But I've been reading about our system, since I fell down a rabbit hole a couple years ago. Things are bad, yes, but there are actually interesting ideas out there, and real efforts at reform that are being tried.
For example, did you know Maryland has a different way of funding hospitals than most other states? [0] And that other states are interested in copying it?
[0] https://www.vox.com/policy-and-politics/2020/1/22/21055118/m...
Each state should be free to experiment (as Maryland has done here) and the federal levels should be restricted to providing funding and basic guidelines that have to be met.
Part of the problem is that as you begin to delve in and see where the outflows are, you start to realize that fixing the fundamental problem involves making the people healthier in general, which will rumble the very foundations of Wall Street.
Many countries around the world enjoy the benefits of coordinated public health departments. Part of the United States' poor response to COVID was because there was no central public health department that could work closely with state agencies to e.g. provide data about what's going on, share best clinical practices, etc. Each state is an island.
So no, I don't agree that the only goal of the federal government should be piggy bank. States should have a lot of latitude with their policies, but generally standardizing things across the nation would be a net positive.
The problem in the US isn't that we can't do things, it's that nobody can agree on what to do. And to solve that problem, let states do their own thing as much as we can, and it'll become obvious where the good systems are.
Or in other words, an argument needs to be made why the EU "works" with individual "states" doing their own thing, but the US cannot "work" unless it's considered as one large country.
Wyoming has the population of Malta [1][2] but the GDP/capita of the United States and Norway [3][4]. It should be expected we'd have a different optimal solution from California.
[1] https://en.wikipedia.org/wiki/Wyoming 588,000 in 2024
[2] https://www.worldometers.info/world-population/population-by... 545,000
[3] https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ... $90,000 in 2024
[4] https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi... $90,000 and $92,000, respectively
It's too big for one-size-fits-all answers. Every state should be able to largely do its own thing as long as it isn't violating the Bill of Rights.
Now it's a one-party state, and the legislature might as well be the state Parliament, taking its marching orders straight from the DNC. The Governor is just as all-in on drinking the blue Kool-aid, and the state Supreme Court seems like it only exists to validate what the other two branches decide. And looking at places like Texas and Florida, seems like the same is happening on the other side of the aisle.
What's infuriating is there are conservatives in blue states and liberals in red states getting just steamrolled to the point of "why should I even vote or participate, when I'm just going to get told to sit down and shut up?" That's not healthy for democracy. The rights of the minority exist for a reason and you can't just vote things away because you have 50.01 percent of the vote.
This is a thing where having more parties would really help. If there were (say) 4 parties, each with ~25% of the seats, then they would have to bargain with each other and form coalitions, which I think would be a really healthy process for democracy.
Using a "first past the post" voting system structurally results in a two party system, because if there are more than two viable parties then the two parties most similar to each other split the vote and both lose to the third, which gives the first two an overwhelming incentive to merge with each other.
Score voting or STAR voting fixes this and allows you to have multiple parties. (Avoid IRV or similar systems, nearly anything is better than FPTP but if you're going to do it at all then do it properly.) Any states that could enact this via referendum are encouraged to do so.
> generally standardizing things across the nation would be a net positive.
The person you replied to said
> federal... should be restricted to providing...basic guidelines that have to be met
You may be closer in opinion than you realize.
Btw what the person you responded to described is how the Canadian healthcare system - which many liberal-type Americans on Reddit appear to admire - works. The federal government sets standards and provides some funding. The provinces implement it their own way.
(Another underlying reality is that the vast majority of people will say education and healthcare are "very important" but very few people will move to improve either of those - beyond going out of state for college.)
This is empirically false. People move to better school districts or enroll their children in private schools all the time. It doesn't require moving to a different state.
that's states' rights and it's enshrined in the constitution
> the only goal of the federal government should be piggy bank
that is indeed the only goal that the founders had in mind, as it should be
Many countries around the world are the size of a single state and lack the geographic diversity of the US.
