jparksmd.com/blog/a-massively-overpaid-cartel (this doctor attempts to refute that the AMA isn't a cartel by making the point that doctors are "overpaid" in the US as compared to Europe by the same factor as for many other professions. He however intentionally avoids the point of the restricted supply, which is the root cause of the issue, the artificially high salaries are simply a symptom of the disease) https://wallstreetpit.com/5769-medical-cartel-md-salaries-high/ https://wallstreetpit.com/5769-medical-cartel-md-salaries-hi... https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a... https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/ https://fee.org/articles/the-medical-cartel-is-keeping-healt...
aaomidi 7y ago
You're forgetting that medicare for all also comes with a lot of promises about free education. The artificial barriers for education will be slowly removed and the supply will quickly match up the demand. The solution isn't going to fix everything immediately, but it IS required for a full solution.
- zanny 7y ago
  Nothing about removing tuition costs to universities changes the AMA artificially restricting the number of medical doctorates issued every year.
  - aaomidi 7y ago
    Except now starting a training program does guarantee you'll have students that don't need a ton of money to pay off their loans. It becomes less risky.
throwaway5752 7y ago
"Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot." That is the peril of this type of analysis. Clinician cost is only 20% of total healthcare spend. Your premise is flawed so your conclusion is invalid.
- oarabbus_ 7y ago
  His premise is not flawed; yours is. Looking only at clinican costs is akin to saying that a sandwich should only cost $1.50 because that's the cost of the ingredients. Doctor wages tie into personal health insurance, medical malpractice insurance costs, hospital system insurance costs, and more. Even if you were correct on the cost bit (you aren't), you're completely ignoring that artificially constraining the SUPPLY of doctors causes massive cumulative ripple effects adding up to significant costs across the system. The AMA is absolutely a cartel restricting supply and artificially keeping wages high. Have you taken a look at any other health care system in the world?
  - throwaway5752 7y ago
    You just proved my point, you know that right? It's the healthcare delivery and the markups along the way. If you paid doctors $0 tomorrow, healthcare costs would go down by 20%, at best, and probably less. Your analogy is perfect, actually. The problem in sandwich cost is rent, utilities, administrative expenses, marketing, an acceptable return on investment to the owners, etc, etc. The actual good being sold, a sandwich, probably costs 10% of what you pay retail. Your repeated use of the phrase "cartel" is not impressive or convincing to me. In every other field: civil engineers, lawyers, real estate agents, accountants, teachers, police, and countless others have licensure, education, and training requirements. And thanks for you concern, but I am familiar with many other global heath systems. I notice you ignore LNPs and PAs in your analysis.
    - oarabbus_ 7y ago
      On the contrary, you proved mine. I worked in medical devices and hospitals for a significant portion of my career, and I really don't care that you aren't impressed by the term "cartel", that's your prerogative to turn a blind eye to the facts. It's a combination of inflated salaries plus numerical shortage of doctors (the two are related) causing the root issues here. You claim to be familiar with other health systems; care to explain why in every other developed nation where doctors are not so overpaid, health care costs are reasonable? NPs and PAs are not allowed to perform a significant number of medical procedures; I see you ignore that, conveniently, and bringing it up isn't much other than a red herring. The "cartel" term has been used both colloquially and in academic literature for quite some time: https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_contents https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_con... Here are some other reading links. http://www.jparksmd.com/blog/a-massively-overpaid-cartel http://www.jparksmd.com/blog/a-massively-overpaid-cartel https://wallstreetpit.com/5769-medical-cartel-md-salaries-high/ https://wallstreetpit.com/5769-medical-cartel-md-salaries-hi... https://www.forbes.com/sites/timworstall/2017/06/04/milton-friedman-told-us-the-answer-decades-ago-now-itll-probably-be-ibms-watson/#363863b61bce https://www.forbes.com/sites/timworstall/2017/06/04/milton-f... https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/ https://fee.org/articles/the-medical-cartel-is-keeping-healt...
glitcher 7y ago
