4 ms·

A lot of the reason hospitals have to charge so much is that they take massive losses on uninsured people in emergency rooms. Medicare for all means they don't

A lot of the reason hospitals have to charge so much is that they take massive losses on uninsured people in emergency rooms. Medicare for all means they don't have to treat anyone for free.

mirzap 2mo ago
They are not taking any losses; they just charge the regular price with a very tiny profit margin. US healthcare costs are heavily inflated. Insurance is a scam that lets the rich get richer. All insurance should be non-profit. We all contribute to the pool at a time when we don't need it so we can use the money when we do, not to make CEOs or stockholders rich. That is how an insurance pool should work. Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary.
- Georgelemental 2mo ago
  No. Under EMTALA, hospitals are required to treat anyone who shows up to the ER regardless of ability to pay; this is an unfunded mandate.
- gizmo686 2mo ago
  It doesn't matter what they charge if the patient doesn't pay it; which is what often happens with uninsured people showing up at the ER. > Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary Under the ACA, excess money in the pool must be rebated to policy holders. In practice, this worked for a few years, but eventually insurance companies ended up increasing cost in order to increase the absolute amount they were allowed to keep. Maybe this is still good (more claims approved), but it is counter productive to the goal of reducing healthcare costs.
  - nradov 2mo ago
    It often happens with insured people showing up at the ER as well. Many patients don't pay their bills, either because they can't afford it or are just deadbeats. As overall healthcare costs have increased, insurers and employers have shifted more costs to plan members through higher deductibles / co-pays / co-insurance. So hospitals end up with a lot more bad debt, and this in turn causes further price inflation.
    - eclipticplane 2mo ago
      Carriers and providers don't make this easy, either. I had a recent doctor's visit, with very good healthcare coverage, that was an in-network facility but an out-of-network provider. Coverage would have kicked in if I had a referral from my PCP, but my PCP recently retired and I was advocating for my own health for a small dermatological issue. They said it was cosmetic, my old PCP said it was not. I got a stack of 10 bills over many months all stating different things -- everything from $0 EOB to over $2k in uncovered expenses. No one would take ownership of sorting out what I was on the hook for. No one I talked to was empowered to actually solve it. It wasn't an affordability problem over $2k (but would be for my elderly grandparents on fixed income). Even asking "If I give you $2k does that resolve the debt?" was answered with "we won't know until we apply the payment" type non-answers. Burn the whole stack down -or- earn enough you can operate on cash for the tier of care you want. Nothing inbetween seems to be working.
- qwytw 2mo ago
  > All insurance should be non-profit. Aren't their profits regulated regardless? If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically? There are many factors, e.g. amongst other things American doctors are better paid than just about anywhere else in the world.
  - qurren 2mo ago
    The bigger factor in the American system is taxes. If everyone in the healthcare industry stack, from suppliers to nurses, is exempt from federal and state taxes, healthcare costs could come down by 70%+.
  - cogman10 2mo ago
    > Aren't their profits regulated regardless? Yes and no. It's sort of a weird thing where insurance is somewhat regulated nationally but also regulated in a piecemeal fashion state by state. There's a non-government standards body called the NAIC which provided national guidance for insurers. Most (all?) states basically say that "if you follow NAIC standards, you are good". > If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically? It's a huge mess. It's not even really a profit vs non-profit thing but rather "what's the motivation". One major issue is that the ACA put in a loss ratio of 80%. Which isn't a terrible thing in principle, it forces insurance companies to spend money on treatment. The problem is it also means that the profit of insurance companies is tied directly to how much they spend on healthcare. As a result, they are incentivized to spend more, not less, on medical treatments so they can justify higher premiums. This is a big part of why I think universal public insurance is a must. Basically the only organization that's motivated to keep costs as low as possible is the government. > American doctors are better paid than just about anywhere else in the world. This is a problem, but the bigger issue and why doctors are paid so well is because becoming a doctor is one of the more costly and hard to do things in america. There are limited spots, schools, and residency requirements that severely restricts the number of possible doctors we add per year. That drives up the their salaries. I have a nephew going to medical school in Idaho of all places, and he's looking at $500k in debt by the end of the whole ordeal.
- nradov 2mo ago
  I'm not necessarily opposed to making all health plans non-profit, but that's kind of a red herring. Many of the largest insurers, like most Blue Cross Blue Shield Association members and EmblemHealth, are already non-profit. They generally don't charge plan members any less than their for-profit peers.
- eclipticplane 2mo ago
  > They are not taking any losses; Not really accurate if you look at the closure of rural and smaller city healthcare facilities. They don't have the base to charge "regular price" to make up for the aging, less healthy, rural populations. We all pay for it, but some pay heavier costs than others.
- bopou 2mo ago
  "Insurance is a scam that lets the rich get richer. All insurance should be non-profit." Such empty platitudes never made for a good argument.
