I was paying around $1200/month last year (a little under that with subsidy).
This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before).
So I guess I'm on a primary care physician merry go round :D
I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered.
But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
> But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.
This is not specifically just a lapse in subsidies for high earners, this is for everyone which is telling how little people actually understand what will happen when the subsidies expire.
The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1].
I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees.
I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("
If you're getting health insurance through your employer, that's a pretty standard price (counting both your contribution and your employer's together).
I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month.
It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately.
I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half.
A switch to a private insurance would lower the costs around half.
I was under the impression that German healthcare was essentially free (government funded) at the point of delivery, with additional top-insurance carried by most people similar to how it is in here in France.
Here I am self-employed and pay about 100 euros a month in top-up insurance (mutuelle) for myself and a couple of kids. Of course, the healthcare costs more, that’s why my taxes are high; but the insurance cost is about €1200 a year, not €2200 a month.
Free at point of delivery does not mean free at all. Netflix is also free when delivering you movies, but it costs a monthly fee.
I think it’s time that we all stop with the nonsense that government funded healthcare is free. Because who ends up funding the government are us, the citizens, and that costs lots of money.
Some governments, like the German one, still make the costs transparent to the citizen, something you can even see in your payslip. Other governments, after failed policies and extreme inefficiencies, hide that and just budget healthcare costs out of the rest of the taxes.
In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. When governments hide that type of information is because they actually do have something they don’t want the normal citizen to see. And that’s worrying and not democratic at all.
My understanding (British citizen living in Berlin) is that the German system looks and acts like a tax, but is actually mandatory payments to one of a handful of almost-but-not-quite-identical private insurance companies, with care being free-at-point-of-use.
It's possible to opt out if you're rich enough, but if you change your mind later it's very hard to return to the normal system.
I'm currently not working*, my monthly insurance cost is €257,78.
* thanks to my very cheap lifestyle, my passive income of only about €1k/month means I don't strictly speaking need to work ever again.
Nevertheless, I am treating this time as a learning opportunity with a view to being able to change career path, given that I think LLMs make the "write the code" skill I've been leaning on for the last two decades redundant in favour of, at a minimum, all the other aspects of "engineering", "product management", and "QA", and possibly quite a bit more than that.
Plus, y'know, get that B1 certificate so I can get dual citizenship.
That will be hard to explain in English but you can find what you're paying to French healthcare system by looking at your paycheck (the document you receive every month that detail your paycheck rather). It basically either 7% or 13% of your paycheck (and .5% of non-work income via the CSG), and you have a hard cap on total contributions (4k/month, and healthcare if a bit more than half of that, so a bit more than 2k/month). It cover universal healthcare of course , but also maternity/paternity leave and invalidity benefits.
Paternity/maternity also cover the pension parents get (half a year of contribution to the pension system per child if you take care of them til they are 13, plus half a month for giving birth) (that's so awkward explaining this in English, sorry)
The maximum personal contribution to public health insurance (GKV) is capped at around 400/m for healthcare (and an additional 200 towards long-term/elderly care). Spouse and children are free if they are unemployed.
If you are paying more than that then you are already paying for private health insurance (PKV) or private supplementation on top of GKV for some premium coverage.
I am not mistaken. I know how to read my own payslip.
Both me and my wife are employed. We have GKV both and we’re basically paying the maximum rate. That’s around €1100/month each, pre-tax. Half of it comes from my official bruto salary and the other half comes from my unofficial bruto salary. Which is how governments hide the costs of public healthcare. Ultimately is part of my salary deductions for the finances of my employer.
Kids are not free: kids doctors don’t work for free. They need to be payed, and they’re paid from the contributions me and other employed fellow citizens pay every month.
> Both me and my wife are employed. We have GKV both and we’re basically paying the maximum rate.
So you aren't paying for your wife - she is paying for herself.
> That’s around €1100/month each, pre-tax
I provided a link in my previous comment to an English language PDF with the exact figures. To get to 1100 you must be also including long-term/elderly care, and then doubling the total to include the employer contribution.
> Ultimately is part of my salary deductions
The employer contribution DOES NOT come out of your salary.
> how governments hide the costs of public healthcare
They literally don't.
> Kids are not free
Don't be pedantic. Your contribution is the same whether you have kids or not.
###
FYI, as you are over the threshold you literally don't need to pay towards GKV, and as you stated you can get private insurance (PKV) with lower premiums (although usually with limited coverage and/or co-payment). So the option is there for you to take.
My Employer sponsored supposedly nice insurance (I say supposedly because they keep being a pain in the ass for pretty much everything) is $200+ per paycheck for me and my spouse, i.e. ~$450/month. That is after my employer covers most of the cost. This stuff is ridiculous.
>Allen is herself a casualty. While she used to pay $487.50 a month, her new healthcare plan, with reduced coverage, has monthly premiums of $1,967.50.
Brutal.
Meanwhile the White House calls it all "fake news".
Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.)
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.”
Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.
You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.
And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right?
As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.
I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot.
In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
In this day and age public healthcare system are not efficient and bill the wrong people.
They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners.
However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country.
These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system.
Private systems work better because each citizen pays into his old age health coverage during his young years.
> In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.
Costs when you get older skyrocket, but not your monthly contribution.
You subsidize your own elderly costs by paying slightly more during your younger years. That slightly more is part of the insurance companies Float, which gets invested and is used 30-40 years later to cover your extra costs in old age.
In a public system there’s no float. Everyone pays to cover the costs of the healthcare for that budget year. Which has the consequence that whenever there are population age shifts, the system becomes not sustainable, which is our current situation in Germany.
If everyone (except unemployed) had private health insurance, population age would be non-problem.
ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population.
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you:
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
You comment sounds like snark but I understand if you don't know what Obamacare is.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.
> the previous administration thought everyone should be "temporarily" paying for her plan. Moving money from person A to person B obviously doesn't make anything cheaper
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
I support subsidies to help low-income citizens who legitimately can't afford health insurance, but some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line.
I don't want my tax dollars wasted on subsidizing them. Give the money to someone who actually needs it.
(Of course the real problem is healthcare costs accelerating out of control. Insurance subsidies won't fix that problem. In fact they make it worse by encouraging healthcare providers and drug companies to raise prices even faster.)
If we start to think about who "actually needs" things, we need to question whether any of the very wealthy "actually need" their wealth. I would be fine with seizing all of anyone's income (including unrealized capital gains) in excess of, say, $20 million just to give everyone else some cute stickers and lollipops. The giant flow of wealth to those at the top is a far greater misallocation than any amount towards the healthcare of anyone not at the top.