> But the current political climate in the US is incapable of dealing with any kind of multifaceted problem. I fear this may be true of all political issues now. Sound bites and catch phrases that way oversimplify complex issues to the point of absurdity seem to sway a lot of voters.
oarabbus_ 7y ago
The AMA is a cartel, and we (in the US) are all suffering for it.
jorblumesea 7y ago
> I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries That's... not true at all. In European countries, single payer covers almost everyone, and the government has negotiating power to drive down prices. This is proven workable and effective in many places, including Canada. Literally every other industrialized nation has solved this problem. If you don't agree with universal healthcare, fine, whatever, but don't go throwing around clearly obvious falsehoods. This is like one of those "we can't solve it" arguments like gun violence where literally every developed country except for the US has solved it.
cma 7y ago
> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous This is not a fair comparison. Medicare/Medicaid predominantly covers the elderly. You can't compare their price spend to a mix including many more healthy people covered in single payer systems in other countries.
philjohn 7y ago
And what's more - look at the UK where we spend half as much per capita on healthcare and achieve broadly similar results. Yes, if you get a sporting injury you're going to be waiting 6-8 weeks for physio, but if you have a heart attack, cancer, are in a serious accident there is no wait.
- pasquinelli 7y ago
  Oh the thought of going to the doctor without that time of uncertainty about the bill that'll be coming. $200? $500? No, no bill is coming.
- makomk 7y ago
  The official NHS target for cancer treatment is that patients should get it within a month of the decision that it's necessary. The NHS has been missing that deadline quite a lot: https://www.theguardian.com/society/2019/jan/10/nhs-england-misses-multiple-targets-for-cancer-treatment https://www.theguardian.com/society/2019/jan/10/nhs-england-...
hristov 7y ago
If you do not want to hear one thing about negotiating power then you are missing the main reason why medical costs are skyrocketing. Medicare/medicaid does not negotiate drug costs down because it is prohibited by law from doing so. This is because of a law signed by the Bush administration (https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_...).
- comnetxr 7y ago
  In a sense, wasn't the choice to not negotiate drug costs itself the result of a negotiation? I believe the way it works is that health insurers and providers threaten to fund fear-mongering attack ads against politicians who support laws that don't like. The politicians cave and carve out rules for the industry. So it's not that the Medicare drug care costs aren't negotiated, its that the chance for lower costs was traded away by Congresspeople of the past (many of whom aren't in office anymore) in exchange for campaign funds. Not literally a campaign fund check, of course, but countering an attack ad costs campaign money that they could be spending otherwise.
adamredwoods 7y ago
There is a WHY (or at least a general why): Obfuscation. - lack of clarity on competitive pricing - obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital) - obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare) - lack of clarity when being billed (getting several bills from several different departments) There's also the problem of insurance companies being a for-profit enterprise that answers more to stockholders than to patients. This is the result of "free market" idealists at work. Health is something that everyone needs, so businesses want a piece of the big pie by trying to wedge themselves somewhere in there. Only massive government overhaul can fix this.
- d1zzy 7y ago
  The typical insurance company returns are pretty small (~5%) so that alone doesn't seem to explain why prices are so high.
  - hcknwscommenter 7y ago
    But that's the return (net margin, not gross cost that the insurance company is adding to the whole system). You have to look at gross, which is way higher (~5x).
- pravda 7y ago
  >This is the result of "free market" idealists at work. Huh? I can't think of anything less free market then the American medical system! Ok, maybe defense contracting is less free market. But at least that is paid for out of federal tax money.
pravda 7y ago
> Well they need to be paid a lot because medical school debt is 250k or more... why? You are doing something called confusing cause and effect. Medical school costs a lot because doctors earn a lot of money.
anarchodev 7y ago
> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. One of the myriad reasons healthcare in the US expensive is the middlemen who stand to profit from taking as big a cut of your premiums as possible, while paying for as little care as possible. Without this fundamental force driving healthcare prices it doesn't seem clear to me at all that prices would stay the same. Your dismissal of single-payer plans like M4A glosses over the largest proposed change to the structure of medical billing.
zanny 7y ago
> One thing that will not make healthcare less expensive is "Medicare For All". A large part of what makes American per-capita healthcare costs so outrageous is how much is treatment rather than prevention. Because going to a doctor is so expensive people just don't go, and then mundane problems that could have been fixed with at worst a routine surgery end up in an emergency room on life support expending a hundred thousand dollars of resources a day to correct. Thats in addition to substantive productivity losses incurred by people being sick all the time without the financial resources to actually fix their ailments. Even when you have health insurance the absurd deductibles mean you can't see a doctor anyway without being out the equivalent of half the months food or your entire utility bill. It is absolutely imperative that any nations people have affordable access to medical professionals before they are suffering ill from all the things they noticed were off but didn't want to become indebted over.
fuzz4lyfe 7y ago
>Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... why? - I honestly don't know. The AARP advocates for social security... why? - I honestly don't know. Imagine if you put the teamsters in charge of infrastructure spending, every road in the country would be under construction perpetually. It would be illegal to shovel your own driveway without paying someone in the union to sit in front of your house and supervise.
tamaharbor 7y ago
Have you ever been on Medicare? It is not that good.
flukus 7y ago
> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. This is what happens with corporate healthcare plans already, those costs get past onto the consumer (middle to upper middle class) and they pay a hidden healthcare tax on every purchase.
- pravda 7y ago
  Heathcare costs are part of employee compensation. The tax is on employees.
  - flukus 7y ago
    Any evidence of this? Some quick googling and I couldn't find anything about about employees with healthcare plans being paid less than employees without them. If I understand the history of it properly, healthcare was always meant to be an extra incentive from a period where they weren't allowed to pay more. It's never been a tax on employees.
    - pravda 7y ago
      Ask yourself this question: why does anyone get paid more then minimum wage?
jachee 7y ago
> The problem is that there is not a single reason that healthcare is so expensive. I'm recently fond of saying that the ultimate root cause of all suffering is greed. If you follow the money, I'm sure that is exactly what you'll find.
analog31 7y ago
What I've noticed is that everybody in the system cries poor and believes that someone else is gouging us. But the system is so labyrinthine that nobody can figure out where the money is actually going. And every group (e.g., doctors) has an investment stake in the other groups (e.g., medical and malpractice insurance companies), or is a partner in an LLC that makes money by buying a machine and billing for its use. Etc. The likely answer is: They are all gouging us. One potential benefit of a single payer system is simply being able to untangle that mess and put every player on a reasonable footing. For instance, make medical school free, but then doctors get to work for the government for a decent professional salary. It might even change the mix of people who are willing to become doctors -- more middle class. The primary expenditures of the medical system should be materials (capital and consumable like drugs) and salaries.
- Ididntdothis 7y ago
  ”The likely answer is: They are all gouging us.” Exactly. It’s pointless to spend time on trying to find a single culprit. Corruption is spread throughout the whole system.
gbacon 7y ago
When you don’t pay for a service, you are not the customer but the vector to get to the real customer. Think: Television, radio, Google, Facebook, healthcare. There are gigantic pools of funds out there in quasi-private insurance, Medicare, and Medicaid. Costs explode. Similarly, gigantic pools of funds are available thanks to subsidized student loans that cannot be bankrupted. College costs explode. Being uninsured is terrifying because the individual healthcare buyer is competing with deep-pocketed insurers and government programs who are much less price-sensitive. Healthcare is expensive because the patient is not the customer. Insurance is going crazy because insurance is legally compelled to pay for oil changes and basic maintenance, so insurers must accept more exposure.

