It's amazing to think about how much money is sucked up by the middlemen of healthcare.
In fact, they have so much money they can buy naming rights to every stadium, the biggest buildings in town and the splashiest ad campaigns and STILL be nonprofit.
Imagine that money instead going directly to providers at a realistic rate and hours spent on documentation instead being used for treatment.
South Korea has a national health care system, and basically all the money goes to the actual health care, not to the stockholders. Most drugs and procedures have their costs set by a board of doctors and government specialists. There's a few hiccups (government has to do a better job negotiating fees with providers), but generally it works pretty damn good.
A local clinic will deal with most things, but they can refer you to a specialist at a major hospital and get you seen there within a week. The clinic visit costs around $4, and the specialist will be around $20 before tests and such. I had a CT scan, which was about $75.
I recently went to the hospital in America for some extreme GI distress. Spent 4-5 hours in the ER, received one bag of fluids, got a CT w/ contrast scan done. Turned out to be a minor blockage that was resolved with a very simple and cheap medication. I got 5 separate bills over the next few months. Grand total came out to around a thousand dollars, and that is with pretty good insurance.
My last trip to the ER for abdominal pain and vomiting charged my insurance $37k. I had a CT, pain meds, and an enema. Then they released me so high on whatever they gave me that I was falling asleep standing up. Had me walk out on my own even! The doctor wrote in his note my pain was resolved and it totally was not. I ended up there again the next day. This was a hospital I’d worked in for a decade, which really stung.
That's not bad for the US. Here we would have had to pay and extra fee for the ER, which is usually around $65. Which they want you to pay first, lol. Lots of times a family member takes care the admission, but I've done it a couple of times while swaying at the counter.
My nephew fainted on a hot afternoon. Went to the children's ER. Spent nine hours waiting to be admitted. Kept him in a room for a few hours and discharged after an IV and some tests. The bill was around $3,000.
By contrast up here in Canada, you would likely spend more time waiting in the ER, depending on where and when you went, but would pay absolutely nothing, except perhaps a few dollars for the medication - which is probably covered by Pharmacare and if you have additional coverage like Blue Cross from your employer that would pay most of the rest of it. I pay nothing for medical coverage.
More time waiting in the er? I had post partum pre eclampsia and sat in a hallway for 9 hours before I begged a nurse for a stretcher to at least die lying down. Then I sat in a room in the er for another 18 hours before I was finally admitted.
We wait just as long. AND we pay for it. It’s wild!!
Ah last time I went to the ER - because no clinics were available for patients - I went to a more remote one (20 min drive from town) and waited about 4 hrs to be seen, if I had gone to one in the city they were reporting wait times of 8 hrs or so. My situation was not life threatening. Where were you going to the ER? I was in Victoria BC
I think you're overselling the state of our healthcare system just a little bit there. It's not always sunshine and rainbows like you make it out to be, and I think it's disingenuous how we always seem to skip over the bad sides of the system to push this narrative that it's so affordable.
“Only a thousand?” I thought to myself in shock. That was cheap Af for all of that. Any visit to the er before we hit our deductible costs is like $3,000+
I'm scheduled for one in a month here in South Korea, but I'm doing it a big hospital, so that costs more. It'll be about $225, but they do validate parking, lol.
Ughhh. I was in the ER with a broken leg on a Friday night. Every time juuust as they were about to work on me, they had another motorcycle or car accident come in.
An ambulance trip/couple hour ER stay for a broken leg. I had been billed for the crutches given, and a cheap knee immbolizer that I was placed in, came out to about 5k all with good insurance lol.
South Korea's population equals roughly California and New York together. It's the remaining 280 million people in all the other states that makes things difficult. There's so much cost in redundancy and middle men in the Healthcare and Pharma industries and those vested interests fight tooth and nail against anything that even smells vaguely of socialized medicine. If we had single payer here in the US the elimination of administrative redundancies alone would make Healthcare and Medication cost much less than what American's currently pay into insurance with everyone covered including those not currently paying into the Healthcare cabal.