> some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line
These are legitimate complaints. Trashing the system because it's overly generous in some respects is insane.
I’m one of those retirees. It’s OK. I was prepared for this, and can afford it, but a hell of a lot of others on a fixed income, are totally screwed.
> Give the money to someone who actually needs it.
Like billionaires. They are the ones that really need it, and they get it; every time. Those yachts don’t pay for themselves.
If anyone thinks poors will be getting any help, they are fooling themselves. Helping poor people is quite unpopular, in the US (where they conveniently forget that most of them are born in the US white, but politicians make it seem as if they are all dark-skinned immigrants). Many of the hardest-hit states will be ones that enthusiastically voted for this.
GP is saying that they’re okay giving up buying first-class tickets if it means someone else gets to live. (Because they pay more for health insurance, which allows someone else to pay less.)
As a supporter of single payer(or really, anything else), I support this move. When half the nation is on subsidized healthcare they aren't so likely to care about costs.
Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families.
Bronze plans with $5-6k deductibles have always ran more than what people paid for rent. Healthcare is the one thing that's outpaced inflation in higher education.
Very good unsubsidized health insurance wasn’t anywhere close to 2k/month inflation adjusted the last time I used COBRA to continue my employer’s insurance after getting laid off.
The underlying issue is inflation adjusted healthcare related spending increased 6x per person since 1970. Some of that is an increase in quality, but middleman are a huge factor.
So first you say it has always cost this much, but in the next breath you say that its cost has outpaced a high rate of inflation. Mathematically, these can't both be true.
Mine has tripled, but last year, I was actually getting some govt help. Not this year. I am fortunate to be able to afford it, but it’s just less than my mortgage.
This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home.
Obamacare is like the NHS, in the UK. Everyone likes to bitch about it, but woe unto the politician that messes with it.
The equally insidious thing is that when they get hit with the new premium anyone who took better coverage, like a silver plan for the ACA, will likely be "forced" to downgrade to a lower (bronze) plan, which means that when they actually get services their costs will further skyrocket (higher deductibles and out of pockets).
Talking about all hell breaking loose... Marjorie Taylor Greene announces her resignation specifically because of rising health care costs (yeah, I'm cynical,there's maybe more to it). Mamdani gets elected on a platform that's essentially "shit costs too much." Maybe folks on both sides are starting to wake up. A guy can dream...
MTG just got her pension. I doubt healthcare costs have anything substantively to do with it. Someone just wants to avoid digging a hole any deeper than they have.
One thing that I’ve been trying to understand about this discourse:
Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed?
In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?
There's a third piece too, which is that insurers are ramping price much faster than inflation. Our (unsubsidized) premiums increased 20% year-over-year, after also increasing faster than the rate of inflation the last few years.
Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get very weird in the near future.
That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much.
Yes to both. High costs were previously partly hidden by subsidies for some consumers purchasing individual or family policies on state ACA exchanges, and now many of them will be forced to pay something closer to the true market price. But just like with college tuition, when the government throws money at a problem that ends up causing costs to explode without permanently improving affordability.
There can be no market clearing price, because healthcare demand is unlimited.
In some countries supply is rationed by using different means such as waiting lists, budgets for funding, or even corruption (I witnessed this in Cuba).
Year-over-year increase in GDP in the U.S. right now is almost exclusively “production” output from the healthcare industry, whose profits are stratospheric and rising. So there’s two useful datapoints here: first, the bill must be paid, or U.S. GDP growth year-over-year falters, not because healthcare costs this much; and second, household debt continues to increase year-over-year to permit continued wage stagnation. Whether insurers end up lowering their profits (and thus prices) as the subsidy expires centers around whether banks extend further debt as a household wages subsidy. As of right now, that seems to be continuing, even though some of that debt market is in the midst of a small crash, so insurers (who have no regulatory limits on profit levels) are unlikely to lower their profit targets as subsidies end.
So long as the political will of U.S. leadership supports that continued profit, and either government and/or banks subsidize worker wages to cover the increased profits, then we’ll continue seeing growth in costs on paper before subsidies. This growth in profits/prices could not be sustained on wages alone, given the continuing decline of inflation-adjusted worker earnings; and so to answer your question, yes: the act of subsidizing is what’s enabling the prices being charged; but, no: the costs of providing healthcare to any one person of a given age are not increasing due to subsidies; just the profits.
Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care?
If you want to understand where the money is actually going then this Peter Attia Drive podcast episode with Dr. Saum Sutaria is the best high level overview that I've heard. Seriously it's worth listening to and will clear up a lot of the misconceptions that many people have.
Doctors are by far the highest paid professional occupation in America. The AMA is the most powerful trade union in history and restricts the number of new doctors, pushing up prices.
Specialist doctors are one of the highest paid professions in almost all countries. There are hardly any jobs more important than those of say a heart surgeon or a neurosurgeon.
I have some questions but I don't want to offend anybody. Aren't there any methods to contract the healthcare to lower the prices down? I heard that in UK they have some requirements that the prices must not go higher than... For a given type of service. Also I read a lot of articles that giving a tablet to a hospitalised person costs 20-50 bucks and people are generally running away from ambulances to not pay
It's a twisty maze of passages, all alike as they say. They have entire classes of certifications for understanding how medical and insurance billing works in this country.
Your taxes would double, and don't even bother trying to say they wouldn't literally every country with public health care pays twice as much as we do in tax
Yep, you and your employer pay $3500/month for the premium. Then you as an individual have a $12k to $15k per year deductible before the insurance even kicks in.
That’s grossly exaggerated. Individual deductibles are limited by law to ~$6500 even on the worst plans. And no one is paying $3500 per month for individual coverage on one of those plans. The actual rates depend on age and zip code, but I’d be very surprised if they’re that high anywhere.
To see the actual costs for yourself, go to healthcare.gov. The “bronze” plans are the ones with high deductibles. If you’re young and healthy, a high-deductible plan combined with an HSA is a very good idea.
People do do that in some limited cases, but it's often impractical. Two common cases are a) there is a need for urgent/emergency care; or b) the patient is generally frail and infirm. In these cases it can be impossible or impractical to arrange for treatment outside the US. That's leaving aside the logistical difficulty of arranging it (plus the costs for travel, etc. associated with carrying out the plan).
Never, because the person who cleans your toilet cannot simply hop on a flight to Mexico every time she needs surgery. But that's also not a great solution for society, to have the software developer caste be the only ones who can afford medicine by taking an expensive vacation.
I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing looks daft from that angle too.
