4 ms·

> Moving to the government/taxes paying for it doesn't fix that. It kinda does, bigger players have more bargaining power. There is no bigger player than the g

by naasking 10mo ago

> Moving to the government/taxes paying for it doesn't fix that. It kinda does, bigger players have more bargaining power. There is no bigger player than the government in a universal healthcare system. Furthermore, a significant cost in healthcare is all of the bureaucracy around billing. Much of that goes away with single payer.

bluedino 10mo ago
It would be very tough to reduce pay for doctors and other staff. The United States medical industry is one of the highest paying in the world.
- naasking 10mo ago
  Doctor and nurses are not bureaucrats. Single payer would significantly reduce the bureaucracy in healthcare, and simplify everything for citizens and businesses.
  - nickff 10mo ago
    The main cost driver in medical care is provider (nurse, doctor, etc.) wages, not bureaucracy or drug prices (though they're frequently cited). I have tired of posting sources for the statistics, but they are very easy to find.
    - cduzz 10mo ago
      So, let's look at UnitedHealth Group; do they deliver health care? If there were single payer, what would their role be in the healthcare delivery process? Apparently they made 2.3 billion in profits on 113 billion in revenue in Q3 of 2025. How much of that friction would evaporate if they weren't in the healthcare delivery infrastructure. Someone once said "the best part is no part" ?
      - nickff 10mo ago
        Compare UPS or FedEx to USPS; the first two companies are profit-seeking, yet very competitive with the 'public-oriented' (and legally privileged) USPS. Having the government in control does not necessarily lead to better value.
        naasking 10mo ago
        They are very competitive in the places where most people live, but the USPS delivers to many more places that the others do not, and still maintains cost competitiveness. This turns out to be a decent analogy to healthcare: insurance companies do not provide the coverage, universality and simplicity that a single payer system would; instead, you'll get something like insurance coverage networks providing spotty and inconsistent care. Either approach has upsides and downsides, but single payer, universal coverage for basic and emergency healthcare seems like a no-brainer.
        cduzz 10mo ago
        I've lived in cities where the city ran the utilities; they were generally way cheaper than the utilities from PG&E. The USPS is obligated to deliver letters at the same cost to everyone in the country, and they do a pretty okay job at it -- I've certainly had horrid events from UPS and FedEx, and those guys get to just pass the crap delivery tasks off to USPS if they don't like it. Lots of old people in the USofA seem to like their government run medical insurance, same with people in the VA system. The Doge crew spent months looking for fraud waste and abuse and I don't see any big law enforcement results from all the fraud they found, and I don't see anyone crowing over all the waste they curtailed. It's possible that the world's more complex than you imagine, and that sometimes people just do their jobs (IE the bureaucrats) and hard problems get solved. Now, tell me again, what part of the health care system is UnitedHealth? What critical problem do they solve?
      - HDThoreaun 10mo ago
        $2.3 billion is nothing in a $5 trillion system. Doctors make around $500 billion in the US. Their wages are much more significant than insurance profits.
    - array_key_first 10mo ago