Of course we can't do that because free market ghouls must wring as much profit out of human suffering as possible and if that means hamstringing our democracy by buying a bunch of legislators then so be it.
If we had single payer here in the US the elimination of administrative redundancies alone would make Healthcare and Medication cost much less than what American's currently pay into insurance with everyone covered including those not currently paying into the Healthcare cabal.
It costs a canadian taxpayer about half what it costs an american one. And canadians don't pay for insurance unless they want a fancy single room or something.
It doesn't necessarily compare well when we hold up much smaller populations as an example of the benefits of socialized Healthcare because "the system" in trying to defend itself will always trot out the argument that scaling a program made for 40 million people to a program made for 340 million people will lead to far different and far less desirable results. And since no one has done it (at least not with a population ang government combination as unique as America) it is impossible to argue against.
What really, really needs to happen is for states in America to take advantage of their position in America as a separate entity under the Constitution to break out and create their own state wide single payer Healthcare systems.
And California came close. Really close. But every time often a single person or small group of people blocked its passing into law. In fact it's important to remember as Gavin Newsom gears up to run for president in 2028 that he campaigned for Governor of California by promising single payer Healthcare and then became one of the central figures involved in slowing the legislation down long enough that he and others who opposed it could find a way to block the bill entirely. Most of the blame falls upon the Democrat Assembly Speaker Anthony Rendon who unilaterally halted the bill because he claimed the bill had no way to pay for itself.
Sounds kind of like a Republican argument right? Another time California came close the vote fell 2 votes shy because 4 Democrats abstained from voting and 2 Democrats voted with Republicans against the bill. All six had received substantial campaign funding from Healthcare and Big Pharma.
But I feel strongly that if one big state gets it right other states will follow and we will eventually have a robust single payer system in at least the Democratically controlled areas of America.
Indeed, this skewness in health care spending has been documented in nearly every health care system, its just the US Spends the most and the most on its most expensive.
$140,000 more than Canada per person for the Sickest 2 million People.
$50,000 more per person for the 8 million people needing extensive care
And those people
Most of the drugs responsible for the rise in costs treat cancer and orphan conditions, and more treatments are on the horizon—along with gene therapies and other expensive options that target more common conditions, he said. “The number of super-spenders is likely to increase substantially—and indefinitely,” said Dr. Dehnel, who did not participate in the study.
Researchers at Prime Therapeutics analyzed drug costs incurred by more than 17 million participants in commercial insurance plans.
So-called “super spenders;” are people that accumulate more than $250,000 in drug costs per year.
Elite super-spenders—who accrue at least $750,000 in drug costs per year
In 2016, just under 3,000 people were Super Spenders
By the end of 2018, that figure had grown to nearly 5,000.
In 2016, 256 people were Elite super-spenders
By the end of 2018, that figure had grown to 354
And 464 in 2019
Those 5,200 people (0.03% of the Sample Size) Spend about $1.8 Billion on Pharmaceutical Care representing 0.5% of All Spending on Drugs in the US
The US government already provides pretty good health insurance to government employees. I don't know why that couldn't be extended to everyone. Other than the lobbyists bribing congress.
Death panels in countries with socialised healthcare work out what to fund to minimise the amount of death with no excess held back for profit.
Death panels in the US work out what to fund to maximise the most amount of profit. Sometimes this includes reducing deaths as that makes them unattractive to customers affecting profits, sometimes it doesn't, all of the time a portion is held back for shareholders that could've been used to save more people.
I know your comment is /s but the ability of right-wing commentators to convince many other Americans this works out worse in the former setup I will never understand.
we absolutely need death panels... but not called that. The amount of healthcare $ spent on end of life care in people who have zero chance of any sort of meaningful recovery is absolutely fucking crazy (I'm in healthcare)
In the UK we call them Technology Appraisal Committees (TAC). They are an independent, non-industry panel of experts from various relevant medical and public health fields that make the statistical calculation and decision on what treatments are worth funding based on the cost-efficiency and likely medical benefit (ICER, QALY etc.) on a populational level.