The US, today, is set up very well for wealthy people. The health care system works great for them. Their doctors are amongst the best in the world. Same with the hospitals they use. The costs are manageable if not reasonable for all of those people. And you can actually go beyond health care and find that almost everything in the US is pretty high quality for wealthy people. Housing, their neighborhoods, their schools, etc. That might help explain why the system is set up the way it is. Everything cascades from there.
All of these can be great, but the class of people that make a neighborhood in "the heights" won't have dog barking, basketballs, drugs and gunshots. The people that don't live in "the heights" could decide tomorrow to no longer have those 4 things either - but they don't because - it's a different class of people.
There is no US healthcare "system" in the sense of having a cohesive entity pursuing a unified goal. It's a bunch of separate entities each pursuing their own goals, often in conflict with each other. If we were designing a healthcare system from scratch it obviously wouldn't look anything like what we have today. But we arrived here through a process that economists call "path dependence", and this makes it stubbornly resistant to systemic improvements.
It's weird to me that americans, especially educated professional americans, have become much more quiet in their online presence due to all the crisis they are facing- what we have now is pretty different
PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, which doesn't seem politically likely.
I'm so sick of this trope. "It's the insurance companies!" "No, it's private equity!" "No, it's the PBMs!" I don't care. Jesus Christ, going to the doctor is rapidly becoming unattainable for more and more people, including the PMC now, and all of the rich people are simply pointing at each other saying "it's the other guy!".
No, it's not fair to argue that. While PE has done some roll ups with certain specialties in certain areas the big health systems are mostly not owned by PE firms. In some areas they're literally owned by churches. I'm not defending abusive PE practices here but if we want to fix anything we need to be clear about what's actually happening.
"Healthcare administrator's growth in the US. Healthcare administrator's growth by 3200% between 1975 and 2010 compared to 150% Physician growth according to Athena Health analysis of data from Bureau of Labor Statistics, the National Center of Health Statistics, and the United States Census Bureau's Current Population survey in accordance to [26]. Admin: administration; HIPAA: Health Insurance Portability and Accountability Act; HITECH Act: Health Information Technology for Economic and Clinical Health Act; DRGs: diagnosis-related group's."
The only class of medical services that has become more affordable over the last 50 years is cosmetic procedures and laser eye surgery:
What value addition do the administrators provide? It might be helpful to understand why competing hospitals still find it useful to employ these people even if the cost is so high.
If a competing hospital can provide equivalent service while also not spending so much on an administrator, why didn't they already do it?
Answering myself, apparently it is a fight between administrators on the hospital end and the administrators on the insurance company end.
The insurance administrators are fighting to provide as less reimbursement as possible and the hospital administrators are fighting to provide as much reimbursement as possible. The administrators are probably doing compliance work, negotiations.
I wonder whether regulations can be used to cap the role of administrators at the expense of slightly less efficient market - this might work if administrators are just adversarially interacting and reducing their scope can help the overall picture.
The administrative overhead is necessary in order to get money from the insurance companies. Without the administrators too administrate and fill out copious amounts of paperwork, the hospital won't get paid by the insurance companies, and if the hospital don't get no money, they can't pay their staff, and staff tend to like getting paid.
This is how the world ends. Administrators on both sides being replaced by AI and consuming all the worlds available compute arguing with each other about healthcare bills.
Unpopular opinion: Evil and greedy insurers are not the biggest problem. The biggest problem is the socialized costs of sugar drinks, junk food, and sedentary life. The food industry operates like a drug cartel who starts the pipeline getting children addicted.
That combined with outrageously expensive magic pill healthcare. A situation partly caused because doctors can't tell patients they are too fat and lazy. Because feelings and hate-crime.
We desperately need to vastly increase the number of physicians in this country to decrease costs. The AMA is the most powerful trade union in history and has locked the number of new doctors a year for many years now. Restricting supply for a service with inelastic demand skyrockets prices and lines their pockets.
Bullshit. The AMA is a voluntary membership organization, not a trade union. They have no power to set prices or engage in collective bargaining.
The immediate bottleneck on producing more physicians is limited Medicare funding for residency slots. Every year some students graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back.
That’s a meaningless statement, look for an actual percentage here.
Healthcare costs have been spiraling for decades in the US, the ACA didn’t impact the long term trends to a noticeable degree. Actual healthcare reform could drive down costs massively, but that would mean a fuck load of people in medical billing getting laid off. Instead you’re paying for your doctor to talk with your insurance provider often for longer than they spend working with you, that’s the ultimate issue with US healthcare costs. Inflation adjusted “healthcare” spending is up from 2,100$/person in 1970 to 14,570 in 2023.
What did the ACA require that shouldn't be part of healthcare in one the wealthiest countries in the world?
Annual check ups? Cancer screenings? Maternity care? Basic mental health?
Forcing the insurance companies to accept patients with preexisting conditions?
These services should be available to everyone.
If a developed country cannot provide these things to its citizens it's a failing state in my book.
You don't need it until you need it, and needing it often comes in the form of a lightning strike from blue sky. The counterargument is that having everyone pay a higher amount makes it feasible to actually have this coverage available, when needed, without bankrupting the insurance companies, because the rare astronomically expensive care is covered by the premiums paid by the vast majority of people who are relatively healthy and are unlikely to need it.
Now whether the on-paper prices for medical care in this country actually have any relationship to objective reality is an entirely separate question of course. In general coming from an outside perspective, combining healthcare and for-profit motives in a single system seems particularly likely to lead to all kinds of perverse incentives, but, it's the system that exists, and it seems unlikely to change any time soon.
What I don't understand however is what IS actually expensive about the care itself?
Doc will get paid his normal rate, $500k per year (maybe more maybe less?)
Nurses all get paid something between 100k and 200k (maybe more maybe less?)
Then we hear about these surgeries that cost 100k.
What exactly is costing 100k for 5 hours of knife and time in a bed?
Wildfire, I understand, there is no way to re-materialize a house for less than (what is basically a fortune these days). But time and materials for a surgery seem to me that it should cost 5k at most?
And at those rates, wouldn't everyone just pay like $15 a month? And if the answer to this question is malpractice costs, can we have two plans:
Technically not. In many states you have the option of posting a refundable security deposit with the government to meet the minimum liability requirement as an alternative to purchasing auto insurance.
The main point of health insurance is to cover things that most people don't need. Prior to the ACA, most health plans had lifetime coverage limits which could leave patients with serious conditions financially ruined or unable to access care. The ACA removed those limits so naturally coverage is now more expensive.
