4 ms·

U.S. health spending on pace to hit $6T

31 points by brandonb 4mo ago

tencentshill 4mo ago
$16,500 per person is insane. Someone is charging way too much for goods and services, and someone is paying it with no questions asked.
- downrightmike 4mo ago
  The Seven-Times Markup: The Johns Hopkins study analyzed the nation's top 100 hospitals by revenue and found that their "chargemaster" prices (the initial sticker price) averaged 700% of the actual cost of providing the service. https://www.beckershospitalreview.com/finance/top-100-us-hospitals-charge-patients-7-times-their-actual-care-cost-study-shows/ https://www.beckershospitalreview.com/finance/top-100-us-hos...
- kelseyfrog 4mo ago
  We could end the Triffin dilemma by no longer maintaining the dollar as the unit of international reserve. This would eliminate the biggest driver of the trade deficit and via a reversing of the Baumol effect, lower the price of health care and education. The only problem? No one has the political will to do it. > Someone is charging way too much for goods and services It's more money chasing meager supply. They're charging market rates. However when the market is distorted through the described arrangement, it's clear what has to change - the structure of international finance.
  - adjejmxbdjdn 4mo ago
    What’s the problem with the trade deficit? Americans are getting actual products and services in return for depreciating IOUs. It’s like a loan where the lender pays interest. Why would anyone be against that? Note: This is different from the strategic interest in maintaining domestic industries. That’s very defensible. But I don’t understand the fear of a trade deficit denominated in your own currency (other countries have bigger genuine concerns with a dollar denominated trade deficit, because if their currency falls against the dollar suddenly, they’re kind of screwed, at least in the short term).
    - kelseyfrog 4mo ago
      The US imports more goods than it exports. It also exports more services than it imports. The US Department of Commerce breaks down the numbers for import and export by goods and services[1]. Sure, the US benefits by having cheap goods. This means precisely that there's more money chasing services. It's why we have cheap televisions(yay!) but expensive healthcare, education, housing. Those things cannot be made elsewhere and imported into the US to benefit from the power of trade imbalance. 1. Page 14 of 56. https://www.bea.gov/sites/default/files/2026-06/trad0426.pdf https://www.bea.gov/sites/default/files/2026-06/trad0426.pdf
Bender 4mo ago
How much of that spending is continuously treating symptoms vs. finding and curing root causes? At what point do the pentagon and other agencies step in and treat this like an unsustainable existential threat to the country?
- 2OEH8eoCRo0 4mo ago
  Never going to happen. Look how people freaked when politely asked to wear a mask.
brandonb 4mo ago
IMO, there's an interesting opportunity for AI to make healthcare deflationary. For example, Medicare is launching a new program in July that pays a fixed rate for achieving defined outcomes, like lowering blood pressure or cholesterol. Medicare's explicit goal here is to create incentives to automate the repetitive parts of care delivery with software. (Much of preventive cardiology is surprisingly algorithmic and guideline-driven, so this is more plausible than it seems.) This reverses the incentives of the current system, where CPT codes incentivize doing more "stuff" (but not necesarily delivering the most effective care efficiently). If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.
- skt5 4mo ago
  > If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution. do you have thoughts on what that looks like? what does the hiring landscape look like?
  - brandonb 4mo ago
    Right now lots of good health companies hiring, including my own (Empirical). https://www.workatastartup.com/ https://www.workatastartup.com/ lets you filter YC companies to see health startups, by stage and location (or remote).
    - skt5 4mo ago
      Any advice for a senior/staff level FAANG dev working in ML tooling but not in the health space interested in this kinda stuff? What are good things to read, etc?
  - tocs3 4mo ago
    do you have thoughts on what that looks like? There is so much to be done and it is not going to be solved by any one thing. That in mind, something like an independent third party patient advocates / advisors would be great. It is hard to be an informed patient these days, Navigating insurance and paperwork is tough and getting second opinions is sometimes had.
downrightmike 4mo ago
Surprised a healthcare CEO hasn't tried to bribe the gov to just let them be the only game in town.
- tocs3 4mo ago
  Aren't they about the only game in town?
androiddrew 4mo ago
The plan to extract as much wealth as possible out of families with members near end of life is showing excellent results.
bhelkey 4mo ago
The US spent $2 Trillion dollars on Medicare and Medicaid in 2024 [1][2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Healthcare for every single resident with this $2 Trillion dollars. [1] https://www.kff.org/medicaid/medicaid-financing-the-basics/#870ed126-45c3-4465-8b9a-ae0eea487dcf https://www.kff.org/medicaid/medicaid-financing-the-basics/#... [2] https://usafacts.org/answers/how-much-does-medicare-cost-the-federal-government/ https://usafacts.org/answers/how-much-does-medicare-cost-the... [3] https://www.bbc.com/news/articles/cwy7zvp5xrqo https://www.bbc.com/news/articles/cwy7zvp5xrqo
MoonWalk 4mo ago
Paywalled.
adjejmxbdjdn 4mo ago
America’s decision to make healthcare a for profit industry is the root of all of this. The obvious points are medicines and equipment. To some degree, these are actually the most justifiable parts of the industry that should be for profit. The parts that are far less justified: - The insurance industry surrounding healthcare. Obamacare brought in some regulation that drastically slowed the growth of healthcare costs. - The education industry surrounding healthcare. Becoming a doctor in the U.S. is incredibly expensive. You rack up massive loans, you’re racking up interest on those loans for years, well into your late 20s (including the loans you racked up for your undergrad), and then you’re spending the first decade of your career all the way to the late 30s, just paying those loans back. You’re one of the most sought after professional in the world and yet it takes you until your late 30s to basically break even. The upshot of that is you charge a ton not just to pay back your loans but to justify spending so much time and energy on a career that means you start being money positive for the first time in your late 30s. - Insurance. The American legal system that does not place any penalty on frivolous lawsuits essentially inserts a significant cost due to bad actors on everyone. Personally, I’m not clear on what this cost actually is and how significant it is, but if you talk to doctors and hospital administrators, they seem to believe it’s incredibly high. - Hospitals being for profit. I actually think for profit hospitals are more efficient than non profit ones, but the problem here is what they prioritize. A non profit hospital system may prioritize family care and regular checkups to keep people healthy and prevent them from falling sick in the first place. A for profit hospital probably prioritizes surgeries and elaborate procedures that make a lot of money. And that’s before we get to spending on customer acquisition, either due to fancy buildings etc or just straight up advertisement and marketing.
silexia 4mo ago
The problem is the artificial restrictions on doctors to drive up prices and the artificial restrictions on medical equipment (patents) to drive up prices.