If only we had some sort of federal Center in charge of Disease Control... ;-)
But I agree with you that the CDC was weirdly passive during COVID. You'd think it would have been their moment to shine.
One of the great failings caused by federalism and those who simp for it is that when a bad solution is arrived upon or a solution becomes outdated immeasurable suffering is caused and prolonged by not letting those states who want to try and improve do so.
There were a dozen states who were on the precipice of having this solved before the feds stuck their dick in it. Remember Romneycare?
If one state can manage to make it actually work, it might be enough.
I suspect less goes to executives than you think. Most of it is going to pay employees in the insurance industry.
The irony is that they are being paid to say "no." Perhaps if they instead went to work as service providers, we could get more services for what we spend.
Keep in mind this is just for Blue Shield California. There are executives of other health insurance systems in other states and regions who are making similar compensation.
However, I'll go ahead and say right now that I support the idea of these executives being paid these salaries, but on one condition: that we first achieve the goal of 100% of Americans having affordable access to healthcare. Once that goal is achieved, then we can start paying executives big bonuses and incentives. Deal? (Yeah, right...)
https://www.blueshieldca.com/content/dam/bsca/en/member/docs...
Below is a summary of the compensation paid in 2024 to Blue Shield of California’s President and Chief Executive Officer (CEO), Chief Financial Officer (CFO), and top three highest paid executives (other than the CEO and CFO) who were employed by Blue Shield of California at year-end.
Paul Markovich
President and Chief Executive Officer
$11,191,674
Sandra Clarke
EVP, Chief Operating Officer
$5,765,368
Peter Long
EVP, Strategy and Health Solutions
$4,360,245
Lisa Davis
EVP, Chief Information Officer
$2,873,613
Michael Stuart
EVP, Chief Financial Officer
$2,406,837
Some other CEOs:
Cerner (EMR provider to the VA), $35 million pay package: https://kffhealthnews.org/morning-breakout/cerner-to-pay-new...
Pfizer, $24.6M pay package: https://www.fiercepharma.com/pharma/rebound-year-pfizer-ceo-...
Epic Systems is a private company, so there's no executive pay information, but the founder Judy Falkner's estimated net worth is $7.8 billion. Perhaps Epic could reduce the price of its very expensive software for providers to help ease healthcare costs and maybe Judy could give up some of those billions and not notice any difference in her quality of life?
You may view those salaries as appropriate for leading companies of this size or immoral and outrageous. But either way executive comp is not the big problem with US healthcare costs.
For one thing, cutting out even that tiny 0.1%, that's a savings of $15 a year if I wasn't paying my insurance company's CEO. I would absolutely love to keep that $15. The idea that more than one dollar every single month from every single person is going to the CEOs of all our healthcare services is actually INSANE when you think about it.
0.1% is actually a LOW amount for some entities in the system. For example, the Cleveland Clinic spends 0.4% of revenue on executive compensation: https://projects.propublica.org/nonprofits/organizations/340...
That really means that out of my $14,570 yearly healthcare cost I could be paying something like $5/month just on executive salary. Who knows, maybe it's even more!
This is, again, insane. Why do Cleveland Clinic executives need to be paid $30 million/year?
This isn't administrative cost, like all the hard-working people who do the clerical work that keeps these systems operating. This is just the salaries of an extremely small group of people, less than 10 people per company.
All of these entities are allowed to make excess profit and/or have loose definitions of non-profit status, and pay CEOs dozens to hundreds of times the salary of their lowest paid employees. There isn't really a limit to the amount they can compensate top executives.
So they can hire bodyguards?
"Top healthcare companies spend 95% of profits on shareholders, study finds"
ref: https://www.healthcare-brew.com/stories/2025/02/21/top-healt...
Executives and shareholders are effectively one organism, with execs serving the function of disrupting the host for optimal extraction.
If we figure that every company involved in your $15k/year healthcare cost is paying 0.1-0.5% of their revenue to executive compensation (Cleveland Clinic as a random example pays 0.4% of revenue to the executives, $30 million) then we are talking about a small streaming video subscription worth of cost just which is allocated not on paying a productive group of administrators to keep the lights on, but instead paying excess incentives to an extremely small group of people.