Bronze plan is shitty catastrophic insurance at like 5x the actuarial cost to try to fund risk pool and all the mandated benefits thst the o/p alluded to
Off the top of my head maternity/neonatal/family planning type of benefits are mandatory for obamacare compliant plans. That essentially outlawed all the affordable young adult catastrophic plans.
I have spent some time looking at healthcare costs, but I have not seen maternity/neonatal/family planning as a significant driver of costs. It would be surprising if so, given falling birthrates and growth in the elderly population.
What you're, essentially, advocating for is a massive increase in premiums for families so that people without children can get a tax cut. Which would objectively benefit me, but would be incredibly disastrous for American society in general which is already struggling with insane family care costs. I would really hope you could see why the second order effects on such a change would be a bad idea.
Which are the specific things you think most people don't need coverage for? Prior to the ACA, it was pretty common to hear stories of people not on employer plans who were shocked to discover a coverage gap they have. Most people don't have much expertise in evaluating healthcare coverage and deciding which services they might need.
Same, but it’s hard to imagine these kind of alternative medicine services are driving huge premium increases. Because they don’t work they tend to be pretty cheap to provide.
> The end result is we all have Cadillac plans that most people don't need.
That's right, those pesky things the ACA says should be covered like emergency services, ambulances and prescription drugs is definitely the issue here. You've definitely found the problem.
I can't believe people keep repeating this lie. Did no one live prior to the ACA where you could easily go bankrupt because your insurance decided it didn't cover things like hospital bills? Because I sure as fuck remember, considering that's what bankrupted my parents.
It should be mentioned that the US has very high wages, and even when subtracting substantial health care insurance cost, the income likely remains higher than what people earn in most other countries.
If you have a high paying job in the US it usually comes with legitimate health insurance paid for by your employer, meaning most of the cost of most healthcare is covered.
If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage.
ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations.
You should go tell that to the waiters who are working for tips.
Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare.
Not to mention you get actual vacation time in Europe and a higher standard of living generally.
Don'tcha know, the only real jobs are "software developer" and "haver of lots of money for investing in software developers". Everyone else can pay $10,000 for their surgery.
it's sarcasm. a lot of arguments against social services like universal health care boil down to "well taxation is theft and therefore they're not actually free because they pay higher taxes"
Reading this sent me down a bit of an OECD data rabbit hole. They seem to agree. However once you read the fine print I'm not so sure. Many things are much more costly in the US (education, travel, food, vehicles, houses...) and the OECD data seems to not control for that. Also my personal experience is there are a large number of very poor people in the USA. Seems like more than in Western Europe for example.
In case you are wandering where the money goes. If you need a gall bladder removed or an appendix removed the bill to you might be $10,000-30,000 but the surgeon, for all of their care and time with you, is compensated less than $100.
I'm confident a surgeon in America is paid more than 100$ for a surgery. They are paid about 400k a year on average. Do the math yourself.
On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations
I did get my gall bladder removed in July, and I know paid my surgeon a lot more than a 100 bucks, which was just the smaller deductible portion of the bill.
I was paying around $1200/month last year (a little under that with subsidy).
This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before).
So I guess I'm on a primary care physician merry go round :D
I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered.
But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
> But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.
This is not specifically just a lapse in subsidies for high earners, this is for everyone which is telling how little people actually understand what will happen when the subsidies expire.
The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1].
[1] https://www.kff.org/affordable-care-act/aca-marketplace-prem...
my premium actually went down because my carrier left aca, but there are no longer any carriers with a decent network in the exchange.
the networks in the illinois aca suck if you live in the chicago area.
You go without coverage of course. Unfortunately.
(It's getting late, Jeff. I'm heading to bed myself.)
I'm so, so sorry to hear this. Can you share which state you're in?
My man, this is the Raspberry Pi guy, Jeff Greeling. He lives in St. Louis, MO.
He is a god, and we mere mortals.
For those like me, who also had no idea:
https://www.jeffgeerling.com/about
He is impressive.
I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees.
I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("
Excuse me, but how in the world were you able to afford 1200/month, you know that's like cheap rent right?
If you're getting health insurance through your employer, that's a pretty standard price (counting both your contribution and your employer's together).
I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month.
It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately.
That’s absolutely not an exception.
I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half.
A switch to a private insurance would lower the costs around half.
I was under the impression that German healthcare was essentially free (government funded) at the point of delivery, with additional top-insurance carried by most people similar to how it is in here in France.
Here I am self-employed and pay about 100 euros a month in top-up insurance (mutuelle) for myself and a couple of kids. Of course, the healthcare costs more, that’s why my taxes are high; but the insurance cost is about €1200 a year, not €2200 a month.
Free at point of delivery does not mean free at all. Netflix is also free when delivering you movies, but it costs a monthly fee.
I think it’s time that we all stop with the nonsense that government funded healthcare is free. Because who ends up funding the government are us, the citizens, and that costs lots of money.
Some governments, like the German one, still make the costs transparent to the citizen, something you can even see in your payslip. Other governments, after failed policies and extreme inefficiencies, hide that and just budget healthcare costs out of the rest of the taxes.
In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. When governments hide that type of information is because they actually do have something they don’t want the normal citizen to see. And that’s worrying and not democratic at all.
My understanding (British citizen living in Berlin) is that the German system looks and acts like a tax, but is actually mandatory payments to one of a handful of almost-but-not-quite-identical private insurance companies, with care being free-at-point-of-use.
It's possible to opt out if you're rich enough, but if you change your mind later it's very hard to return to the normal system.
I'm currently not working*, my monthly insurance cost is €257,78.
* thanks to my very cheap lifestyle, my passive income of only about €1k/month means I don't strictly speaking need to work ever again.
Nevertheless, I am treating this time as a learning opportunity with a view to being able to change career path, given that I think LLMs make the "write the code" skill I've been leaning on for the last two decades redundant in favour of, at a minimum, all the other aspects of "engineering", "product management", and "QA", and possibly quite a bit more than that.
Plus, y'know, get that B1 certificate so I can get dual citizenship.
That will be hard to explain in English but you can find what you're paying to French healthcare system by looking at your paycheck (the document you receive every month that detail your paycheck rather). It basically either 7% or 13% of your paycheck (and .5% of non-work income via the CSG), and you have a hard cap on total contributions (4k/month, and healthcare if a bit more than half of that, so a bit more than 2k/month). It cover universal healthcare of course , but also maternity/paternity leave and invalidity benefits.