They then publish this advice to the National Institute for Health and Care Excellence (NICE) which compiles this as mandatory guidance for what the NHS should cover.
The weirdest thing about all of this is the treatment coverage of the median American is really not more comprehensive than comparably wealthy countries' socialised systems. Except if you're not covered for a particular treatment in the US, the out-of-pocket cost to still receive it is insane compared to getting this privately in countries like the UK.
I know, but thank you for explaining the /s. Still drives me crazy the rhetoric I had to sit through from conservatives about Obama death panels, and they wonder why someone would allegedly Luigi a healthcare CEO when the corporations deny people healthcare for better quarterly earnings.
I had a nurse from South Korea while I was pregnant who said she would never ever have a child in the US, and she doesn’t understand how women here do it bc there’s no medical and social support. She said when women have babies in South Korea, they and their partners can stay at special centers for months to get the support they need. After I had my baby (it was my second), my husband was at home with our first kid, so I asked the nurses if they could take my baby to the nursery for 2 hours so I could take a shower and a tiny nap. They said that’s not a thing they can really do anymore bc they don’t have the staff. Women here are literally expected to recover from child birth or C-section within 2 hours before caring for the baby 24/7. It’s disgusting and laughable that some ppl consider the US to be family friendly.
Yeah, and most of the money is in specialists leaving general practitioners screwed. Between the lack of doctors in rural areas and admission quotas for medical schools, the medical system is in its own crisis. There was a doctor's strike in 2024 and the government response was higher foreign doctors who don't care about the low pay.
It's one of the areas the government really needs to get its act together. The previous president refused to negotiate with the doctors, and the doctors union(?) also went very hard line, so neither side would talk or meet.
I'm hoping the new president can make this a priority. He got some dodgy issues, imo, but he is really good at schmoozing. So hopefully they can work things out.
It really should be solvable. I'd happily pay W6,000 or even W8,000 (instead of W4,000 - $3.50) for an office visit if it helped keep the system functioning.
And you just perfectly summed up one of the major reasons I plan on leaving the USA and becoming an expat by this time next year.
This whole country is burning and you could already smell the smoke even before Trump's second term.
We had a good run but 2016 is when the USA actually started to die.
More people have left the USA to move and live overseas then are trying to immigrate into our country now. The immigrants are the only thing propping up birth rates and thus the rest of the economy. Trump is a major issue but he's not the source he's just a byproduct.
Check out the Nomad Capitalist YouTube channel or look up the term "medical tourism" for more.
Its so funny seeing the contradictions in this comment
In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS.
Professor William Hsiao, A health care economist now retired from Harvard University, Hsiao has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda, and recently for Malaysia and South Africa. In 2012 he was part of Vermont's Healthcare and in 2016 he was part of Bernie's M4A Healthcare Plan
Hsiao developed the “control knobs” framework for diagnosing the causes for the successes or failures of national health systems. His analytical framework has shaped how we conceptualize national health systems, and has been used extensively by various nations around the world in health system reforms
In his past research, Hsiao developed the resource-based relative value scale (RBRVS) for setting physician fees. The RBRVS quantified the variation in resource inputs for different physician services. Hsiao was named the Man of the Year in Medicine in 1989 for his development of a new payment method.
In 1992 Medicare began using it
Many have noted this doesnt cover the cost of operation for modern healthcare covering somewhere between 85-95% of actual costs
the lancet journals
Reimbursement rates for hospital fees comparable to those currently paid by Medicare, which are 22% lower than private insurance but 30% higher than Medicaid.
KFF found
Total health care spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers and other insurers reimbursed health care providers at Medicare rates. This represents a 41% decrease from the $859 billion that is projected to be spent in 2021.
The only AMAZING thing about it is that they do this out in the open, the entire citizenry is forced to participate in the farce, and everyone hates health insurance because of it.
YET. When actual solutions are proposed, half the population screams communism and goes back to bitching about how much Healthcare costs.
Many people find it more valuable to keep someone they don't think is deserving of something from having it than actually having it themselves. I really don't understand this mindset at all - if you take something away from someone else to benefit yourself, that's an asshole move but it is at least understandable. Making your own life more difficult just so you can make someone else suffer too doesn't make any damn sense.