In reality, if CEO compensation was capped to something reasonable like $500,000/year or 10x the pay of the lowest paid employee, there would still be CEOs and the quality of CEOs would not decline because it would still be the highest paid job on the market. Everyone involved in our economy would be just that much richer if the wealth wasn't getting unnecessarily concentrated.
And that's an argument you can certainly have, but it seems strange to make it a precondition to fixing the healthcare system, when cutting executive pay would resolve only a small fraction of the problem.
Uh, Blue Shield of California is a nonprofit mutual benefit corporation. There are no "unrealized capital gains."
I think about the fact that everyone in the hospital gets a private room a lot. Having a private room does not increase health outcomes at all, but it costs an absolute ton of money. It does increase satisfaction so it should be available, but hospital users should be able to choose shared rooms and get a portion of the savings they create but this just isnt possible in the US because of the incentives we've created.
Vertical integration.
UnitedHealthcare's (Larger insurance company in the US) profits are effectively limited by the Medical Loss Ratio rules from the Affordable Care Act.
But they are owned by UnitedHealth Group, which also owns OptumHealth (the largest network of physicians in the US), OptumRx (pharmacies), and OptumInsight (technology consulting, which goes into the COGS for UnitedHealthcare). This is where they make their profits.
UHG controls which physicians + pharmacies are in their network and what their negotiated rates for many services are (the exception being medicare + medicaid).
Here's a write up on their strategy: https://www.unionhealthcareinsight.com/post/unitedhealth-gro...
And an infographic that breaks it down: https://static.wixstatic.com/media/be1b8b_b0d4ebb04ce04b44a3...
they kinda have it on chart but without overhead numbers: insurance collects 1T of payments, than for business segments, they pay around 60% of that as medical expenses, and for individual plans it is more like 40% of medical expenses, meaning for individual plans insurance corps have 60% profit margin.
In my state, I pay $15k/year in school taxes, yet I have no children. I pay $1000/year in property taxes to support my city's library, yet I don't have a library card. People are taxed for lots of things they don't actually benefit from. I don't think we would need to force rich people to use the plans. If they want to buy medical services from private doctors, sure we can let them.
The issue then becomes more about allocation of resources (how many doctors are available to be seen on the public system vs. only available to self-pay customers) rather than the issue being about how to collect taxes.
(I personally don't mind subsidizing my library + local school district... good schools and libraries are good for the community)
Just sharing random coffee break thoughts... it always blows my mind is how many people _don't_ think like this. When base conditions improve for society, the conditions improve for _everyone_ regardless if they directly benefit you.
I'm also in the boat where I don't have kids, but I'd also like to live in a place that has educated people - so schools make perfect sense to me. Heck, even if I didn't benefit from it, providing children education is just the gosh-darn right thing to do.
It's just lack of trust. It's not that people want a worse community, it's that they have a hard time believing that taking extra money from their paycheck will create a better community.
Part of it is real; seeing massive amounts of state/local government waste and corruption makes it feel safer to keep your extra dollars instead of giving them away.
Part of it is difficulty evaluating timelines; more tax dollars for a better elementary school to be built in 3 years and to yield higher educated people 18 years from now it a lot to bet on.
"these benefit everyone including those who don't use them directly! how could you be against it?"
"this money that I'm having to pay is either overpaid to corrupt vendors, or just straight wasted, why would we ever want to increase how much we're paying into this system?"
in reality you can't have one without the other. it's up to each person to decide whether they can take the bad with the good
You're less likely to see sick people.
Healthy people are more productive (you'll have better businesses)
Healthy people are nicer (especially if we consider mental health, and then violence)
Healthy people use the ER less.
https://www.wsj.com/health/healthcare/medicaid-insurers-doct...
