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The actual labor share of income is significantly higher when you include employer contributions to employee health insurance premiums. Healthcare costs have be

• throwway120385 4mo ago
  Why wouldn't a single-payer solution work? The margin that the insurance companies take for themselves seems like a good place to start. From there it would spiral out to the third to half of time that all of the clinical staff spend just dealing with insurance issues and insurance billing.
  • dominotw 4mo ago
    insurance issues are provider and insurer going back and forth detrmining if doctors assessment of necessity is agreed upon. i am not familiar with universal system. In that system if your doctor thinks something is medically necessary then thats the end of it and its gets done?
    • nradov 4mo ago
      All healthcare systems have some form of rationing. Even if your doctor thinks something is medically necessary it can only get done if the system actually has capacity. In most countries where there is universal coverage with a single payer, certain expensive treatments have long waiting lists or are simply unavailable at any price. Thus we see wealthy Canadians coming to the USA as medical tourists and paying cash for procedures like MRI scans or joint replacements in order to avoid the queue back home. There are always trade-offs, it's just a matter of what we want to prioritize.
      • dominotw 4mo ago
        yea queue is fine . i was wondering about gp's claim that universal would be more efficient because there is no more back and forth about approving. i wasnt sure if it simply takes a different form or gets eliminated completly.
    • throwway120385 4mo ago
      In my experience, insurance issues are usually insurer and patient going back and forth and then patient getting 6 different answers from 6 different representatives, then reviewing the 3000 page plan document, finding the single line that properly describes what should have happened, calling the insurance company, explaining to the rep how your plan works, and demanding that it be reprocessed. Like my wife has to do this frequently and spends several hours per month dealing with this but she has saved us probably tens of thousands of dollars in mis-processed claims that the insurance companies can't even properly handle. I usually am the person carefully reading plan docs, finding the proper billing codes, and explaining things like that to the insurance company. Sometimes we have to get the doctor's billing people to code things, like once they coded something that was an outpatient appointment as a minor surgery which could have cost us a lot of money. So in my book since we get to speculate about what the system should look like, it should absolutely result in people getting care without all of this run-around. It's about eliminating as much misery as possible from the system and letting people just get treated and providers just get paid. We can talk about efficiency once the misery is gone.
      • dominotw 4mo ago
        you think there is scope for a non profit here that can advocate on behalf of patients and read the contracts. perhaps with ais help.
      • nradov 4mo ago
        Yes, part of the overall solution needs to be health plan transparency on clinical guidelines and coverage rules. Currently much of that is concealed, or applied unevenly. But we're not going to eliminate misery from the healthcare system. Demand is effectively infinite, mainly from patients with complex conditions, and supply is finite. Developed countries with more socialized healthcare systems typically do a pretty good job of delivering basic primary care but things often fall apart when more complex or specialized care is needed. Those systems also ration and deny care but it tends to be through forcing patients to wait in long queues, or simply not offering expensive treatments at all. Like under the UK NHS, some prescription cancer drugs just aren't available. So that's a different form of misery.
  • nradov 4mo ago
    I'm not necessarily opposed to a single-payer system but the margin that for-profit insurance companies take is a tiny fraction of overall healthcare spending. You could zero it out and it would barely move the needle. And many of the largest commercial health plans such as most Blue Cross Blue Shield Association members are non-profit. There is literally no margin. Provider organizations spend a huge amount of effort dealing with Medicare and Medicaid, which are pretty close to being a "single-payer solution" already in many cases. From an administrative overhead perspective they aren't always easier to work with than commercial health plans. Plus they have enormous problems with fraud, waste, and abuse.
    • ambicapter 4mo ago
      The mandated low margin is part of the problem. When your margins are regulated, the only way to increase profits is to just make everything more expensive. More revenue, same margin, more profits. Humane health care is incompatible with free market economics.
      • wqaatwt 4mo ago
        Perhaps its not compatible. But that’s tangential to the situation in the US, at the very minimum you need to have price transparency in any ‘free market’ system.
        • saghm 4mo ago
          I think the point is that we might as well just give up the pretense of a free market healthcare solution and just focus on what's humane.