      From what I've heard from doctors online, a large chunk of their time is basically spent just coaxing insurance. They waste time figuring out what they can and cannot bill, tailoring that to every patient, and constantly keeping records of everything. I think, for many doctors especially in small practices, treatment is a minority of their time. Obviously, paying someone 300K a year to sit on a 1 hour peer to peer explaining why they think they should do a surgery is just bad business. But, we do it, and I think a lot.
      - naasking 10mo ago
        Exactly. You can believe the "main cost driver in medical care is provider (nurse, doctor, etc.) wages" all the live long day, until you realize they too spend a lot of their time dealing with bureaucracy. The true cost of bureaucracy cannot be accounted for by simply tallying the number of bureaucrats and their salaries.
- larkost 10mo ago
  This is true, but frontline healthcare staff wages are only one part of the problem. For specifics you can see details here (e.g.: US average front-line healthcare worker salary: €74.450, Germany: €40.522): https://www.qunomedical.com/en/research/healthcare-salary-index https://www.qunomedical.com/en/research/healthcare-salary-in... But even absent any movement there you have a lot of savings to be had away from that: 1. The U.S. medical administration costs have ballooned, in large part because of the highly adversarial billing system between insurers and practitioners. Medicare/Medicaid is much less (but not completely) unpredictable. Doctors complain bitterly about the prices at times, but the system is much more efficient. 2. U.S. insurance companies are woefully inefficient. To the point that companies complained bitterly when the ACA required them to pay out 80% of premiums as medical payments. Before that there were companies making more than 20% profits. The most efficient insurance companies today use about 12% of their revenues for non-medical care. In comparison Medicaid uses about 3.9%. There are lots of other parts you could address as well: 1. Fraud drawn to the huge payouts for medical bills. If people's accidents were just covered as a normal part of life those payouts, and most of that fraud just goes away. 2. Malpractice insurance. This is like the first, but would mostly be solved by a combination of single payer and a working medical review system (seriously, what we have now is the definition of regulatory capture).
- mrguyorama 10mo ago
  >The United States medical industry is one of the highest paying in the world. Which the industry views as a historical accident, and now that they basically own all the hospitals and other companies, you can expect them to fix it. I would expect neutering Doctor labor power will happen soon. This admin will get a small donation or two, and the republicans will insist that letting doctors have high wages is the sole cause of our expensive healthcare. They've never really cared about the truth, seeing as they have often claimed "Medical tort" is the cause of healthcare costs, even though places like Texas, which have limits of Medical tort payout don't have cheaper healthcare.
  - HDThoreaun 10mo ago
    Medical tort is a large part of our bloated healthcare costs. The problem with these discussions is that our healthcare system is horrible and has many things going wrong, so both sides can simultaneously be right.
- wyre 10mo ago
  Wages for doctors and staff are not the cause of high medical bills. The US spends something like $4.9 trillion dollars on medical care, and employs around 1 million physicians, 4.5 million nurses, or 9.8 million health care workers in total [1]. If this was paid out in wages the average health care worker would be make almost $500k/year. Compare that to the wage of the average doctor at $335k/year [2] or average nurse at under $100k/year. There is a lot of money in medical care that is not going to wages. [1]https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html https://www.census.gov/library/stories/2021/04/who-are-our-h... [2]https://www1.salary.com/Doctor-Salary.html https://www1.salary.com/Doctor-Salary.html