smallmancontrov 2mo ago
No, this absolutely does not explain the US's wildly off-base per-capita expenditure because uninsured people still go in the denominator of the per-capita figure! I'm sure the per-insured-capita figure is worse but that's not what we are comparing! Americans are constantly trying to exclude uninsured people from their statistics (and, worse, from the care itself) but the comparable countries don't do this so it is utterly ridiculous to propose that the correct statistical comparison is one in which the US excludes the undesirables while other countries don't. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Total health spending per capita in PPP$ 2024 2023 2022 United States 14,885 13,818 12,898 Switzerland 9,963 9,301 9,089 Norway 9,393 8,909 8,533 Germany 9,365 8,503 8,652 Netherlands 8,436 7,615 7,517 Austria 8,401 7,697 7,700 Luxembourg 8,087 7,173 6,854 Sweden 7,871 7,364 6,977 Ireland 7,813 7,027 6,748 Belgium 7,750 7,178 6,906 Australia 7,469 7,015 6,907
- Scoundreller 2mo ago
  The fun part is when you break those numbers down between government and non-government expenditure. You’ll find that US governmental spending on health care per capita is higher than every other country’s entire (gov and non-gov) spending per capita. https://www.oecd.org/en/publications/health-at-a-glance-2025_8f9e3f98-en/full-report/health-expenditure-per-capita_affe6b0a.html#title-1855a8b826 https://www.oecd.org/en/publications/health-at-a-glance-2025...
  - qwytw 2mo ago
    That number seems hard to believe? Specifically that non government spending would be this low. Presumably "compulsory" includes way more than direct government spending. https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locations=OE-US-CH https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locat... According to the world bank it's closer to 40:60 (government spending still being the majority). So that puts it behind Switzerland but still more than combined spending in just about any other country.
tptacek 2mo ago
That claim is at odds with the working paper's methodology, which gets a good chunk of the $1T in savings it discussed by assuming very sharp cuts to practitioner compensation.
pstuart 2mo ago
It also means that emergency rooms can be used just for emergencies and ongoing and preventative care can happen in clinics. Cheaper to operate and preventing preventable emergencies lowers the load.
- cwmoore 2mo ago
  Usually tied to employer coverage contracts, and with strictly limited menu of offerings for patient health needs.
- analog31 2mo ago
  Here's what happens in my locale. If you show up in an ER, they quickly decide whether you need emergency care, or regular urgent care, delivered in the same facility. And medicine is anything if not statistical, so they know the amount of each kind of service that they need to plan for.
  - Auracle 1mo ago
    In my locale urgent care is only open from like 9am-4pm on weekdays, reduced hours on Saturdays, and closed on Sundays. I could make observations about who tends to be there at either but that might rustle some jimmies.
    - analog31 1mo ago
      My jimmies are hard to rustle. I'm fortunate that I have flexible hours, and can leave work if I need to visit a clinic. If either of my adult kids gets sick, they start making calls to find someone who can take their shift. So I suspect it boils down to individual or family circumstances.
cwmoore 2mo ago
A lot of the rest of the reasons are carrying the deadweight of administering regulation, and dancing with the existing and prospective malpractice suits that randomly benefit the system sometimes, but always cost everybody, and warp the practice of medicine and patient healthcare experiences.
- nradov 2mo ago
  So what's the solution? Some states have already limited malpractice liability but that hasn't done much to hold down costs. When patients are harmed by preventable medical errors they should be compensated.
  - cwmoore 2mo ago
    The solution is NOT to decide on one problem at a time to all agree on solving by incremental compromise, or trust free market competition driving what is in reality a non-free market. Most patients never file a lawsuit, even if things don't go well, and most injuries that aren't deaths or newsworthy are not worth the trouble to an "overburdened" court system itself imposing a lot of burdens. And the quality life years lost waiting to share a verdict with attorneys ought to count for everyone affected, not just those who spearhead a trial by catastrophe. I think the solution is to make the practice of medicine more scientific, and less dominated by competitive incentives, but as long as research and development, reform, or even consumer choice, is strictly a cost, that will be considered "too expensive", if not "too risky".
    - nradov 2mo ago
      That's a non answer. The medical profession is already embracing evidence-based medicine as well as specific tools such as checklists and EHRs to reduce preventable errors. But there will always be some providers who are simply sloppy or incompetent or even malicious. Nothing else you proposed is actionable, just vague complaints and hand waving.
    - cwmoore 2mo ago
      [dead]
brandonb 2mo ago
Uncompensated care attributable from uninsured patients is ~2–3% of operating revenue/costs. So it's there but not massive.
- deleted 2mo ago
  [deleted]

A lot of the reason hospitals have to charge so much is that they take massive losses on uninsured people in emergency rooms. Medicare for all means they don't have to treat anyone for free.

mirzap 2mo ago

They are not taking any losses; they just charge the regular price with a very tiny profit margin. US healthcare costs are heavily inflated. Insurance is a scam that lets the rich get richer. All insurance should be non-profit. We all contribute to the pool at a time when we don't need it so we can use the money when we do, not to make CEOs or stockholders rich. That is how an insurance pool should work. Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary.