by eric_b 7y ago

otakucode 7y ago

No reason? Hey, let's assume you're running a business. Only it's a special business. The customers really need your service. And they don't pay for your service. Someone else pays the bill for them. And they are extremely interested in acquiring the absolute top quality possible when using the service. So when you charge $50, but the guy across town charges $500, the customer will fight tooth and nail to get in and use your competitor instead. Call it 'reverse capitalism.' That's insurance-supported medical care in the US. No one wants to go to the cut-rate bargain-basement doctor. And the majority of patients aren't paying their own medical bills. The insurance company is footing that bill. So when their kid gets sick, they're price-shopping in reverse. They only want the premium level, and offering a good deal actively stops people from using the service. And that doesn't even get into the price-fixing that insurance companies engage in, entirely legally, because insurance is determined to be "not commerce" and therefore exempt from all antitrust laws. There is definitely a reason why Americas sub-standard care is so expensive - insurance.

MuffinFlavored 7y ago

> so they need to charge a lot... why? - I honestly don't know. Does anybody else know the answer to this? > Doctor's are paid too much... why? Are US doctors paid too much when compared to say... Japanese doctors? European doctors?

eric_b 7y ago
In many cases US doctors make 2x (or more if you're a specialist) than their European counterparts. The outcomes are not materially better in most cases. (Also, I'm just picking on one small reason for healthcare costs, the point is that is just one of many)
- MuffinFlavored 7y ago
  > In many cases US doctors make 2x (or more if you're a specialist) than their European counterparts. That sounds outrageous but isn't the same for software engineers as well? Senior level software engineers in (not San Francisco/New York/Los Angeles) can easily make $80k - $160k.
  - zanny 7y ago
    The salaries given relate back to expenses paid. Doctors in Europe broadly don't pay anything for medical school and thus don't have a mcmansion of debt to recoup after graduating. Developers throughout Europe find their salaries regularly pegged to cost of living wherever they are. In the US salaries are distorted for 2 reasons - most major global tech companies are here and thus there is higher demand for developers here than elsewhere - and two that those tech companes congregate in the most expensive cost of living places on Earth due to NIMBYism and Americas broken city planning culture. In general almost everyone in the US is paid, comparatively, more than their European counterparts because their raw income has to afford to cover potential medical expenses that nobody else abroad has to contend with. Americans also get much reduced food, utilities, and housing benefits compared to the broader first world.
    - 7y ago

th0ma5 7y ago

I don't think negotiating power is debunked.

kaibee 7y ago

> (I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous) It is illegal for Medicare to negotiate drug prices. That needs to be fixed.

Andrex 7y ago
I was going to comment the same thing. Pointing to Medicare/Medicaid as examples for why drug negotiation doesn't work is an impressively incorrect line of thought.
- maxerickson 7y ago
  Medicaid mandates drug prices at a fixed percentage of what private buyers pay.
  - jacobush 7y ago
    So just raise prices.
    - maxerickson 7y ago
      Private buyers won't just automatically pay more, so they can't "just raise prices". Of course prices will still be raised, but the point is that Medicaid drug spending is rather directly linked to negotiated prices for drugs, not just based on whatever the manufacturer asks.
maxerickson 7y ago
The private companies that administer much of Medicare drug coverage in fact do negotiate prices. CMS can't step into those negotiations.
hcknwscommenter 7y ago
And Medicare costs are lower than private healthcare. OP just seems to be arguing that it's not low enough?

JMTQp8lwXL 7y ago

Software Engineers in the US often make 2x as much as our European counterparts, yet we don't have any artificial limits on the number of people able to study Software Engineering. I'm not disagreeing with you the point on the AMA, but even if they removed their limits -- would many more people want to enter the field? It seems extremely intensive, not only during your education and residency, but on the job too. 12+ hours days, multiple days per week? No thanks.

robbrit 7y ago
Speaking for Canada rather than Europe but I imagine the argument is mostly the same. The supply and demand ratios are different. Canada has very few pure software firms like Google or Amazon compared to the US, so there is significantly less competition for the engineers that work there. This drives prices down - or rather, prevents prices from being driven up.
oarabbus_ 7y ago
>In 2011, 43,919 students applied to medical schools. However, only 20,176 of those applicants were accepted into at least one medical school. In other words, 54% of applicants got rejected to every medical school they applied to. Even if we remove the bottom 10% or even 20% of un-accepted individuals (who we might assume, unfairly or not, are not cut out to be doctors) an absolutely significant number of people would enter the field.
- madengr 7y ago
  I wonder what’s the graduation rate for medical school? You’d think it should be difficult enough to flunk out 2/3 of the students (like engineering), but I’m guessing that is not the case.
  - realitygrill 7y ago
    It's practically 100%. Once you're in, they'll do everything in their power to graduate you (legitly). Every incentive they have points at a perfect graduation rate. EDIT: In the US, anyway. Things are different in, say, Caribbean medical schools.

geddy 7y ago

> Doctor's are paid too much... why? You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures. If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.

baq 7y ago
they sue and get awarded insane damages, which is probably something that could be regulated more strictly, but then what do i know.
- notadoc 7y ago
  You think the government should cap the price of suffering? What do you think should happen with malpractice or medical errors? For example, take this recent news story and pretend this was in the USA, where a woman goes in for a routine procedure and ends up with an abortion. https://nypost.com/2019/09/24/doctor-performed-abortion-on-wrong-woman-because-of-hospital-mixup/ https://nypost.com/2019/09/24/doctor-performed-abortion-on-w... How would you like to strictly regulate damages for that? What do you think is reasonable for that situation? How about if someone is rendered disabled or impaired? Marred? Dead?
  - hcknwscommenter 7y ago
    People like to point to malpractice and lawyers and blame it all on that. Every actual study I've read totals the cost of tort liability (insurance, law suits, damages, etc.) at about 5% of total health care spending. Significant to be sure, but not the bogey man people like to make it out to be.
    - notadoc 7y ago
      It sounds like an industry argument that would be introduced by insurers to benefit insurers, since it would obviously benefit them. I see no benefit to the patient to limiting medical error liability, but I'd be interested to hear the arguments in favor.

