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There's plenty of waste. It doesn't matter how much you pour at the top of a leaky pipeline, very little of it will make its way down to the desired recipients.

There's plenty of waste. It doesn't matter how much you pour at the top of a leaky pipeline, very little of it will make its way down to the desired recipients. You're spending $15,000 per capita per year on healthcare for what can at best be described as mediocre outcomes. The Netherlands spends $6000 and is near the tops of the charts when it comes to quality. What's the ratio of effectiveness per dollar we're looking at here? 5 to 1? It doesn't matter whether or not people like it when you cut, you have to if your want your country to exist in 50 years. But just as importantly you have to get rid of the leeches in the middle of the pipe and make sure the money that's left is actually doing work for you.

ivraatiems 3mo ago
The spend is on private health insurance going to for-profit middlemen. It's not mostly on the government. People love to crow about Medicare and Medicaid (safety net government-run insurance) waste but the vast majority of "waste" is the record profits put up by private companies.
- kansface 3mo ago
  Insurance companies don't make much money, actually. Hospitals, physicians, and pharma are at the top of the list (60% or so of total spending). Total insurance overhead is perhaps between 10 and 20%.
  - retornam 3mo ago
    please cite your sources, we can't take your comment at face value without citations.
    - kansface 3mo ago
      I asked ChatGPT of course, and the response roughly corresponded to my expectations so I went no further. Doctors make way more here than elsewhere (British doctors aren’t making 500-750k a year), pharma makes most of its money here, and hospitals charge an arm and a leg - it all checks out, no? Alternatively, if insurance were straight up responsible for doubling health care costs in any easily attributable way, we could easily get rid of it and would have done so by now. The only reason it can continue to exist is that it occupies a no-man’s land of utility.
      - ivraatiems 3mo ago
        It doesn't check out, you were one Google away from correct information (which I cited above), and relying on ChatGPT to confirm your priors for you and then parroting what it (incorrectly) says is an insulting way to engage in this community. Please don't do it. Also, the average doctor's salary is around $386k/year, and is heavily propped up by extremely rare specialties who make much more. The average primary care doctor makes around $240-280k/year. It's true that the US pays doctors much much more than the rest of the world, and is also facing a historic doctor shortage which drives up costs - but your numbers are still way, way off, probably because you eyeballed instead of doing research.
  - ivraatiems 3mo ago
    That's not true, and you were foolish to trust ChatGPT on this instead of researching it yourself. Also, if you are spending even 20% of a budget on things that are useless or net negative for the effort you are engaged in, you are wasting that 20%. "60% of the healthcare system's spending was on providing healthcare" is not a GOOD thing, that's an indictment! In 2024, insurance was 31% of national health expenditure: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo... That's a third of the whole system just spent on middlemen whose whole job is to make access to care harder. The single largest proportion of our expenditure was on the most useless part of the system. Private health insurance costs more than physicians, hospitals, prescription drugs, or Medicare or Medicaid.
- Starman_Jones 3mo ago
  Through Medicare and Medicaid, the US spends more public money per capita on healthcare than any other country spends period. This is largely because Medicare/Medicaid were not allowed to negotiate pricing; they were legally required to accept whatever price companies wanted to set for a treatment. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Aurornis 3mo ago
> You're spending $15,000 per capita per year on healthcare You’re using a number that includes private and public spending. There are problems with this topic, but it’s a different topic than federal government spending waste. There are some real federal government spending inefficiencies, but you picked a topic that is predominantly private spend.
- benj111 3mo ago
  It's still $8000 per capita just for socialised healthcare. So still more than NL. The US has the worst of both worlds.
  - brewdad 3mo ago
    The socialized segment of US healthcare is almost entirely the over 65 population and those too disabled to work any job. Obviously, the spending on those groups will be higher than the entire population as a whole. That it is does nothing to prove inefficiency.
    - benj111 3mo ago
      It kinda of does. Because you're still spending more than NL still have to worry about paying health insurance, still have to worry about how you're going to pay to give birth etc etc. To be clear this is per capita, not per recipient.
jmull 3mo ago
Isn’t healthcare is the prime example of government run programs being much more efficient and efficacious than privatized ones? The US has a massive tangled hodgepodge of private companies, having poor coverage, very high prices, and quite poor outcomes. Meanwhile there are numerous European countries with public healthcare systems that are far cheaper and provide much better outcomes. Here’s one of a million sources: https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/ https://www.pgpf.org/article/how-does-the-us-healthcare-syst...