Georgelemental 2mo ago
No. Under EMTALA, hospitals are required to treat anyone who shows up to the ER regardless of ability to pay; this is an unfunded mandate.
gizmo686 2mo ago
It doesn't matter what they charge if the patient doesn't pay it; which is what often happens with uninsured people showing up at the ER. > Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary Under the ACA, excess money in the pool must be rebated to policy holders. In practice, this worked for a few years, but eventually insurance companies ended up increasing cost in order to increase the absolute amount they were allowed to keep. Maybe this is still good (more claims approved), but it is counter productive to the goal of reducing healthcare costs.
- nradov 2mo ago
  It often happens with insured people showing up at the ER as well. Many patients don't pay their bills, either because they can't afford it or are just deadbeats. As overall healthcare costs have increased, insurers and employers have shifted more costs to plan members through higher deductibles / co-pays / co-insurance. So hospitals end up with a lot more bad debt, and this in turn causes further price inflation.
  - eclipticplane 2mo ago
    Carriers and providers don't make this easy, either. I had a recent doctor's visit, with very good healthcare coverage, that was an in-network facility but an out-of-network provider. Coverage would have kicked in if I had a referral from my PCP, but my PCP recently retired and I was advocating for my own health for a small dermatological issue. They said it was cosmetic, my old PCP said it was not. I got a stack of 10 bills over many months all stating different things -- everything from $0 EOB to over $2k in uncovered expenses. No one would take ownership of sorting out what I was on the hook for. No one I talked to was empowered to actually solve it. It wasn't an affordability problem over $2k (but would be for my elderly grandparents on fixed income). Even asking "If I give you $2k does that resolve the debt?" was answered with "we won't know until we apply the payment" type non-answers. Burn the whole stack down -or- earn enough you can operate on cash for the tier of care you want. Nothing inbetween seems to be working.
qwytw 2mo ago
> All insurance should be non-profit. Aren't their profits regulated regardless? If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically? There are many factors, e.g. amongst other things American doctors are better paid than just about anywhere else in the world.
- qurren 2mo ago
  The bigger factor in the American system is taxes. If everyone in the healthcare industry stack, from suppliers to nurses, is exempt from federal and state taxes, healthcare costs could come down by 70%+.
- cogman10 2mo ago
  > Aren't their profits regulated regardless? Yes and no. It's sort of a weird thing where insurance is somewhat regulated nationally but also regulated in a piecemeal fashion state by state. There's a non-government standards body called the NAIC which provided national guidance for insurers. Most (all?) states basically say that "if you follow NAIC standards, you are good". > If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically? It's a huge mess. It's not even really a profit vs non-profit thing but rather "what's the motivation". One major issue is that the ACA put in a loss ratio of 80%. Which isn't a terrible thing in principle, it forces insurance companies to spend money on treatment. The problem is it also means that the profit of insurance companies is tied directly to how much they spend on healthcare. As a result, they are incentivized to spend more, not less, on medical treatments so they can justify higher premiums. This is a big part of why I think universal public insurance is a must. Basically the only organization that's motivated to keep costs as low as possible is the government. > American doctors are better paid than just about anywhere else in the world. This is a problem, but the bigger issue and why doctors are paid so well is because becoming a doctor is one of the more costly and hard to do things in america. There are limited spots, schools, and residency requirements that severely restricts the number of possible doctors we add per year. That drives up the their salaries. I have a nephew going to medical school in Idaho of all places, and he's looking at $500k in debt by the end of the whole ordeal.
nradov 2mo ago
I'm not necessarily opposed to making all health plans non-profit, but that's kind of a red herring. Many of the largest insurers, like most Blue Cross Blue Shield Association members and EmblemHealth, are already non-profit. They generally don't charge plan members any less than their for-profit peers.
eclipticplane 2mo ago
> They are not taking any losses; Not really accurate if you look at the closure of rural and smaller city healthcare facilities. They don't have the base to charge "regular price" to make up for the aging, less healthy, rural populations. We all pay for it, but some pay heavier costs than others.
bopou 2mo ago
"Insurance is a scam that lets the rich get richer. All insurance should be non-profit." Such empty platitudes never made for a good argument.