ergothus 7y ago

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or more (though I'm sure if the median price differences are less dramatic than the extreme examples, the results I vaguely recall said there was still a noteworthy difference) How does this not indicate some fundamental difference between the US and other "developed" nations outside of the factors you list above? (Honest question)

eric_b 7y ago
I think we agree. I'm just saying it's not a single fundamental difference between the US system and other systems, it's myriad differences that combine to make things way more expensive in the US.
- ergothus 7y ago
  But you eliminate negotiation as one of those factors using other countries as a reasoning. I've never heard that this is debunked (though I don't expect that it is the sole factor). Do you have sources? Or did I misunderstand and you are just saying that negotiation (or lack thereof) alone isn't responsible for all the cost headaches?
bluecalm 7y ago
MRI is like 5x cheaper here (I paid less than 300$ for both knees) without any insurance just doing it privately. The reason I think is that it's easier to open a medical business here, people can't sue for damages (or they can but will never be awarded anything substantial), there is less regulation you need to comply with and the doctors and technicians make less money. All this makes it possible to provide medical services at reasonable price. We have public single payer healthcare. The quality is low and lines are long (it's several months at least if you would like to get free MRI using that option and then like a year or more to get actual arthroscopy). Still I think shitty but somehow working public option keeps private providers in check because they can't charge arbitrary amount as there is always shitty option to fall back on. To give you an idea about prices here if you go private: typical doctor visit: 40$, dentist (one tooth filling): 60$, arthroscopy: 1000$, full blood panel with about everything under the sun included (hormones, vitamins, minerals, insulin response etc.): 200$. The quality of service is low but higher than in major metro areas in US (according to my sister who lives in NYC). This is Poland so low wages are surely one component that makes cheap services possible but I think not the only nor the most important one.

nemothekid 7y ago

>- Doctor's are paid too much... why? Haven't doctor's historically had high salaries? Becoming a doctor requires years of training which leads to a low supply of doctors for a field that has always had high demand. Likewise, Doctors seem to be overworked so I'm not sure I can say they are being overpaid. I don't think all the money that is being spent on healthcare is actually being funneled into doctors pockets. You did say there are a top 15 reasons, but I think doctor salaries are a bad example.

kelnos 7y ago
No, the low supply of doctors is caused by the AMA, which keeps the number of accredited medical schools low. In the 90s, they were instrumental in getting Congress to pass laws that cap the number of residencies permitted per year. Medicare pays much of residents' salaries, and the law stipulates a maximum number it will pay for, a number that was fixed in 1997, and only changed once, in 1999 (and then only for teaching hospitals in rural areas). The US population has grown by around 25% since then, but we're still getting the same number of new practicing doctors per year that we got over 20 years ago. Doctors are overworked because we have a shortage, not for any reason inherent to their profession.

ambernightcruse 7y ago

Part of the problem is that Medicare/Medicaid pays market prices. Its a pricetaker not a pricesetter, because of poor regulation, in spite of its larger position. If you pay market prices, expect inflation every year on top.

maxerickson 7y ago
No they do not.

evantahler 7y ago

This episode of planet money talks about this https://www.npr.org/2019/09/04/757645741/what-medicare-for-all-might-mean-for-jobs https://www.npr.org/2019/09/04/757645741/what-medicare-for-a... Because of redundancies in the US system, there are like 5:1 administrators for each doctor. That’s a huge source of the costs. Medicare for all will likely cut a lot of those jobs to gain the savings. This show talks about if that’s good or bad for society.

eric_b 7y ago
It amuses me when people think that letting the government run something will make it more efficient. I do not disagree there is tremendous waste in the current system. I strongly believe that expanding the government's role will only make it worse.
- romwell 7y ago
  If only we had examples where the government running something like healthcare resulted in a better outcome for citizens. Perhaps a country in Europe, as developed as the US is. I mean, a country that we literally border with would be too much to ask for. Perhaps some of us would be less amused by the concept of government-run healthcare. Too bad we don't have the example of literally all of Europe, Australia, and Canada to kill that amusement vibe.
  - ch4s3 7y ago
    To play devil’s advocate, those nations are also good at providing other services that the US provides poorly.
  - ytNumbers 7y ago
    In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer. By that yardstick, countries like Canada and England stack up quite poorly when compared to the USA. Canadians don't come to the US to save money on health care. They come to the US because they have an expensive potentially fatal medical condition, and they might not survive a six month waiting period for treatment.