Paternity/maternity also cover the pension parents get (half a year of contribution to the pension system per child if you take care of them til they are 13, plus half a month for giving birth) (that's so awkward explaining this in English, sorry)
You must be mistaken…
The maximum personal contribution to public health insurance (GKV) is capped at around 400/m for healthcare (and an additional 200 towards long-term/elderly care). Spouse and children are free if they are unemployed.
https://www.tk.de/resource/blob/2189790/9321e565c304a9cc33bb...
If you are paying more than that then you are already paying for private health insurance (PKV) or private supplementation on top of GKV for some premium coverage.
I am not mistaken. I know how to read my own payslip.
Both me and my wife are employed. We have GKV both and we’re basically paying the maximum rate. That’s around €1100/month each, pre-tax. Half of it comes from my official bruto salary and the other half comes from my unofficial bruto salary. Which is how governments hide the costs of public healthcare. Ultimately is part of my salary deductions for the finances of my employer.
Kids are not free: kids doctors don’t work for free. They need to be payed, and they’re paid from the contributions me and other employed fellow citizens pay every month.
> Both me and my wife are employed. We have GKV both and we’re basically paying the maximum rate.
So you aren't paying for your wife - she is paying for herself.
> That’s around €1100/month each, pre-tax
I provided a link in my previous comment to an English language PDF with the exact figures. To get to 1100 you must be also including long-term/elderly care, and then doubling the total to include the employer contribution.
> Ultimately is part of my salary deductions
The employer contribution DOES NOT come out of your salary.
> how governments hide the costs of public healthcare
They literally don't.
> Kids are not free
Don't be pedantic. Your contribution is the same whether you have kids or not.
###
FYI, as you are over the threshold you literally don't need to pay towards GKV, and as you stated you can get private insurance (PKV) with lower premiums (although usually with limited coverage and/or co-payment). So the option is there for you to take.
My Employer sponsored supposedly nice insurance (I say supposedly because they keep being a pain in the ass for pretty much everything) is $200+ per paycheck for me and my spouse, i.e. ~$450/month. That is after my employer covers most of the cost. This stuff is ridiculous.
You're still allowed to visit the same PCP although it might not be covered, or covered out-of-network with a higher patient responsibility.
>Allen is herself a casualty. While she used to pay $487.50 a month, her new healthcare plan, with reduced coverage, has monthly premiums of $1,967.50.
Brutal.
Meanwhile the White House calls it all "fake news".
Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?
Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.)
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.”
https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/
Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations.
Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.
You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.
Health care is fine here if you have a decent job. Health care is not that great in public systems and you still pay for it with higher taxes
And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right?
As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.
I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot.
In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
In this day and age public healthcare system are not efficient and bill the wrong people.
They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners.
However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country.
These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system.
Private systems work better because each citizen pays into his old age health coverage during his young years.
> In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.
Actually the solution is to go full private.
Costs when you get older skyrocket, but not your monthly contribution.
You subsidize your own elderly costs by paying slightly more during your younger years. That slightly more is part of the insurance companies Float, which gets invested and is used 30-40 years later to cover your extra costs in old age.
In a public system there’s no float. Everyone pays to cover the costs of the healthcare for that budget year. Which has the consequence that whenever there are population age shifts, the system becomes not sustainable, which is our current situation in Germany.
If everyone (except unemployed) had private health insurance, population age would be non-problem.
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ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population.
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you:
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
You comment sounds like snark but I understand if you don't know what Obamacare is.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
All house and senate GOP members voted "no" on ACA. Obamacare is a lot of things, but a "GOP healthcare plan" isn't one of those things.
They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.
It's always cost ~$2k a month, the only difference is the previous administration thought everyone else should be "temporarily" paying for her plan.
I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper.
> the previous administration thought everyone should be "temporarily" paying for her plan. Moving money from person A to person B obviously doesn't make anything cheaper
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
I support subsidies to help low-income citizens who legitimately can't afford health insurance, but some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line.
https://www.cnbc.com/2025/10/17/aca-enhanced-subsidy-lapse-g...
I don't want my tax dollars wasted on subsidizing them. Give the money to someone who actually needs it.
(Of course the real problem is healthcare costs accelerating out of control. Insurance subsidies won't fix that problem. In fact they make it worse by encouraging healthcare providers and drug companies to raise prices even faster.)
If we start to think about who "actually needs" things, we need to question whether any of the very wealthy "actually need" their wealth. I would be fine with seizing all of anyone's income (including unrealized capital gains) in excess of, say, $20 million just to give everyone else some cute stickers and lollipops. The giant flow of wealth to those at the top is a far greater misallocation than any amount towards the healthcare of anyone not at the top.
> some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line
These are legitimate complaints. Trashing the system because it's overly generous in some respects is insane.
I’m one of those retirees. It’s OK. I was prepared for this, and can afford it, but a hell of a lot of others on a fixed income, are totally screwed.
> Give the money to someone who actually needs it.
Like billionaires. They are the ones that really need it, and they get it; every time. Those yachts don’t pay for themselves.
If anyone thinks poors will be getting any help, they are fooling themselves. Helping poor people is quite unpopular, in the US (where they conveniently forget that most of them are born in the US white, but politicians make it seem as if they are all dark-skinned immigrants). Many of the hardest-hit states will be ones that enthusiastically voted for this.
It doesn't add to the discussion, but an anonymous upvote wouldn't convey my appreciation for how apropos this comment is.
Why is buying first class tickets bad?
GP is saying that they’re okay giving up buying first-class tickets if it means someone else gets to live. (Because they pay more for health insurance, which allows someone else to pay less.)
It’s good that they choose to do that themselves. In fact, the US allows you to SEND THE GOVERNMENT A GIFT at https://www.pay.gov/public/search/global?formSearchCategory=...
(You can even Venmo)
If you want to do it, do it for real, instead of just being performative.
But don’t try to force everyone to follow your performative pseudo gift.
> the US allows you to SEND THE GOVERNMENT A GIFT
How is this relevant? Cutting the deficit doesn’t solve the problem. And the folks who created this mess just blew out the deficit by trillions.
As a supporter of single payer(or really, anything else), I support this move. When half the nation is on subsidized healthcare they aren't so likely to care about costs.
Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families.
when the gov foots the bill, there's no reason to have competition.
Before 1985, there was no for-profit healthcare. Worked pretty good.
Before 1985 healthcare costs were very low, and population was way younger.
> Before 1985, there was no for-profit healthcare
Wait, what changed in 1985?
No, it definitely did not always cost $2k a month.
Bronze plans with $5-6k deductibles have always ran more than what people paid for rent. Healthcare is the one thing that's outpaced inflation in higher education.
Very good unsubsidized health insurance wasn’t anywhere close to 2k/month inflation adjusted the last time I used COBRA to continue my employer’s insurance after getting laid off.