31 points by brandonb 4mo ago

$16,500 per person is insane. Someone is charging way too much for goods and services, and someone is paying it with no questions asked.

downrightmike 4mo ago
The Seven-Times Markup: The Johns Hopkins study analyzed the nation's top 100 hospitals by revenue and found that their "chargemaster" prices (the initial sticker price) averaged 700% of the actual cost of providing the service. https://www.beckershospitalreview.com/finance/top-100-us-hospitals-charge-patients-7-times-their-actual-care-cost-study-shows/ https://www.beckershospitalreview.com/finance/top-100-us-hos...
kelseyfrog 4mo ago
We could end the Triffin dilemma by no longer maintaining the dollar as the unit of international reserve. This would eliminate the biggest driver of the trade deficit and via a reversing of the Baumol effect, lower the price of health care and education. The only problem? No one has the political will to do it. > Someone is charging way too much for goods and services It's more money chasing meager supply. They're charging market rates. However when the market is distorted through the described arrangement, it's clear what has to change - the structure of international finance.
- adjejmxbdjdn 4mo ago
  What’s the problem with the trade deficit? Americans are getting actual products and services in return for depreciating IOUs. It’s like a loan where the lender pays interest. Why would anyone be against that? Note: This is different from the strategic interest in maintaining domestic industries. That’s very defensible. But I don’t understand the fear of a trade deficit denominated in your own currency (other countries have bigger genuine concerns with a dollar denominated trade deficit, because if their currency falls against the dollar suddenly, they’re kind of screwed, at least in the short term).
  - kelseyfrog 4mo ago
    The US imports more goods than it exports. It also exports more services than it imports. The US Department of Commerce breaks down the numbers for import and export by goods and services[1]. Sure, the US benefits by having cheap goods. This means precisely that there's more money chasing services. It's why we have cheap televisions(yay!) but expensive healthcare, education, housing. Those things cannot be made elsewhere and imported into the US to benefit from the power of trade imbalance. 1. Page 14 of 56. https://www.bea.gov/sites/default/files/2026-06/trad0426.pdf https://www.bea.gov/sites/default/files/2026-06/trad0426.pdf

Bender 4mo ago

How much of that spending is continuously treating symptoms vs. finding and curing root causes? At what point do the pentagon and other agencies step in and treat this like an unsustainable existential threat to the country?