belltaco 7y ago

GreenJelloShot 7y ago
Define "better".
- ceejayoz 7y ago
  Substantially cheaper, with similar patient outcomes.

mullen 7y ago

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur. Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Don't want to pay what the government says it is going to pay? Good luck finding customers then, because the government is bargaining on behalf of all of the customers in the US. People who say this stuff are the same people who proclaim there is no solution to a problem that the only occurs in the US. Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.

simonsarris 7y ago
> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Why do you think this would be true? Why do you think the bargaining power would work the way you think it would? If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case? What about other goods? Laptops? Cruise missiles? etc. Actually is it true for any good which the US Gov is the sole buyer? Can you think of even a single good where your supposition is true?
- romwell 7y ago
  Perhaps this is a good reason: >Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.
  - deleted 7y ago
    [deleted]
  - GreenJelloShot 7y ago
    Really? So there are zero people from other industrial nations that come into the US for health care?

notadoc 7y ago

> Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... That sounds like a strange conspiracy, do you have evidence to support that? Keep in mind 20+ years ago that insurance was much cheaper, deductibles were almost nonexistent, and care networks were giant. Talk to your US parents or grandparents about their costs of health care, you'll still be stunned at how much cheaper it was. Medical schools and the AMA still existed then too BTW.

evancich 7y ago
Look up what "match day" and the NRMP is.
oarabbus_ 7y ago
The AMA quite literally fits the definition of a cartel. It's quite absurd to use the term "conspiracy". Academic papers going back to (at least) 1977 have suggested this: https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_contents https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_con... Here are some other reading links. http://www.jparksmd.com/blog/a-massively-overpaid-cartel http://www.jparksmd.com/blog/a-massively-overpaid-cartel (this doctor attempts to refute that the AMA isn't a cartel by making the point that doctors are "overpaid" in the US as compared to Europe by the same factor as for many other professions. He however intentionally avoids the point of the restricted supply, which is the root cause of the issue, the artificially high salaries are simply a symptom of the disease) https://wallstreetpit.com/5769-medical-cartel-md-salaries-high/ https://wallstreetpit.com/5769-medical-cartel-md-salaries-hi... https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a... https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/ https://fee.org/articles/the-medical-cartel-is-keeping-healt...

aaomidi 7y ago

You're forgetting that medicare for all also comes with a lot of promises about free education. The artificial barriers for education will be slowly removed and the supply will quickly match up the demand. The solution isn't going to fix everything immediately, but it IS required for a full solution.

zanny 7y ago
Nothing about removing tuition costs to universities changes the AMA artificially restricting the number of medical doctorates issued every year.
- aaomidi 7y ago
  Except now starting a training program does guarantee you'll have students that don't need a ton of money to pay off their loans. It becomes less risky.

throwaway5752 7y ago

"Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot." That is the peril of this type of analysis. Clinician cost is only 20% of total healthcare spend. Your premise is flawed so your conclusion is invalid.

oarabbus_ 7y ago
His premise is not flawed; yours is. Looking only at clinican costs is akin to saying that a sandwich should only cost $1.50 because that's the cost of the ingredients. Doctor wages tie into personal health insurance, medical malpractice insurance costs, hospital system insurance costs, and more. Even if you were correct on the cost bit (you aren't), you're completely ignoring that artificially constraining the SUPPLY of doctors causes massive cumulative ripple effects adding up to significant costs across the system. The AMA is absolutely a cartel restricting supply and artificially keeping wages high. Have you taken a look at any other health care system in the world?
- throwaway5752 7y ago
  You just proved my point, you know that right? It's the healthcare delivery and the markups along the way. If you paid doctors $0 tomorrow, healthcare costs would go down by 20%, at best, and probably less. Your analogy is perfect, actually. The problem in sandwich cost is rent, utilities, administrative expenses, marketing, an acceptable return on investment to the owners, etc, etc. The actual good being sold, a sandwich, probably costs 10% of what you pay retail. Your repeated use of the phrase "cartel" is not impressive or convincing to me. In every other field: civil engineers, lawyers, real estate agents, accountants, teachers, police, and countless others have licensure, education, and training requirements. And thanks for you concern, but I am familiar with many other global heath systems. I notice you ignore LNPs and PAs in your analysis.
  - oarabbus_ 7y ago
    On the contrary, you proved mine. I worked in medical devices and hospitals for a significant portion of my career, and I really don't care that you aren't impressed by the term "cartel", that's your prerogative to turn a blind eye to the facts. It's a combination of inflated salaries plus numerical shortage of doctors (the two are related) causing the root issues here. You claim to be familiar with other health systems; care to explain why in every other developed nation where doctors are not so overpaid, health care costs are reasonable? NPs and PAs are not allowed to perform a significant number of medical procedures; I see you ignore that, conveniently, and bringing it up isn't much other than a red herring. The "cartel" term has been used both colloquially and in academic literature for quite some time: https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_contents https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_con... Here are some other reading links. http://www.jparksmd.com/blog/a-massively-overpaid-cartel http://www.jparksmd.com/blog/a-massively-overpaid-cartel https://wallstreetpit.com/5769-medical-cartel-md-salaries-high/ https://wallstreetpit.com/5769-medical-cartel-md-salaries-hi... https://www.forbes.com/sites/timworstall/2017/06/04/milton-friedman-told-us-the-answer-decades-ago-now-itll-probably-be-ibms-watson/#363863b61bce https://www.forbes.com/sites/timworstall/2017/06/04/milton-f... https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/ https://fee.org/articles/the-medical-cartel-is-keeping-healt...