Does that mean we can’t have these things unless the wealthy want them?
it's even more complicated, because you can have insurance fully accepted at one clinic and "not contracted" with a different clinic. it's a total mess.
I spent 18 years in Canada. The healthcare I got was as good as anything I received in America (in both cases it depends on where you live, unfortunately) and looking ahead to 2026 was cheaper (comparing my tax burden in Ontario to the terrible insurance I can afford for 2026 in America).
At least in UK's chart, "GP & Primary Care", "Private GP Services" and "Administration" are separated. Same in Germany too.
Doctor time talking to an insurance company either directly or through paperwork is not actually providing any care during that time. Where things go vicious is because doctors are now so inefficient the time they are actually useful becomes increasingly valuable driving ever more paperwork to justify that time.
In private practice a physician now needs to handle extra employee(s), there’s often a range of software system issues etc. Even in a hospital setting where other people are handling most of this stuff that’s a long way from zero friction.
The insidious issue is even a 1% drop on doctor efficiency gets magnified by everyone taking a cut of the transaction.
I don't see a single outcome pointed at insurance companies... somehow.
> The outcome is $4.9T - which would make it the 3rd largest economy in the world, a high 8% admin costs - compared to the UK’s 2% admin, with medical bankruptcy still possible. We’ve never agreed on what we value. So we built a system that embodies our disagreement: employer-based coverage (market choice) plus Medicare (social insurance) plus Medicaid (safety net) plus exchanges (regulated markets).
> Decision #1: Workers pay at least twice
Here’s the first thing that jumps out: if you work a job in America (and you presumably do, to afford the internet where you’re reading this), you’re already paying for healthcare in multiple places on this chart:
Taxes: federal, state, and local taxes finance Medicare, Medicaid, and various public health programs in so many places. Our attempt at embedding it in single payer.
Payroll: if you’re employed, your employer pays taxes on Medicare (even though you presumably can’t use it until you retire at 65). This is a cost that doesn’t go to your salary.
Insurance premiums: get deducted from your paycheck to fund the employer group plans ($688B from employees alone).
The operational resistance alone would be too much: I’ve watched hospital execs squeeze out thinning margins and payer executives navigate quarterly earnings calls. We’re talking about unwinding a $1T+ private insurance industry, reconfiguring every hospital’s revenue model, and convincing Americans to trust the federal government with something they currently (sort of) get through their jobs. That ship didn’t just sail - it sank decades ago.
But the people in and using those industries have no desire to change so anything that does happen is likely to occur slowly from expansion - e.g, bringing Medicare to earlier and more people, and expand children coverage, etc.
1. Doctors, Nurses, Administration (management and field administration), other. We need to know total employment and total salaries (including private practices).
2. OTC, prescription and hospital administered drugs (separated for acute, such as ER, and chronic, such as inpatient and elective surgery). We need to know how much is being spent on these, which is _potentially_ one of the culprits of large discrepancy between US healthcare vs European healthcare. What would be great to have these by large cohorts of population (<20; 20-65; 66-85; 85<) and maybe the top 5 buckets (i am guessing: cardiovascular - chronic; diabetes; accidents; hospice; dialysis)
3. Facility expenses (rent, maintenance, utilities, other contractor)
4. Other
Without these, very hard to opine reasonably on the state of affairs. And to be fair, I suspect there is a reason why proper expense breakdowns are not available.
I've been on a mock jury for a personal injury lawsuit--and it was obvious to a couple of us that the smoking gun presented by the defense clearly showed she was running up the bill on something minor. We were pointing out the problem--did that sway the majority? No. The general opinion seemed to be she was owed something for what had happened--and they had failed on the voir dire, they asked about my background, didn't ask anything about family. Oops--I knew it would end up all going to the lawyer and doctors, nothing to her (the proposed amount was less than the bills she had run up.) I played it fair and didn't speak up about what would happen.