The underlying issue is inflation adjusted healthcare related spending increased 6x per person since 1970. Some of that is an increase in quality, but middleman are a huge factor.
So first you say it has always cost this much, but in the next breath you say that its cost has outpaced a high rate of inflation. Mathematically, these can't both be true.
A) Inflation in healthcare costs is well documented and unrivaled
B) Biden papered over A) with "temporary" covid subsidies in 2021 and those are going away, revealing A) again
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Mine has tripled, but last year, I was actually getting some govt help. Not this year. I am fortunate to be able to afford it, but it’s just less than my mortgage.
This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home.
Obamacare is like the NHS, in the UK. Everyone likes to bitch about it, but woe unto the politician that messes with it.
The equally insidious thing is that when they get hit with the new premium anyone who took better coverage, like a silver plan for the ACA, will likely be "forced" to downgrade to a lower (bronze) plan, which means that when they actually get services their costs will further skyrocket (higher deductibles and out of pockets).
Talking about all hell breaking loose... Marjorie Taylor Greene announces her resignation specifically because of rising health care costs (yeah, I'm cynical,there's maybe more to it). Mamdani gets elected on a platform that's essentially "shit costs too much." Maybe folks on both sides are starting to wake up. A guy can dream...
MTG just got her pension. I doubt healthcare costs have anything substantively to do with it. Someone just wants to avoid digging a hole any deeper than they have.
One thing that I’ve been trying to understand about this discourse:
Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed?
In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?
There's a third piece too, which is that insurers are ramping price much faster than inflation. Our (unsubsidized) premiums increased 20% year-over-year, after also increasing faster than the rate of inflation the last few years.
Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get very weird in the near future.
That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much.
But isn't it insurers actually set how much a service is going to cost you and then make "a discount" on that figure?
Yes to both. High costs were previously partly hidden by subsidies for some consumers purchasing individual or family policies on state ACA exchanges, and now many of them will be forced to pay something closer to the true market price. But just like with college tuition, when the government throws money at a problem that ends up causing costs to explode without permanently improving affordability.
> true market price
There can be no market clearing price, because healthcare demand is unlimited.
In some countries supply is rationed by using different means such as waiting lists, budgets for funding, or even corruption (I witnessed this in Cuba).
Year-over-year increase in GDP in the U.S. right now is almost exclusively “production” output from the healthcare industry, whose profits are stratospheric and rising. So there’s two useful datapoints here: first, the bill must be paid, or U.S. GDP growth year-over-year falters, not because healthcare costs this much; and second, household debt continues to increase year-over-year to permit continued wage stagnation. Whether insurers end up lowering their profits (and thus prices) as the subsidy expires centers around whether banks extend further debt as a household wages subsidy. As of right now, that seems to be continuing, even though some of that debt market is in the midst of a small crash, so insurers (who have no regulatory limits on profit levels) are unlikely to lower their profit targets as subsidies end.
So long as the political will of U.S. leadership supports that continued profit, and either government and/or banks subsidize worker wages to cover the increased profits, then we’ll continue seeing growth in costs on paper before subsidies. This growth in profits/prices could not be sustained on wages alone, given the continuing decline of inflation-adjusted worker earnings; and so to answer your question, yes: the act of subsidizing is what’s enabling the prices being charged; but, no: the costs of providing healthcare to any one person of a given age are not increasing due to subsidies; just the profits.
Where does all that money go to, though?
Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care?
If you want to understand where the money is actually going then this Peter Attia Drive podcast episode with Dr. Saum Sutaria is the best high level overview that I've heard. Seriously it's worth listening to and will clear up a lot of the misconceptions that many people have.
https://peterattiamd.com/saumsutaria/
Both. Also there's a culture of infinite consumption of medical services.
Doctors are by far the highest paid professional occupation in America. The AMA is the most powerful trade union in history and restricts the number of new doctors, pushing up prices.
Specialist doctors are one of the highest paid professions in almost all countries. There are hardly any jobs more important than those of say a heart surgeon or a neurosurgeon.
I have changed my mind on this after looking at the data. Not much cost can be attributed to the doctors.
I have some questions but I don't want to offend anybody. Aren't there any methods to contract the healthcare to lower the prices down? I heard that in UK they have some requirements that the prices must not go higher than... For a given type of service. Also I read a lot of articles that giving a tablet to a hospitalised person costs 20-50 bucks and people are generally running away from ambulances to not pay
It's a twisty maze of passages, all alike as they say. They have entire classes of certifications for understanding how medical and insurance billing works in this country.
Japan has something to that effect. There are ways to make it happen.
Corrupt congress people will vote down any such proposals.
Nationalize health care. Doctors should work for the government, hospitals should be owned by the government; for profit health care is a scam.
Your taxes would double, and don't even bother trying to say they wouldn't literally every country with public health care pays twice as much as we do in tax
We pay more tax for healthcare in the US than virtually anyone else. Last I looked, only Norway had us beat in terms of taxes for healthcare.
Then how our taxes are lower on average than most other developed countries?
Does it really matter if cost is in "insurance" or in tax? Wouldn't overall lower total be better?
Yeah, it sucks living in a society where the people in power have contempt for you and your family, doesn't it.
I read healthcare now amounts to buying a new car every year. (Except, of course, nothing new in your driveway, nothing to resell, etc.)
This is misleading.
Health insurance premiums cost about as much as buying a new car every year. Healthcare is generally on top of those premium payments.
I suspect it was health insurance premiums being discussed. Thanks.
Yep, you and your employer pay $3500/month for the premium. Then you as an individual have a $12k to $15k per year deductible before the insurance even kicks in.
That’s grossly exaggerated. Individual deductibles are limited by law to ~$6500 even on the worst plans. And no one is paying $3500 per month for individual coverage on one of those plans. The actual rates depend on age and zip code, but I’d be very surprised if they’re that high anywhere.
To see the actual costs for yourself, go to healthcare.gov. The “bronze” plans are the ones with high deductibles. If you’re young and healthy, a high-deductible plan combined with an HSA is a very good idea.
12-15k? Lol the highest one Ive ever seen in a high deductible plan was $7500 and that still had some co-pays and coinsurance
I pay $120/mo. I don't understand. Are you including the employer paid share in this calculation?
You are lucky to have employer-provided health care.
At what point does it become a better financial decision to do telehealth and medical procedures completely in a different country?
Can you be health insured outside of the country you live?