glitcher 7y ago

> But the current political climate in the US is incapable of dealing with any kind of multifaceted problem. I fear this may be true of all political issues now. Sound bites and catch phrases that way oversimplify complex issues to the point of absurdity seem to sway a lot of voters.

oarabbus_ 7y ago

The AMA is a cartel, and we (in the US) are all suffering for it.

jorblumesea 7y ago

> I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries That's... not true at all. In European countries, single payer covers almost everyone, and the government has negotiating power to drive down prices. This is proven workable and effective in many places, including Canada. Literally every other industrialized nation has solved this problem. If you don't agree with universal healthcare, fine, whatever, but don't go throwing around clearly obvious falsehoods. This is like one of those "we can't solve it" arguments like gun violence where literally every developed country except for the US has solved it.

cma 7y ago

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous This is not a fair comparison. Medicare/Medicaid predominantly covers the elderly. You can't compare their price spend to a mix including many more healthy people covered in single payer systems in other countries.

philjohn 7y ago

And what's more - look at the UK where we spend half as much per capita on healthcare and achieve broadly similar results. Yes, if you get a sporting injury you're going to be waiting 6-8 weeks for physio, but if you have a heart attack, cancer, are in a serious accident there is no wait.

pasquinelli 7y ago
Oh the thought of going to the doctor without that time of uncertainty about the bill that'll be coming. $200? $500? No, no bill is coming.
makomk 7y ago
The official NHS target for cancer treatment is that patients should get it within a month of the decision that it's necessary. The NHS has been missing that deadline quite a lot: https://www.theguardian.com/society/2019/jan/10/nhs-england-misses-multiple-targets-for-cancer-treatment https://www.theguardian.com/society/2019/jan/10/nhs-england-...

hristov 7y ago

If you do not want to hear one thing about negotiating power then you are missing the main reason why medical costs are skyrocketing. Medicare/medicaid does not negotiate drug costs down because it is prohibited by law from doing so. This is because of a law signed by the Bush administration (https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_...).

comnetxr 7y ago
In a sense, wasn't the choice to not negotiate drug costs itself the result of a negotiation? I believe the way it works is that health insurers and providers threaten to fund fear-mongering attack ads against politicians who support laws that don't like. The politicians cave and carve out rules for the industry. So it's not that the Medicare drug care costs aren't negotiated, its that the chance for lower costs was traded away by Congresspeople of the past (many of whom aren't in office anymore) in exchange for campaign funds. Not literally a campaign fund check, of course, but countering an attack ad costs campaign money that they could be spending otherwise.

adamredwoods 7y ago

There is a WHY (or at least a general why): Obfuscation. - lack of clarity on competitive pricing - obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital) - obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare) - lack of clarity when being billed (getting several bills from several different departments) There's also the problem of insurance companies being a for-profit enterprise that answers more to stockholders than to patients. This is the result of "free market" idealists at work. Health is something that everyone needs, so businesses want a piece of the big pie by trying to wedge themselves somewhere in there. Only massive government overhaul can fix this.