          • nradov 4mo ago
            Is it humane to leave a patient to die in an ambulance when a single-payer nationalized healthcare system is over capacity? https://www.theguardian.com/society/2025/apr/06/englands-nhs-crews-watching-patients-die-in-back-of-ambulances-due-to-ae-delays https://www.theguardian.com/society/2025/apr/06/englands-nhs... I'm not trying to be snarky here, the point is that there is no easy solution and optimizing based on what politicians subjectively consider "humane" isn't going to get us anywhere. If we want to actually fix the problem then we need to focus on what's economically feasible rather than low-effort hot takes and sound bites. Free markets, with reasonable limits, can be part of that solution by revealing consumer preferences and allowing for efficient allocation of limited resources.
  • wqaatwt 4mo ago
    There are countries in Europe which have entirely privatized healthcare systems (not even medicare/medicaid equivalents). US tried adopting some of their practices with Obamacare and even that didn’t work out. Singlepayer isn’t really necessary to have a reasonably affordable and accessible healthcare system proper regulation is.
    • autoexec 4mo ago
      As successful as Obamacare has been it didn't really do much to lower the cost of healthcare or claw back the billions wasted to insurance company profits. There might be some kind of regulation just as effective as single payer, but we've never seen it anywhere in the US.
      • jmye 4mo ago
        > As successful as Obamacare has been it didn't really do much to lower the cost of healthcare It dramatically lowered the cost to consumers. Further, conflating overall healthcare spend with the portion of spend tied to a significantly lower-cost population is apples and oranges at best and represents a fundamental misunderstanding of healthcare cost in general. It's ok to not have opinions about things you know you don't understand.
        • autoexec 4mo ago
          "lowered" hasn't made much difference. Before the affordable care act Americans spent more and got less for their money and that hasn't changed. Insurance companies are still stuffing their pockets with billions and denying coverage. Americans struggled to afford the care that they needed before the affordable care act, and they still struggle to afford the care that they need today. The affordable care act was a very small improvement, but it didn't move the needle compared to other nations
      • wqaatwt 4mo ago
        > but we've never seen it anywhere in the US. Well just copy paste the Swiss system (of course that’s not feasible both the “free market” and pro “socialized” single payer supporters would hate it). However they have a heavily regulated, reasonably affordable fully private healthcare system.
• dlev_pika 4mo ago
  Yeah, I guess the rest of the developed world doesn’t really ‘get it’ - fools!
  • b40d-48b2-979e 4mo ago
    Could America be wrong? No, no, it's the other countries!
  • dominotw 4mo ago
    they get subsidized by usa pharma industry. Their costs will rise if pharma prices are negotiated by govt here too.
    • autoexec 4mo ago
      That sounds good to me. Why should millions of Americans die every year because they can't afford their medications just so that other countries can get their meds at extremely low prices? Let's also have the US government negotiate our prices and let things even out across the board.
• legitster 4mo ago
  The data here would already include healthcare contributions.
• ToucanLoucan 4mo ago
  > If we want to increase the labor share then we'll drive down healthcare spending. It may not be simple but it's clear the United States is doing something catastrophically wrong. All the other healthcare systems on the planet in developed countries have problems, sure. But we spend magnitudes more money to receive middling-to-shit healthcare. Medical debt and bankruptcy is a unique American problem that also happens to be the most reliable way for otherwise productive and prosperous members of our society to end up fucking homeless. Because they got SICK. I rarely use the word "evil" but that really fits IMO. Like you cannot tell me with a straight face that the insurance industry couldn't be blown the fuck off the map tomorrow and literally everyone who doesn't own an insurance company isn't instantly better off.
  • arjie 4mo ago
    If the insurance companies disappeared tomorrow, presumably all medical care is paid for at point of use by patients? That would mean stochastically facing catastrophic bills from providers. I am sympathetic to the idea that healthcare providers and systems here should be making no more than in, say, Europe, but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.
    • wqaatwt 4mo ago
      > would be very unhappy. Significantly increasing the supply of doctors would solve that, though.