People do do that in some limited cases, but it's often impractical. Two common cases are a) there is a need for urgent/emergency care; or b) the patient is generally frail and infirm. In these cases it can be impossible or impractical to arrange for treatment outside the US. That's leaving aside the logistical difficulty of arranging it (plus the costs for travel, etc. associated with carrying out the plan).
Never, because the person who cleans your toilet cannot simply hop on a flight to Mexico every time she needs surgery. But that's also not a great solution for society, to have the software developer caste be the only ones who can afford medicine by taking an expensive vacation.
Sometimes it doesn't matter about the insurance if the price is right. Medical tourism is a thing already.
Ironically, a great many people from public systems actually come here to pay for procedures they cannot get or have to wait ages for.
I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing looks daft from that angle too.
The US, today, is set up very well for wealthy people. The health care system works great for them. Their doctors are amongst the best in the world. Same with the hospitals they use. The costs are manageable if not reasonable for all of those people. And you can actually go beyond health care and find that almost everything in the US is pretty high quality for wealthy people. Housing, their neighborhoods, their schools, etc. That might help explain why the system is set up the way it is. Everything cascades from there.
> Housing, their neighborhoods, their schools
All of these can be great, but the class of people that make a neighborhood in "the heights" won't have dog barking, basketballs, drugs and gunshots. The people that don't live in "the heights" could decide tomorrow to no longer have those 4 things either - but they don't because - it's a different class of people.
There is no US healthcare "system" in the sense of having a cohesive entity pursuing a unified goal. It's a bunch of separate entities each pursuing their own goals, often in conflict with each other. If we were designing a healthcare system from scratch it obviously wouldn't look anything like what we have today. But we arrived here through a process that economists call "path dependence", and this makes it stubbornly resistant to systemic improvements.
https://en.wikipedia.org/wiki/Path_dependence
If you want to know whom US healthcare is for, look at who makes the most money from it. There's your answer.
stopped buying insurance when the co-pays became unaffordable
and you never find a real doctor anymore anyway
It's weird to me that americans, especially educated professional americans, have become much more quiet in their online presence due to all the crisis they are facing- what we have now is pretty different
Private equity should be banned from healthcare.
What could go wrong putting a bunch of finance bros at the wheel of a "Pay this amount or suffer/die" industry?
PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, which doesn't seem politically likely.
I'm so sick of this trope. "It's the insurance companies!" "No, it's private equity!" "No, it's the PBMs!" I don't care. Jesus Christ, going to the doctor is rapidly becoming unattainable for more and more people, including the PMC now, and all of the rich people are simply pointing at each other saying "it's the other guy!".
Burn it all down, start over.
Isn’t it fair to argue that it’s PE doing all this consolidation?
No, it's not fair to argue that. While PE has done some roll ups with certain specialties in certain areas the big health systems are mostly not owned by PE firms. In some areas they're literally owned by churches. I'm not defending abusive PE practices here but if we want to fix anything we need to be clear about what's actually happening.
The root cause:
https://www.researchgate.net/figure/Healthcare-administrator...
"Healthcare administrator's growth in the US. Healthcare administrator's growth by 3200% between 1975 and 2010 compared to 150% Physician growth according to Athena Health analysis of data from Bureau of Labor Statistics, the National Center of Health Statistics, and the United States Census Bureau's Current Population survey in accordance to [26]. Admin: administration; HIPAA: Health Insurance Portability and Accountability Act; HITECH Act: Health Information Technology for Economic and Clinical Health Act; DRGs: diagnosis-related group's."
The only class of medical services that has become more affordable over the last 50 years is cosmetic procedures and laser eye surgery:
https://healthblog.ncpathinktank.org/why-cant-the-market-for...
What value addition do the administrators provide? It might be helpful to understand why competing hospitals still find it useful to employ these people even if the cost is so high.
If a competing hospital can provide equivalent service while also not spending so much on an administrator, why didn't they already do it?
Answering myself, apparently it is a fight between administrators on the hospital end and the administrators on the insurance company end.
The insurance administrators are fighting to provide as less reimbursement as possible and the hospital administrators are fighting to provide as much reimbursement as possible. The administrators are probably doing compliance work, negotiations.
I wonder whether regulations can be used to cap the role of administrators at the expense of slightly less efficient market - this might work if administrators are just adversarially interacting and reducing their scope can help the overall picture.
The administrative overhead is necessary in order to get money from the insurance companies. Without the administrators too administrate and fill out copious amounts of paperwork, the hospital won't get paid by the insurance companies, and if the hospital don't get no money, they can't pay their staff, and staff tend to like getting paid.
This is how the world ends. Administrators on both sides being replaced by AI and consuming all the worlds available compute arguing with each other about healthcare bills.
Unpopular opinion: Evil and greedy insurers are not the biggest problem. The biggest problem is the socialized costs of sugar drinks, junk food, and sedentary life. The food industry operates like a drug cartel who starts the pipeline getting children addicted.
That combined with outrageously expensive magic pill healthcare. A situation partly caused because doctors can't tell patients they are too fat and lazy. Because feelings and hate-crime.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7524435/ (I think their 27% figure is way too conservative)
It's like the worst possible combination of free market capitalism/libertarianism with social liberalism.
We desperately need to vastly increase the number of physicians in this country to decrease costs. The AMA is the most powerful trade union in history and has locked the number of new doctors a year for many years now. Restricting supply for a service with inelastic demand skyrockets prices and lines their pockets.
Bullshit. The AMA is a voluntary membership organization, not a trade union. They have no power to set prices or engage in collective bargaining.
The immediate bottleneck on producing more physicians is limited Medicare funding for residency slots. Every year some students graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back.
https://savegme.org/
Who lobbies for the regulations that limit funding for residency and have these ridiculous regulations to start with?
Which ridiculous regulations? Can you give us a specific CFR reference? I don't understand your question.
https://archive.is/UwqzL
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> laundry list of
That’s a meaningless statement, look for an actual percentage here.
Healthcare costs have been spiraling for decades in the US, the ACA didn’t impact the long term trends to a noticeable degree. Actual healthcare reform could drive down costs massively, but that would mean a fuck load of people in medical billing getting laid off. Instead you’re paying for your doctor to talk with your insurance provider often for longer than they spend working with you, that’s the ultimate issue with US healthcare costs. Inflation adjusted “healthcare” spending is up from 2,100$/person in 1970 to 14,570 in 2023.
https://www.healthsystemtracker.org/chart-collection/u-s-spe...
What did the ACA require that shouldn't be part of healthcare in one the wealthiest countries in the world?
Annual check ups? Cancer screenings? Maternity care? Basic mental health? Forcing the insurance companies to accept patients with preexisting conditions?
These services should be available to everyone.