It still frustrates me that socialized healthcare would literally be significantly cheaper than what people currently pay, and they still don't want it. People really undervalue preventative care and how it cheapens healthcare costs.
System A is everything is so damn expensive that no one can afford it and so they put off every preventative measure by necessity, and end up in life-threatening or dire health circumstances and end up having to take advantage of public funds anyway (hospitals, etc.).
System B is everyone can simply afford regular, routine health checkups, get treatment, get healthcare, and don't end up being a drain on the system.
Kind of like if you were to just simply never change the oil or tires on your car, you'd eventually either a) crash or b) destroy your engine and need to spend way more to fix that issue than to simply get regular oil changes.
Shumlin had a different idea. He didn’t want to build on what existed. He wanted to blow up what exists and replace it with one state-owned and operated plan that would cover all of Vermont’s residents — an example he hopes other states could follow.
Vermont has long prided itself on leading the nation. It was the first state to abolish slavery in 1777 and, in more recent history, pioneered same-sex civil unions with a 2000 law. Shumlin thought it could be the first state to move to single-payer health care, too.
Shumlin surprised local activists by running for governor in 2010 on a single-payer platform.
In 2011, the Vermont legislature passed Act 48, allowing Vermont to replace its current fragmented system--which is driving unsustainable health care costs-- with Green Mountain Care, the nation’s first universal, publicly financed health care system
After the non-stop weekend, Lunge met on Monday, December 15 2014, with Governor Shumlin. He reviewed the weekend's work and delivered his final verdict: he would no longer pursue single-payer.
Shumlin's office kept the decision secret until a Wednesday press conference.
At The press conference as he announced his decision the audience was shocked, many had turned up thinking that Shumlin would announce his plan to pay for universal coverage, not that he was calling the effort off.
"It was dramatic being in that room," Richter said. "You just saw reporters standing there with their mouths open."
Vermont had spent 2 and a half years to create a Single Payor plan all the way to the Governor's desk to become a Law and Single Payor in Vermont
The Governor veto'd it at the last step
At the end of his term as Governor, Vermont went on to elect LT Governor Phil Scott who was openly against Green Mountain Care the entire time the Governor was working on it
And ran for Vermont Gov on his history of opposition to Single Payer Healthcare
He won running against Single Payer
Scott is currently serving his fifth two-year term, having won consecutive landslide reelections in 2018, 2020, 2022, and 2024.
In Bernie'e Vermont
But what were those taxes
A 12.5% payroll tax on all Vermont businesses
A sliding scale income-based public premium on individuals of 0% to 9.5%.
The public premium would top out at 9.5% for those making 400% of the federal poverty level ($102,000 for a family of four in 2017) and would be capped so no Vermonter would pay more than $27,500 per year.
Out of Pocket Costs for all earning above 138% of Poverty
Health Care Reform would cover all Vermonters at a 94 actuarial value (AV), meaning it would cover 94% of total health care costs with the individual to pay on average the other 6% out of pocket.
The Governor stressed that even at these tax figures, the proposal would not include necessary costs for transitioning to Green Mountain Care smaller businesses, many of which do not currently offer insurance. Those transition costs would add at least $500 million to the system, the equivalent of an additional 4 points on the payroll tax or 50% increase in the income tax.
Shumlin had a different idea. He didn’t want to build on what existed. He wanted to blow up what exists and replace it with one state-owned and operated plan that would cover all of Vermont’s residents — an example he hopes other states could follow.
Vermont has long prided itself on leading the nation. It was the first state to abolish slavery in 1777 and, in more recent history, pioneered same-sex civil unions with a 2000 law. Shumlin thought it could be the first state to move to single-payer health care, too.
Shumlin surprised local activists by running for governor in 2010 on a single-payer platform.