And all the national systems have a fox guarding the henhouse problem. Provide proper treatment for the expensive stuff or lower the standards? So long as you make a sufficient portion of the electorate think you're doing a good job the reality is the standards get lowered. And cook the books in pretending it's fair. (Two examples that come to mind: Including "fairness" in the measure of health system quality--automatic selection for UHC, and comparing infant mortality (they admitted the comparison was not valid, did it anyway.) The reality is the biggest "cause" of infant mortality in the developed world is how the medical world falls on the stillbirth/infant mortality line. Even elsewhere--Cuba gets it's good infant mortality numbers by setting a minimum birth weight. The ones that were born too early and never had a chance get classed as stillbirths.)
Is this funded by an insurance company?
It is a fairly effective system to extract money from customers (patients) while also ensuring that patients do not use too many services (afaik, US population has shorter life spans than rest of Western world).
We effectively do the same in New Zealand even though our healthcare system is very similar to the NHS. Once you go into state funded nursing, then you can keep NZ$284,636 of assets (if unmarried) and NZ$56 per week of any income. Median house price is NZ$770,000 so individuals often are forced to sell their home.
So effectively bankrupted although not quite $0.
When you work for money, you can do whatever you want with the money once you've earned it. But being compensated with "health insurance", you've got almost no control over it; you get what the company gives you - and btw, you can't purchase the same thing on your own, with your own money (way too expensive for most middle-class folks).
Detach health insurance from employment. Open "health insurance plans" to the free market, just like auto insurance. Free employers from all the administrative overhead of managing health insurance for employees (the stock market will love it!) And let health insurance companies work for their actual customers (health care patients!)
Or, just open Medicare to all.
It's hard to get an actual number, but many say nearly 1 million people work in health insurance in the US. And I'm not sure that even counts the people whose job it is to interface with them. That's a ton of jobs(and salaries) that likely wouldn't even exist in a sane system.
It's tracked by the Dept of Labor.
A friend of mine is rich. We both have a health insurance plan from UnitedHealthcare. His experience is radically different from mine. He can make a phone call, and actually talk to his doctor within a few minutes. He can see his doctor the same day he asks to. He talks to one person who manages all the BS for him.
Sounds a lot like the Spanish healthcare system.
Actually, the data doesn't even support that notion for the rich. But then, they can opt to fly to a specialist...
Every time we (the US) try to fix / change anything, a bunch of wonks with irrational arguments whine and complain until they get their way. The initiative fails, and we don't fix / change anything.
In short, we value letting irrational sabotage any form policy making; because we don't exclude people who negotiate in bad faith.
This whole thing loses all credibility by not listing those things.
Most people generally don't have a problem with the idea of being charged a fee for a healthcare service. They have a problem with a system that grossly inflates that fee so that people who had nothing to do with the service get paid at the expense of people who are ill or injured. And of course, with the people in the system who are heavily incentivized to make sure that those dead-weight actors get as much money as possible.
There is a healthy concept of insurance where people pay to hedge against potential risk, and that's all fine and good. But one of the most insidious social diseases is mandatory insurance, or industries expecting individuals to insure themselves in any capacity whatsoever.
It is never ok for a business (or government) to offer a service that comes with risks, but then ask their customers/subjects to insure themselves for the risk to the business/government.
If I am charging people $100 for a service, then I ask them to insure themselves and everyone reliably insures themselves (the majority at least), they can still afford to pay my me $100, so why don't i just raise the cost to $100+$10000 where $10000 is the maximum the insurance will pay? You see the problem right, all the insurance achieved is the increase in prices, people still pay the same, you just now have a middle-man economy sucking up all the wealth/value people are generating.
If we could all agree on one thing, I wish it would be this. No more mandatory insurance in any context. Not fire, not flood, not health, not cars. Optional is fine, people who can afford it can hedge against the risk. But a bank shouldn't require fire insurance on mortgaged homes.
Businesses must eat the cost of doing business, in the end the price increase they impose will be less than the price increase of insurance mandates. That, or greed should be a felony (not happening).