If a developed country cannot provide these things to its citizens it's a failing state in my book.
"ACA required stuff" is a fox news talking point.
You don't need it until you need it, and needing it often comes in the form of a lightning strike from blue sky. The counterargument is that having everyone pay a higher amount makes it feasible to actually have this coverage available, when needed, without bankrupting the insurance companies, because the rare astronomically expensive care is covered by the premiums paid by the vast majority of people who are relatively healthy and are unlikely to need it.
Now whether the on-paper prices for medical care in this country actually have any relationship to objective reality is an entirely separate question of course. In general coming from an outside perspective, combining healthcare and for-profit motives in a single system seems particularly likely to lead to all kinds of perverse incentives, but, it's the system that exists, and it seems unlikely to change any time soon.
What I don't understand however is what IS actually expensive about the care itself?
Doc will get paid his normal rate, $500k per year (maybe more maybe less?) Nurses all get paid something between 100k and 200k (maybe more maybe less?)
Then we hear about these surgeries that cost 100k.
What exactly is costing 100k for 5 hours of knife and time in a bed?
Wildfire, I understand, there is no way to re-materialize a house for less than (what is basically a fortune these days). But time and materials for a surgery seem to me that it should cost 5k at most?
And at those rates, wouldn't everyone just pay like $15 a month? And if the answer to this question is malpractice costs, can we have two plans:
I trust you doc: $15 / month
I might sue the doc after: $1500 / month
That’s how insurance works. You pay for a plan you likely don’t need so everyone older than you is reasonably covered.
If young people elected to get a barebones plan while in good health, who would subsidize them when they grow older?
That’s not how insurance works. No insurance company coerces you to buy it, as Obama did.
You're forced to buy auto insurance.
You aren’t. You are required to buy LIABILITY, which is protection in case you harm SOMEONE ELSE. You are not required to protect YOURSELF.
In some states, if you can post a bond, you aren’t even required to carry liability.
The government does not coerce you to buy a product for yourself.
Technically not. In many states you have the option of posting a refundable security deposit with the government to meet the minimum liability requirement as an alternative to purchasing auto insurance.
The main point of health insurance is to cover things that most people don't need. Prior to the ACA, most health plans had lifetime coverage limits which could leave patients with serious conditions financially ruined or unable to access care. The ACA removed those limits so naturally coverage is now more expensive.
Have you been on an ACA bronze plan? I wouldn’t consider it a Cadillac plan nor did I find it covering lots of unnecessary things.
Bronze plan is shitty catastrophic insurance at like 5x the actuarial cost to try to fund risk pool and all the mandated benefits thst the o/p alluded to
Can you explain what these mandated benefits you think shouldn't be covered?
Off the top of my head maternity/neonatal/family planning type of benefits are mandatory for obamacare compliant plans. That essentially outlawed all the affordable young adult catastrophic plans.
I have spent some time looking at healthcare costs, but I have not seen maternity/neonatal/family planning as a significant driver of costs. It would be surprising if so, given falling birthrates and growth in the elderly population.
Do you have data that shows this is the case?
What you're, essentially, advocating for is a massive increase in premiums for families so that people without children can get a tax cut. Which would objectively benefit me, but would be incredibly disastrous for American society in general which is already struggling with insane family care costs. I would really hope you could see why the second order effects on such a change would be a bad idea.
This is factually incorrect and in fact the opposite of what a Cadillac plan means.
Obamacare plans are actually the opposite: they are high deductible with limited networks.
Obamacare plans typically have deductibles between $5,000 to $9,000, with a narrow selection of networks, and high premiums if unsubsidized.
This is the opposite of what a a Cadillac plan is (or used to be).
Which are the specific things you think most people don't need coverage for? Prior to the ACA, it was pretty common to hear stories of people not on employer plans who were shocked to discover a coverage gap they have. Most people don't have much expertise in evaluating healthcare coverage and deciding which services they might need.
In California, apparently acupuncture is required to be covered. I’d be happy to give up my acupuncture coverage for a lower premium. https://www.fiercehealthcare.com/payer/states-essential-bene...
Same, but it’s hard to imagine these kind of alternative medicine services are driving huge premium increases. Because they don’t work they tend to be pretty cheap to provide.
> The end result is we all have Cadillac plans that most people don't need.
That's right, those pesky things the ACA says should be covered like emergency services, ambulances and prescription drugs is definitely the issue here. You've definitely found the problem.
I can't believe people keep repeating this lie. Did no one live prior to the ACA where you could easily go bankrupt because your insurance decided it didn't cover things like hospital bills? Because I sure as fuck remember, considering that's what bankrupted my parents.
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It should be mentioned that the US has very high wages, and even when subtracting substantial health care insurance cost, the income likely remains higher than what people earn in most other countries.
If you have a high paying job in the US it usually comes with legitimate health insurance paid for by your employer, meaning most of the cost of most healthcare is covered.
If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage.
ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations.
You should go tell that to the waiters who are working for tips.
Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare.
Not to mention you get actual vacation time in Europe and a higher standard of living generally.
Don'tcha know, the only real jobs are "software developer" and "haver of lots of money for investing in software developers". Everyone else can pay $10,000 for their surgery.
yes, but the people in europe aren't free(tm) /s
how exactly ?
it's sarcasm. a lot of arguments against social services like universal health care boil down to "well taxation is theft and therefore they're not actually free because they pay higher taxes"
See /s flag ?
Sorry not good with the recognizing these.
Insufficient gunshots per diabetes.
Reading this sent me down a bit of an OECD data rabbit hole. They seem to agree. However once you read the fine print I'm not so sure. Many things are much more costly in the US (education, travel, food, vehicles, houses...) and the OECD data seems to not control for that. Also my personal experience is there are a large number of very poor people in the USA. Seems like more than in Western Europe for example.
In case you are wandering where the money goes. If you need a gall bladder removed or an appendix removed the bill to you might be $10,000-30,000 but the surgeon, for all of their care and time with you, is compensated less than $100.
I'm confident a surgeon in America is paid more than 100$ for a surgery. They are paid about 400k a year on average. Do the math yourself.
On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations
It’s actually about $600 just for the surgery. It’s about 10 RVUs x $60 per RVU. You add some RVU modifiers to get it to about $1000.
Your point still stands, but it’s still a bit more than $100
Source: I’m a MD
I did get my gall bladder removed in July, and I know paid my surgeon a lot more than a 100 bucks, which was just the smaller deductible portion of the bill.
Bullshit. Even Medicare will pay a surgeon about $600 for CPT code 44970 and commercial health plans are higher than that.