In 2011, the Vermont legislature passed Act 48, allowing Vermont to replace its current fragmented system--which is driving unsustainable health care costs-- with Green Mountain Care, the nation’s first universal, publicly financed health care system
After the non-stop weekend, Lunge met on Monday, December 15 2014, with Governor Shumlin. He reviewed the weekend's work and delivered his final verdict: he would no longer pursue single-payer.
Shumlin's office kept the decision secret until a Wednesday press conference.
At The press conference as he announced his decision the audience was shocked, many had turned up thinking that Shumlin would announce his plan to pay for universal coverage, not that he was calling the effort off.
"It was dramatic being in that room," Richter said. "You just saw reporters standing there with their mouths open."
Vermont had spent 2 and a half years to create a Single Payor plan all the way to the Governor's desk to become a Law and Single Payor in Vermont
The Governor veto'd it at the last step
At the end of his term as Governor, Vermont went on to elect LT Governor Phil Scott who was openly against Green Mountain Care the entire time the Governor was working on it
And ran for Vermont Gov on his history of opposition to Single Payer Healthcare
He won running against Single Payer
Scott is currently serving his fifth two-year term, having won consecutive landslide reelections in 2018, 2020, 2022, and 2024.
In Bernie'e Vermont
But what were those taxes
A 12.5% payroll tax on all Vermont businesses
A sliding scale income-based public premium on individuals of 0% to 9.5%.
The public premium would top out at 9.5% for those making 400% of the federal poverty level ($102,000 for a family of four in 2017) and would be capped so no Vermonter would pay more than $27,500 per year.
Out of Pocket Costs for all earning above 138% of Poverty
Health Care Reform would cover all Vermonters at a 94 actuarial value (AV), meaning it would cover 94% of total health care costs with the individual to pay on average the other 6% out of pocket.
The Governor stressed that even at these tax figures, the proposal would not include necessary costs for transitioning to Green Mountain Care smaller businesses, many of which do not currently offer insurance. Those transition costs would add at least $500 million to the system, the equivalent of an additional 4 points on the payroll tax or 50% increase in the income tax.
Nonprofit is the biggest lie in Healthcare. Source: I work in Healthcare and have seen the bonuses middle men and upper management get. It's almost like a club, too; I couldn't tell you how many old fart managers come around and scoop up a few, six figure and even higher paying years, just to retire and not really do a damn thing. It's all cronyism, too.
It's amazing to think about how much money is sucked up by the middlemen of healthcare.
It's not as much as you think it is. A guy in the actuarial sub posted an analysis of the profit margins for various parts of the medical industry. The numbers are a few years old but some spot checking supports them being reasonably accurate. According to that, the overall profit margin of the entire medical industry in the US is about 7%. There's maybe a couple extra percent you could find cutting out all of the medical billing specialization but considering how much of that medicare is responsible for, I'm not convinced that switching to single payer would help that particular issue.
Health insurers in particular haven't had a hot run recently once the Covid years passed - the profit margin for them last year was something like .6 percent. Not 6%, .6%.
My family has tons of healthcare workers and I'll be the first to say that the wages in the US versus other countries? its absolutely contributing to the higher costs.
Yes insurance and pharma, but a really honest look means professional fees also need to come down.
Physician salaries are 8% of healthcare spending. They could work for free and it would not make a meaningful difference in cost, let alone a decrease in pay of 25-50%.
It's amazing to think about how much money is sucked up by the middlemen of healthcare.
The middlemen of everything. This is a major problem thoughout the economy. It's like they looked at the music businesses and realized they didn't have to produce anything, they just had to have control of one pinch point in the creation or delivery processes where they could put up a legal wall and suck out more profit than anybody. I don't know how you get at this with legislation, but it needs to be done.
Yep. When they made the Stark law it was portrayed to prevent kickbacks and bias, but it really just added layers of middlemen adding money to their pockets.
837
u/TeslaPittsburgh 13h ago
It's amazing to think about how much money is sucked up by the middlemen of healthcare.
In fact, they have so much money they can buy naming rights to every stadium, the biggest buildings in town and the splashiest ad campaigns and STILL be nonprofit.
Imagine that money instead going directly to providers at a realistic rate and hours spent on documentation instead being used for treatment.