      • nradov 4mo ago
        There are certainly some things that we could do to increase the supply of physicians by reducing the cost of education, expanding access to combined BS/MD programs, and increasing the number of residency slots. But those measures will have marginal effects, and take years to show up in supply numbers. There just aren't a lot more people who are mentally and physically capable of doing this work. Part of the problem is that we force physicians to waste too much time on administrative work. Some of this could be delegated to cheaper employees or not done at all, thus effectively increasing supply. Administrative overhead is also one of the factors driving physicians to quit and pivot to other careers or retire early, which further constrains supply. This part is controversial but we'll also have to shift a lot of primary care to Physician Assistants and Nurse Practitioners. Care quality might be lower in some cases but for routine conditions it's probably better to see a PA/NP today instead of waiting weeks for a physician.
• ajross 4mo ago
  Is there a reference you can cite with corrected numbers? Honestly this sounds like excuse-making, especially when used as a jumping point into a decidedly partisan take (complete with scare quotes!) on the essentially unrelated subject of public health care financing. The idea seems to have merit, but it's unconvincing to people outside your bubble and I'm dubious.
  • nradov 4mo ago
    You misinterpreted by comment. It was not partisan, and was based on reality and cold economics rather than ideology. None of the major US political parties have workable reform proposals that could actually be implemented and achieve net positive results. This is a complex topic with no tl;dr possible. If you want to be able to participate in discussions on a rational, quantitative basis then a good starting point is "The Price We Pay: What Broke American Health Care--and How to Fix It" by Marty Makary, MD. It goes into the numbers far better than I can cover in a short HN comment. https://www.bloomsbury.com/us/price-we-pay-9781635574128/ https://www.bloomsbury.com/us/price-we-pay-9781635574128/
    • ajross 4mo ago
      > [my comment] was not partisan, and was based on reality and cold economics rather than ideology That's what all partisans think. Nonetheless you put needless scare quotes around Medicare for All, dismissed it as a "total fantasy", and, I guess, helpfully suggested I read a book by (literally!) the head of the Trump administration's FDA as a reference for "What Broke American Health Care". If that was all done in good faith, then you're in an echo chamber and need to escape.
      • nradov 4mo ago
        Is there anything in that book that is factually incorrect, or are you going to stick with a lazy, low-effort dismissal? If you had actually read it you would know that it's refreshingly free of partisan ideology. The quotes around "Medicare For All" were intended not to scare anyone but to identify a general set of policy proposals that have been floating around lately.
• sofixa 4mo ago
  Removing a useless middleman party that needs a profit margin, and removing the perverse incentives of them having to prove their value thus having inflated prices with fake discounts, and centralising all healthcare purchasing power in a single entity, is absolutely going to solve a lot of challenges US healthcare faces
• illithid0 4mo ago
  You're citing some of the results of a runaway healthcare industrial complex, such as drug prices, as reasons why the thing that would keep such a complex from emerging won't work. Employers might be contributing more to healthcare costs, but that's because they have to in order to keep coverage for their employees at all as premiums increase, and individual out-of-pocket costs are still rising as a result of coverage denial and high deductibles.
• deleted 4mo ago
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• AnEro 4mo ago
  I've built and audited medical billing systems and billing practices. It isn't an economics issue in a traditional sense. Infact it would drastically reduce complexity of these systems and payments over time, even allowing private insurers to exist but have to compete with a base general coverage. (many smarter people than me at princeton did economics showing this worked out as a net less expensive than what we are doing now) The biggest reason why its not the simplistic solution, is politics of all the middle men (me) making exponential returns from solutions to these systemic issues. Too much money in the system being flawed, look at pricing for any HIPAA safe products and thats just technology. Money is so hard to get for healthcare providers it is its own industry of revenue cycle management and thrid party billers. Most of these physician lead practices charge more is because planning your account around reemburcement cycles from insurance companies are 30-120 days if your lucky is an advanced accounting problem. (Thats excluding complexities of audits, LOPs, network rates etc.) Medicare/medicaid the fraud side has lots of tiny wins through leaning on tax information more, taking the model from the successful basic income studies and trials worked out.
  • nradov 4mo ago
    I'm not sure what you mean by pricing for "HIPAA safe products"? It's not particularly expensive to comply with the HIPAA Privacy Rule, and honestly that level of privacy and security is the minimum we ought to expect in any industry that deals with sensitive consumer data. There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale and increase negotiating power with commercial health plans. Which is one of the factors driving up overall healthcare system costs.