smallmancontrov 2mo ago

No, this absolutely does not explain the US's wildly off-base per-capita expenditure because uninsured people still go in the denominator of the per-capita figure! I'm sure the per-insured-capita figure is worse but that's not what we are comparing! Americans are constantly trying to exclude uninsured people from their statistics (and, worse, from the care itself) but the comparable countries don't do this so it is utterly ridiculous to propose that the correct statistical comparison is one in which the US excludes the undesirables while other countries don't. 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... Total health spending per capita in PPP$ 2024 2023 2022 United States 14,885 13,818 12,898 Switzerland 9,963 9,301 9,089 Norway 9,393 8,909 8,533 Germany 9,365 8,503 8,652 Netherlands 8,436 7,615 7,517 Austria 8,401 7,697 7,700 Luxembourg 8,087 7,173 6,854 Sweden 7,871 7,364 6,977 Ireland 7,813 7,027 6,748 Belgium 7,750 7,178 6,906 Australia 7,469 7,015 6,907

Scoundreller 2mo ago
The fun part is when you break those numbers down between government and non-government expenditure. You’ll find that US governmental spending on health care per capita is higher than every other country’s entire (gov and non-gov) spending per capita. https://www.oecd.org/en/publications/health-at-a-glance-2025_8f9e3f98-en/full-report/health-expenditure-per-capita_affe6b0a.html#title-1855a8b826 https://www.oecd.org/en/publications/health-at-a-glance-2025...
- qwytw 2mo ago
  That number seems hard to believe? Specifically that non government spending would be this low. Presumably "compulsory" includes way more than direct government spending. https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locations=OE-US-CH https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locat... According to the world bank it's closer to 40:60 (government spending still being the majority). So that puts it behind Switzerland but still more than combined spending in just about any other country.

tptacek 2mo ago

That claim is at odds with the working paper's methodology, which gets a good chunk of the $1T in savings it discussed by assuming very sharp cuts to practitioner compensation.

pstuart 2mo ago

It also means that emergency rooms can be used just for emergencies and ongoing and preventative care can happen in clinics. Cheaper to operate and preventing preventable emergencies lowers the load.

cwmoore 2mo ago
Usually tied to employer coverage contracts, and with strictly limited menu of offerings for patient health needs.
analog31 2mo ago
Here's what happens in my locale. If you show up in an ER, they quickly decide whether you need emergency care, or regular urgent care, delivered in the same facility. And medicine is anything if not statistical, so they know the amount of each kind of service that they need to plan for.
- Auracle 1mo ago
  In my locale urgent care is only open from like 9am-4pm on weekdays, reduced hours on Saturdays, and closed on Sundays. I could make observations about who tends to be there at either but that might rustle some jimmies.
  - analog31 1mo ago
    My jimmies are hard to rustle. I'm fortunate that I have flexible hours, and can leave work if I need to visit a clinic. If either of my adult kids gets sick, they start making calls to find someone who can take their shift. So I suspect it boils down to individual or family circumstances.

cwmoore 2mo ago

A lot of the rest of the reasons are carrying the deadweight of administering regulation, and dancing with the existing and prospective malpractice suits that randomly benefit the system sometimes, but always cost everybody, and warp the practice of medicine and patient healthcare experiences.

nradov 2mo ago
So what's the solution? Some states have already limited malpractice liability but that hasn't done much to hold down costs. When patients are harmed by preventable medical errors they should be compensated.
- cwmoore 2mo ago
  The solution is NOT to decide on one problem at a time to all agree on solving by incremental compromise, or trust free market competition driving what is in reality a non-free market. Most patients never file a lawsuit, even if things don't go well, and most injuries that aren't deaths or newsworthy are not worth the trouble to an "overburdened" court system itself imposing a lot of burdens. And the quality life years lost waiting to share a verdict with attorneys ought to count for everyone affected, not just those who spearhead a trial by catastrophe. I think the solution is to make the practice of medicine more scientific, and less dominated by competitive incentives, but as long as research and development, reform, or even consumer choice, is strictly a cost, that will be considered "too expensive", if not "too risky".
  - nradov 2mo ago
    That's a non answer. The medical profession is already embracing evidence-based medicine as well as specific tools such as checklists and EHRs to reduce preventable errors. But there will always be some providers who are simply sloppy or incompetent or even malicious. Nothing else you proposed is actionable, just vague complaints and hand waving.
  - cwmoore 2mo ago
    [dead]

brandonb 2mo ago

Uncompensated care attributable from uninsured patients is ~2–3% of operating revenue/costs. So it's there but not massive.

deleted 2mo ago
[deleted]