For health insurance, it should be a simple subsidy for those who can't pay out of pocket. Some industries must be regulated, even in a capitalist free-market country. Health care, prisons, law enforcement, defense contractors, banks to name a few. Regulated as in centrally price-controlled.
For uninsured people that get sick, house burns down, car accident,etc... the government (for health care) or businesses convert the cost to debt. Same as when someone takes out a mortgage and refuses to pay at some point, or refuses to pay their car notes.
It's like we have had this 50+ year running experiment, it's failing really badly and everyone is coming up with ideas that don't involve scraping the experiment, just modifying it and waiting a bit longer to see if it works out.
Theoretically because you are not the sole provider offering that service and the patient could go elsewhere, or in this case, the insurance company would require the patient to go elsewhere. Obviously, this sucks absolute donkey balls and health care will always involve a healthy dose of "I can't just shop around for where to get help for a heart attack".
In my naive opinion banning discriminatory pricing (no special negotiated insurance pricing), the sale of medical debt, and counting bill forgiveness as tax deductible charity would be a good start. With the absolute technical and capital-intensive marvel that is modern health care I just don't see anyone being able to reasonably get away with no insurance. Maybe there is a mandated co-insurance for all plans that could be covered by HSA accounts that everyone would get access to. That way there is a cost that is transparent to the patient that scales. At that point though I would just go to single payer.
(Rant incoming) Another thing that might need to happen is billing caps based off of certain outcomes. Especially in the emergency medicine realm. If you go to the emergency room and rack up a huge bill for something simple there should be a cap on the amount the hospital can actually recover. All I see is (rightfully) constant bitching and moaning from ER staff that people should be going to primary care or urgent care for issues which are less resource intensive and cheaper. The issue is the ER could provide those same services for just as cheap. Build out those same capabilities in or near the ER. The triage nurse can then send those low priority patients to the facility right down the hall. The issue is hospital admins have no incentive to do that, because as you said, why bill $200 when you can bill a minimum of $2,000 when you have your patient captive.
I also think it is silly we ask people to self-triage. It externalizes a lot of the costs to other parts of society. I can attest to this from the constant Volunteer Fire Department air-raid sirens I hear followed by a "EMS to Well Now Urgent Care for Patient in Distress". I'm sure the volleys love having their evening interrupted when it could have been a simple walk down an aisle.
I have no problem with the sale of medical debt--what's needed is sanity in the debt collection business. Combined with making one-party record the law of the land--you're automatically free to record telephone calls without notice.
Bill forgiveness as charity? No, that's counting twice. They didn't collect the debt in the first place, there is no profit to be taxed and thus you are deducting $0.
ER: Two problems here.
ERs are mandated to stabilize a patient, urgent cares are not. Thus you see people in ERs with situations that could be handled in an urgent care because the urgent care rejects them for unpaid bills. And the ER can't provide those services just as cheap--a big part of what you're paying for in the ER is potential even if it's not actually used. The freestanding radiologist books their machines as solid as can be done without too much friction. The ER needs the same machines but needs them available NOW. I've been in an urgent care over a kidney stone--they had a CAT manned and ready to go at 3am (the only urgent care in town even open at those hours even before you consider the machines--every ER needs those machines 24/7.) CATs don't cost much to run, the main cost is the machine and personnel time (operator and radiologist) and that's incurred whether it's doing anything useful or not. (And then the urgent care punted anyway. Yeah, you're right, stone, we can't deal with it, go over to the ER.)
I will also say that transport isn't always as simple as you make it out to be. Consider that stone I just mentioned--the ER was half a mile away, trivial under normal conditions. Even under those conditions I could have *slowly* walked it--except there was a major street in the way and I most definitely did not want to cross that. Is a taxi going to take the call? No. Call a friend/rideshare/ambulance.
Bill forgiveness doesn't necessarily target the for-profit hospitals. Not talking about debt discharge. It actually probably isn't even the right term. Essentially what shouldn't be allowed is non-profit hospitals counting discounts for low-income individuals as charity performed by hospital. The value of the charity shouldn't be sticker price but actual cost of services. Maybe that is already the case, but what I hear from randoms suggest that is why some hospitals are happy to "work" with you on your bill. I shouldn't have included "tax-deductible" in there, this is more about maintaining non-profit status.