    • AnEro 4mo ago
      The ops is crazy expensive, any service you get or buy into also instantly gets at least a 30% mark up. Look at the price of transport EDI clearinghouses vs healthcare! Yeah, it is stuff we should be doing for all data, but one mistake will leave you(business owner or contractor) with intergenerational debt or leave you criminal liable. > There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale There are plenty, in name at least many states have regulations to force this. Those larger roll ups are still clusters of smb doing 1-10m revenue monthly. They constantly fail and change hands behind the scenes, and are usually only protected by government regulations that reduce risk room to investors normally don’t have in other industries businesses. Their margins are like gambling almost and it’s a key driver of the service issues Americans face.
• derektank 4mo ago
  While healthcare spending isn’t included in some economic measures like wages (which has contributed to the distorted productivity-pay gap discourse), labor share as discussed in this article is actually calculated using total compensation, the “total of payments to labor to produce output, including wages, benefits, and other monetary or nonmonetary payments,” which includes employer contributions to medical care not just wages and salaries.[0] They do discuss payroll share later on though, which doesn’t include non-wage compensation. [0] https://www.bls.gov/opub/hom/opt/calculation.htm https://www.bls.gov/opub/hom/opt/calculation.htm
• ETH_start 4mo ago
  I strongly agree that socializing the healthcare industry will not help in any way. To the extent that healthcare costs have skyrocketed, it's precisely because of government intervention in the U.S. Healthcare industry has massively increased over the last 50 years, especially in the form of tax incentives for employers to compensate employees by way of health insurance. Anyway, with respect to the labor share of income, that is not correct. Employer contributions to employee health insurance premiums are included in the labor share.
  • saghm 4mo ago
    > To the extent that healthcare costs have skyrocketed, it's precisely because of government intervention in the U.S. Healthcare industry has massively increased over the last 50 years, especially in the form of tax incentives for employers to compensate employees by way of health insurance. It fails to follow logically that one specific way the government got involved that drove costs up means that any possible intervention is worse than completely being hands-off. How do you explain pretty much every other developed country in the world having more government involvement but lower costs than the US?
    • robinsonb5 4mo ago
      The problem is, quite simply, insurance. When something is paid for from a big nebulous ball of money rather than straight out of people's pockets, the downward pressure on prices just isn't there in the same way. The conversations between practitioners and insurers are about whether something is necessary, not about whether or not the practitioner is charging too much for it. Here in the UK we see it, too - not so much in human healthcare since we have the NHS - but very definitely in animal healthcare; vets' bills have skyrocketed over the last couple of decades, in a mutually-reinforcing feedback loop with the rise in pet health insurance.
      • saghm 4mo ago
        > Here in the UK we see it, too - not so much in human healthcare since we have the NHS - but very definitely in animal healthcare; vets' bills have skyrocketed over the last couple of decades, in a mutually-reinforcing feedback loop with the rise in pet health insurance. Kind of amazing how perfectly this illustrates that in the exact same economy, the system with single payer mostly works to keep prices sane, and the private insurance model goes off the rails
• pinko 4mo ago
  Do other countries' state healthcare system costs count towards their labor share of income? If not, it seems sensible not to account for them that way in the US, or you're creating a much more serious apples and oranges problem for international statistics (which are often cited/compared for these figures)...
  • pinko 4mo ago
    [flagged]
• jmye 4mo ago
  > And no, there's no simple solution to this problem. The notion that something like "Medicare for All" would solve the problem is a total fantasy, disconnected from actual US healthcare economics. Any real solution will have to work on multiple angles including preventive care, PBMs, provider wages, rationing, drug prices, fraud, malpractice insurance, interoperability technology, etc. I have been saying this for years. I'm so tired of social media memes turning into sage wisdom for an entire generation who can barely spell healthcare, let alone have any vague understanding of it. I'm and-then'ing, not disagreeing, but the big healthcare cost fix, IMO, still centers around education cost reform, and fixing the supply of mid-levels+ across the country.