bluedino 10mo ago

It would be very tough to reduce pay for doctors and other staff. The United States medical industry is one of the highest paying in the world.

naasking 10mo ago
Doctor and nurses are not bureaucrats. Single payer would significantly reduce the bureaucracy in healthcare, and simplify everything for citizens and businesses.
- nickff 10mo ago
  The main cost driver in medical care is provider (nurse, doctor, etc.) wages, not bureaucracy or drug prices (though they're frequently cited). I have tired of posting sources for the statistics, but they are very easy to find.
  - cduzz 10mo ago
    So, let's look at UnitedHealth Group; do they deliver health care? If there were single payer, what would their role be in the healthcare delivery process? Apparently they made 2.3 billion in profits on 113 billion in revenue in Q3 of 2025. How much of that friction would evaporate if they weren't in the healthcare delivery infrastructure. Someone once said "the best part is no part" ?
    - nickff 10mo ago
      Compare UPS or FedEx to USPS; the first two companies are profit-seeking, yet very competitive with the 'public-oriented' (and legally privileged) USPS. Having the government in control does not necessarily lead to better value.
      - naasking 10mo ago
        They are very competitive in the places where most people live, but the USPS delivers to many more places that the others do not, and still maintains cost competitiveness. This turns out to be a decent analogy to healthcare: insurance companies do not provide the coverage, universality and simplicity that a single payer system would; instead, you'll get something like insurance coverage networks providing spotty and inconsistent care. Either approach has upsides and downsides, but single payer, universal coverage for basic and emergency healthcare seems like a no-brainer.
      - cduzz 10mo ago
        I've lived in cities where the city ran the utilities; they were generally way cheaper than the utilities from PG&E. The USPS is obligated to deliver letters at the same cost to everyone in the country, and they do a pretty okay job at it -- I've certainly had horrid events from UPS and FedEx, and those guys get to just pass the crap delivery tasks off to USPS if they don't like it. Lots of old people in the USofA seem to like their government run medical insurance, same with people in the VA system. The Doge crew spent months looking for fraud waste and abuse and I don't see any big law enforcement results from all the fraud they found, and I don't see anyone crowing over all the waste they curtailed. It's possible that the world's more complex than you imagine, and that sometimes people just do their jobs (IE the bureaucrats) and hard problems get solved. Now, tell me again, what part of the health care system is UnitedHealth? What critical problem do they solve?
    - HDThoreaun 10mo ago
      $2.3 billion is nothing in a $5 trillion system. Doctors make around $500 billion in the US. Their wages are much more significant than insurance profits.
  - array_key_first 10mo ago
    From what I've heard from doctors online, a large chunk of their time is basically spent just coaxing insurance. They waste time figuring out what they can and cannot bill, tailoring that to every patient, and constantly keeping records of everything. I think, for many doctors especially in small practices, treatment is a minority of their time. Obviously, paying someone 300K a year to sit on a 1 hour peer to peer explaining why they think they should do a surgery is just bad business. But, we do it, and I think a lot.
    - naasking 10mo ago
      Exactly. You can believe the "main cost driver in medical care is provider (nurse, doctor, etc.) wages" all the live long day, until you realize they too spend a lot of their time dealing with bureaucracy. The true cost of bureaucracy cannot be accounted for by simply tallying the number of bureaucrats and their salaries.
larkost 10mo ago
This is true, but frontline healthcare staff wages are only one part of the problem. For specifics you can see details here (e.g.: US average front-line healthcare worker salary: €74.450, Germany: €40.522): https://www.qunomedical.com/en/research/healthcare-salary-index https://www.qunomedical.com/en/research/healthcare-salary-in... But even absent any movement there you have a lot of savings to be had away from that: 1. The U.S. medical administration costs have ballooned, in large part because of the highly adversarial billing system between insurers and practitioners. Medicare/Medicaid is much less (but not completely) unpredictable. Doctors complain bitterly about the prices at times, but the system is much more efficient. 2. U.S. insurance companies are woefully inefficient. To the point that companies complained bitterly when the ACA required them to pay out 80% of premiums as medical payments. Before that there were companies making more than 20% profits. The most efficient insurance companies today use about 12% of their revenues for non-medical care. In comparison Medicaid uses about 3.9%. There are lots of other parts you could address as well: 1. Fraud drawn to the huge payouts for medical bills. If people's accidents were just covered as a normal part of life those payouts, and most of that fraud just goes away. 2. Malpractice insurance. This is like the first, but would mostly be solved by a combination of single payer and a working medical review system (seriously, what we have now is the definition of regulatory capture).
mrguyorama 10mo ago
>The United States medical industry is one of the highest paying in the world. Which the industry views as a historical accident, and now that they basically own all the hospitals and other companies, you can expect them to fix it. I would expect neutering Doctor labor power will happen soon. This admin will get a small donation or two, and the republicans will insist that letting doctors have high wages is the sole cause of our expensive healthcare. They've never really cared about the truth, seeing as they have often claimed "Medical tort" is the cause of healthcare costs, even though places like Texas, which have limits of Medical tort payout don't have cheaper healthcare.
- HDThoreaun 10mo ago
  Medical tort is a large part of our bloated healthcare costs. The problem with these discussions is that our healthcare system is horrible and has many things going wrong, so both sides can simultaneously be right.
wyre 10mo ago
Wages for doctors and staff are not the cause of high medical bills. The US spends something like $4.9 trillion dollars on medical care, and employs around 1 million physicians, 4.5 million nurses, or 9.8 million health care workers in total [1]. If this was paid out in wages the average health care worker would be make almost $500k/year. Compare that to the wage of the average doctor at $335k/year [2] or average nurse at under $100k/year. There is a lot of money in medical care that is not going to wages. [1]https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html https://www.census.gov/library/stories/2021/04/who-are-our-h... [2]https://www1.salary.com/Doctor-Salary.html https://www1.salary.com/Doctor-Salary.html