2OEH8eoCRo0 4mo ago
Never going to happen. Look how people freaked when politely asked to wear a mask.

brandonb 4mo ago

IMO, there's an interesting opportunity for AI to make healthcare deflationary. For example, Medicare is launching a new program in July that pays a fixed rate for achieving defined outcomes, like lowering blood pressure or cholesterol. Medicare's explicit goal here is to create incentives to automate the repetitive parts of care delivery with software. (Much of preventive cardiology is surprisingly algorithmic and guideline-driven, so this is more plausible than it seems.) This reverses the incentives of the current system, where CPT codes incentivize doing more "stuff" (but not necesarily delivering the most effective care efficiently). If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.

skt5 4mo ago
> If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution. do you have thoughts on what that looks like? what does the hiring landscape look like?
- brandonb 4mo ago
  Right now lots of good health companies hiring, including my own (Empirical). https://www.workatastartup.com/ https://www.workatastartup.com/ lets you filter YC companies to see health startups, by stage and location (or remote).
  - skt5 4mo ago
    Any advice for a senior/staff level FAANG dev working in ML tooling but not in the health space interested in this kinda stuff? What are good things to read, etc?
- tocs3 4mo ago
  do you have thoughts on what that looks like? There is so much to be done and it is not going to be solved by any one thing. That in mind, something like an independent third party patient advocates / advisors would be great. It is hard to be an informed patient these days, Navigating insurance and paperwork is tough and getting second opinions is sometimes had.

downrightmike 4mo ago

Surprised a healthcare CEO hasn't tried to bribe the gov to just let them be the only game in town.

tocs3 4mo ago
Aren't they about the only game in town?

androiddrew 4mo ago

The plan to extract as much wealth as possible out of families with members near end of life is showing excellent results.

bhelkey 4mo ago

The US spent $2 Trillion dollars on Medicare and Medicaid in 2024 [1][2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Healthcare for every single resident with this $2 Trillion dollars. [1] https://www.kff.org/medicaid/medicaid-financing-the-basics/#870ed126-45c3-4465-8b9a-ae0eea487dcf https://www.kff.org/medicaid/medicaid-financing-the-basics/#... [2] https://usafacts.org/answers/how-much-does-medicare-cost-the-federal-government/ https://usafacts.org/answers/how-much-does-medicare-cost-the... [3] https://www.bbc.com/news/articles/cwy7zvp5xrqo https://www.bbc.com/news/articles/cwy7zvp5xrqo

MoonWalk 4mo ago

Paywalled.

adjejmxbdjdn 4mo ago

America’s decision to make healthcare a for profit industry is the root of all of this. The obvious points are medicines and equipment. To some degree, these are actually the most justifiable parts of the industry that should be for profit. The parts that are far less justified: - The insurance industry surrounding healthcare. Obamacare brought in some regulation that drastically slowed the growth of healthcare costs. - The education industry surrounding healthcare. Becoming a doctor in the U.S. is incredibly expensive. You rack up massive loans, you’re racking up interest on those loans for years, well into your late 20s (including the loans you racked up for your undergrad), and then you’re spending the first decade of your career all the way to the late 30s, just paying those loans back. You’re one of the most sought after professional in the world and yet it takes you until your late 30s to basically break even. The upshot of that is you charge a ton not just to pay back your loans but to justify spending so much time and energy on a career that means you start being money positive for the first time in your late 30s. - Insurance. The American legal system that does not place any penalty on frivolous lawsuits essentially inserts a significant cost due to bad actors on everyone. Personally, I’m not clear on what this cost actually is and how significant it is, but if you talk to doctors and hospital administrators, they seem to believe it’s incredibly high. - Hospitals being for profit. I actually think for profit hospitals are more efficient than non profit ones, but the problem here is what they prioritize. A non profit hospital system may prioritize family care and regular checkups to keep people healthy and prevent them from falling sick in the first place. A for profit hospital probably prioritizes surgeries and elaborate procedures that make a lot of money. And that’s before we get to spending on customer acquisition, either due to fancy buildings etc or just straight up advertisement and marketing.

silexia 4mo ago

The problem is the artificial restrictions on doctors to drive up prices and the artificial restrictions on medical equipment (patents) to drive up prices.