d1zzy 7y ago
The typical insurance company returns are pretty small (~5%) so that alone doesn't seem to explain why prices are so high.
- hcknwscommenter 7y ago
  But that's the return (net margin, not gross cost that the insurance company is adding to the whole system). You have to look at gross, which is way higher (~5x).
pravda 7y ago
>This is the result of "free market" idealists at work. Huh? I can't think of anything less free market then the American medical system! Ok, maybe defense contracting is less free market. But at least that is paid for out of federal tax money.

pravda 7y ago

> Well they need to be paid a lot because medical school debt is 250k or more... why? You are doing something called confusing cause and effect. Medical school costs a lot because doctors earn a lot of money.

anarchodev 7y ago

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. One of the myriad reasons healthcare in the US expensive is the middlemen who stand to profit from taking as big a cut of your premiums as possible, while paying for as little care as possible. Without this fundamental force driving healthcare prices it doesn't seem clear to me at all that prices would stay the same. Your dismissal of single-payer plans like M4A glosses over the largest proposed change to the structure of medical billing.

zanny 7y ago

> One thing that will not make healthcare less expensive is "Medicare For All". A large part of what makes American per-capita healthcare costs so outrageous is how much is treatment rather than prevention. Because going to a doctor is so expensive people just don't go, and then mundane problems that could have been fixed with at worst a routine surgery end up in an emergency room on life support expending a hundred thousand dollars of resources a day to correct. Thats in addition to substantive productivity losses incurred by people being sick all the time without the financial resources to actually fix their ailments. Even when you have health insurance the absurd deductibles mean you can't see a doctor anyway without being out the equivalent of half the months food or your entire utility bill. It is absolutely imperative that any nations people have affordable access to medical professionals before they are suffering ill from all the things they noticed were off but didn't want to become indebted over.

fuzz4lyfe 7y ago

>Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... why? - I honestly don't know. The AARP advocates for social security... why? - I honestly don't know. Imagine if you put the teamsters in charge of infrastructure spending, every road in the country would be under construction perpetually. It would be illegal to shovel your own driveway without paying someone in the union to sit in front of your house and supervise.

tamaharbor 7y ago

Have you ever been on Medicare? It is not that good.

flukus 7y ago

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. This is what happens with corporate healthcare plans already, those costs get past onto the consumer (middle to upper middle class) and they pay a hidden healthcare tax on every purchase.

pravda 7y ago
Heathcare costs are part of employee compensation. The tax is on employees.
- flukus 7y ago
  Any evidence of this? Some quick googling and I couldn't find anything about about employees with healthcare plans being paid less than employees without them. If I understand the history of it properly, healthcare was always meant to be an extra incentive from a period where they weren't allowed to pay more. It's never been a tax on employees.
  - pravda 7y ago
    Ask yourself this question: why does anyone get paid more then minimum wage?

jachee 7y ago

> The problem is that there is not a single reason that healthcare is so expensive. I'm recently fond of saying that the ultimate root cause of all suffering is greed. If you follow the money, I'm sure that is exactly what you'll find.

analog31 7y ago

What I've noticed is that everybody in the system cries poor and believes that someone else is gouging us. But the system is so labyrinthine that nobody can figure out where the money is actually going. And every group (e.g., doctors) has an investment stake in the other groups (e.g., medical and malpractice insurance companies), or is a partner in an LLC that makes money by buying a machine and billing for its use. Etc. The likely answer is: They are all gouging us. One potential benefit of a single payer system is simply being able to untangle that mess and put every player on a reasonable footing. For instance, make medical school free, but then doctors get to work for the government for a decent professional salary. It might even change the mix of people who are willing to become doctors -- more middle class. The primary expenditures of the medical system should be materials (capital and consumable like drugs) and salaries.

Ididntdothis 7y ago
”The likely answer is: They are all gouging us.” Exactly. It’s pointless to spend time on trying to find a single culprit. Corruption is spread throughout the whole system.

gbacon 7y ago

When you don’t pay for a service, you are not the customer but the vector to get to the real customer. Think: Television, radio, Google, Facebook, healthcare. There are gigantic pools of funds out there in quasi-private insurance, Medicare, and Medicaid. Costs explode. Similarly, gigantic pools of funds are available thanks to subsidized student loans that cannot be bankrupted. College costs explode. Being uninsured is terrifying because the individual healthcare buyer is competing with deep-pocketed insurers and government programs who are much less price-sensitive. Healthcare is expensive because the patient is not the customer. Insurance is going crazy because insurance is legally compelled to pay for oil changes and basic maintenance, so insurers must accept more exposure.