RE ER. I don't see how keeping the ER and Urgent Care separate matters. In a combined system you would still have two sets of doctors, two sets of CAT scan machines and operators and radiologists, okay maybe not separate but the capacity for both (an appropriately reserved). In the current system you actually have more overhead from having a whole separate billing system, HR, building, landscaping, etc. Yes, the ER still needs to stabilize a patient whether they can pay or not but that becomes *cheaper* when you have a whole other pipeline to send them to. You aren't engaging a highly paid ER doctor and set of ER nurses to prescribe antibiotics to the homeless person that just came in. You can have the RN, or an internal medicine doctor do it instead in the area down the hall. If at any point that homeless person starts to code or the RN/Internal Med doc identifies something concerning, they can get them over to the ER. But again, if you are the hospital why would you do this? You can take in that homeless patient and charge them big money for some antibiotics and hopefully get reimbursed by the government. It's not like the hospital would even lose money on it, you would still charge for the urgent care services, just at the reduced reasonable price it takes to provide them plus a little more. Heck, I'm sure that an urgent care wing incorporated into an ER would beat any standalone urgent care in the business sense, you've generally got a whole waiting room full of prospective customers.. but alas.. you would cannibalize your ER "sales".
And if that cannibalization of ER sales would leave the ER unprofitable, then raise your prices! I don't think any reasonable person would be mad if you charged what it actually costs to provide lifesaving care. Insurance companies would be okay with paying real costs for the fewer cases of legitimate emergencies if they know that the much more common cases of people going to the ER for more minor things would be much cheaper. I would posit that with urgent care support you would need less ER capacity as you wouldn't have it filled up with non-emergent cases.
And yeah, it would be ideal to have them in the same building close together. Retrofitting would be hard or impossible. It would mostly be for new hospitals going forward. It all boils down to designing hospitals to be the most efficient as possible at providing care to patients, not efficiency on generating the most profits.
Maybe not now, but 10-ish years ago that was the French system. Very poor people get outpatient care that is free at the point of service. Everyone else gets highly regulated private insurance with a strong market component. Emergent/inpatient care is provided by hospitals that aren't part of the insurance system.
There are definitely some trade-offs there, but I wouldn't be opposed to such a system in the US.
> The $441B in prescription drugs - the story of incentivizing American innovation over price controls.
This itself speaks for how messedup the entire design is.
In other words, allow US citizens to "opt out" of the US healthcare system and participate in the German one? You'd have to make some allowances for replacing taxes with costs, billing, and allow "German" healthcare to operate in the US ...
We see similar things in education. People wonder how many European systems are cheaper than US universities: Well, it's very easy to see once you attend a university in Spain and then one in the US. The shape of the university, from facilities to salaries to class sizes, make them look like completely different organisms, even though 18 year olds come in from one side and come out with degrees in the other. And note that this is also connected to healthcare: How many doctors do we train, or bring in from other countries? How many years do they spend training, and how much debt do they incur getting training? How much are they going to ask in pay just to handle that debt?
Changing the US system is a very good idea, but the changes would be very traumatic to most people working for the system, or invested in the system. All of them would lobby against changes that make their lives worse, and therefore makes legislature that makes the change happen very difficult to pass.
Seems fine? Especially if you subtract a substantial amount of benefits fringe.
Normal specialists in the US out-earn chief physicians in Germany by hundreds of thousands of dollars. All the fringe benefits in the world aren’t gonna buy you a new boat.
Source: am a US physician.
Why do people readily accept this for everything else, but don't see the reality in regards to healthcare?
and also "free market"?
oh, and just for fun, also define "outcome"
2) The "efficient" option is to let the big problems die.
that is _not_ synonymous with "absent of regulation."
market failures exist, believe it or not.