ivraatiems 3mo ago

The spend is on private health insurance going to for-profit middlemen. It's not mostly on the government. People love to crow about Medicare and Medicaid (safety net government-run insurance) waste but the vast majority of "waste" is the record profits put up by private companies.

kansface 3mo ago
Insurance companies don't make much money, actually. Hospitals, physicians, and pharma are at the top of the list (60% or so of total spending). Total insurance overhead is perhaps between 10 and 20%.
- retornam 3mo ago
  please cite your sources, we can't take your comment at face value without citations.
  - kansface 3mo ago
    I asked ChatGPT of course, and the response roughly corresponded to my expectations so I went no further. Doctors make way more here than elsewhere (British doctors aren’t making 500-750k a year), pharma makes most of its money here, and hospitals charge an arm and a leg - it all checks out, no? Alternatively, if insurance were straight up responsible for doubling health care costs in any easily attributable way, we could easily get rid of it and would have done so by now. The only reason it can continue to exist is that it occupies a no-man’s land of utility.
    - ivraatiems 3mo ago
      It doesn't check out, you were one Google away from correct information (which I cited above), and relying on ChatGPT to confirm your priors for you and then parroting what it (incorrectly) says is an insulting way to engage in this community. Please don't do it. Also, the average doctor's salary is around $386k/year, and is heavily propped up by extremely rare specialties who make much more. The average primary care doctor makes around $240-280k/year. It's true that the US pays doctors much much more than the rest of the world, and is also facing a historic doctor shortage which drives up costs - but your numbers are still way, way off, probably because you eyeballed instead of doing research.
- ivraatiems 3mo ago
  That's not true, and you were foolish to trust ChatGPT on this instead of researching it yourself. Also, if you are spending even 20% of a budget on things that are useless or net negative for the effort you are engaged in, you are wasting that 20%. "60% of the healthcare system's spending was on providing healthcare" is not a GOOD thing, that's an indictment! In 2024, insurance was 31% of national health expenditure: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo... That's a third of the whole system just spent on middlemen whose whole job is to make access to care harder. The single largest proportion of our expenditure was on the most useless part of the system. Private health insurance costs more than physicians, hospitals, prescription drugs, or Medicare or Medicaid.
Starman_Jones 3mo ago
Through Medicare and Medicaid, the US spends more public money per capita on healthcare than any other country spends period. This is largely because Medicare/Medicaid were not allowed to negotiate pricing; they were legally required to accept whatever price companies wanted to set for a treatment. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Aurornis 3mo ago

> You're spending $15,000 per capita per year on healthcare You’re using a number that includes private and public spending. There are problems with this topic, but it’s a different topic than federal government spending waste. There are some real federal government spending inefficiencies, but you picked a topic that is predominantly private spend.

benj111 3mo ago
It's still $8000 per capita just for socialised healthcare. So still more than NL. The US has the worst of both worlds.
- brewdad 3mo ago
  The socialized segment of US healthcare is almost entirely the over 65 population and those too disabled to work any job. Obviously, the spending on those groups will be higher than the entire population as a whole. That it is does nothing to prove inefficiency.
  - benj111 3mo ago
    It kinda of does. Because you're still spending more than NL still have to worry about paying health insurance, still have to worry about how you're going to pay to give birth etc etc. To be clear this is per capita, not per recipient.

jmull 3mo ago

Isn’t healthcare is the prime example of government run programs being much more efficient and efficacious than privatized ones? The US has a massive tangled hodgepodge of private companies, having poor coverage, very high prices, and quite poor outcomes. Meanwhile there are numerous European countries with public healthcare systems that are far cheaper and provide much better outcomes. Here’s one of a million sources: https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/ https://www.pgpf.org/article/how-does-the-us-healthcare-syst...