The healthcare market is taxing reproduction out of existence
(aaronstannard.com)281 points by Aaronontheweb 2 days ago
281 points by Aaronontheweb 2 days ago
Car seats as contraception is just a specific enumeration of the general. "busybodies as contraception" problem wherein the "has so few real problems they stop minding their business and mind other's business" classes try to force priorities on the rest of society that the rest of society can't yet afford to have. And it's not just contraception or kids. Pretty much everything in our economy gets shot in the foot by this to some extent.
Contraception is a bargain deal for any class, assuming you were not intending to have a kid.
I also question the idea that safety regulations (let's call them that) are the result of a class of people who have "so few real problems they stop minding their business and mind other's business." I get the idea, but couldn't the high cost of obstetrics and child car seat requirements be due to the wishes and decisions of people outside of this supposed class?
But babies going through car windows is bad. I don't want that. Not even just for the baby, but for me. We don't need projectile babies. Ballistic babies, if you will.
It’s not the car seats that are the contraception, it is the cars themselves.
What does that mean? Plenty of people have been conceived in the backseat, and some in the front. But seriously, what are you talking about?
car-dependent infrastructure and urban design is hostile to human life.
I actually thought about including this in the piece (and how car sizes become a problem once you hit 4+ kids) but decided to keep it more focused on just the healthcare costs
Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading. Presumably, you'd be paying those even if you didn't have the child. That said, the cost of health insurance for a family is pretty outrageous. My premiums are along the same lines as the ones here (although less noticeable since they're paid by my employer).
> Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading.
I see your point, but do you not think that if you're a family of 4, having to pay $40K before insurance kicks in is ridiculously expensive, and out of reach for most Americans?
I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums). The deductibles can be so high that you're pretty much always paying out of pocket.
> I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums).
Self-employed here. My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible with typically a $20 co-pay. It covers 3 prescriptions, therapy sessions for each of us, various older age diagnostic checks, and almost all office visits. In addition, if either of us develops cancer or is hit by a truck, we will not be rendered bankrupt.
So I'd say ... nah.
i'm 36, self-employed. silver plans in my state are ~800/month next year, with 8k deductible, no out of network coverage at all, with no in-network providers out of my state, so god forbid I get injured while traveling to visit my in-laws. the marketplace is a joke and health insurance in this country is pointless.
> My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible
That's really nice - are there state/government subsidies involved?
I work for a top tier company and my premiums are not that much lower than yours.
When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).
Yes, those are numbers with
(a) for 2025, federal premium subsidies in effect ($19k/year of subsidy) ! (b) for 2026, NM temporary subsidies
A reminder that until the end of this year almost everyone gets subsidies. Nobody in the US, no matter their income level, should be paying more than 8.3% of their AGI for health insurance. That all changes come Jan 1st 2026, thanks to the current Congress. Our premiums would be $2531/month had NM not stepped in to use some of those sweet, sweet fossil fuel extraction taxes to help us out.
Oh yeah, deductible in 2025 was actually $2800. At our age (early 60s) and general health (good), gold plans make much more sense (if you can afford them).
That's crazy, I looked it up and the average cost for a hip replacement here in the private system in Australia is about $24k (US$16k).
You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.
You had health insurance but it did not cover that?
Had the same reaction when I saw how the 40K was calculated (BTW I strongly believe in Medicare for all to control costs and to pay for civilization. To be paid out of progressive taxes on all income).
If Aaronontheweb had the misfortune of getting seriously sick, required surgery .. he would pay $7,150 for something that could easily cost $100K+++. Saying he's paying premiums just for having a baby really feels like weaselly logic .. so he thinks he or the rest of his family will absolutely never fall sick? What if a cancer diagnosis hits one of you out of the blue (I hope it doesn't, but that's what insurance is for).
The charges you mention are likely all from hospitals. How about Pluvicto for advanced prostate cancer at $42,500 per monthly dose? All the players are in on it.
The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.
I only keep this plan because we're planning on having children, so yes, it's included in the pricing decision.
Did you try reading the lengthy section of the article where I answered your question?
I think OP here is just keeping a completely dominated plan (and his health insurance company knows it). He has less than 50 employees, he is not required to offer health insurance to his employees and he should go on the ACA market.
Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies (which, by the way, in 2021-2026, were available to everyone) by tweaking his income (easy to do when you have a company).
He also says uninformed things like:
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those.
The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
> HMOs or EPOs that have some issues with them: coinsurance
What matters at the end of the day when you have a child is your maximum out of pocket (which you will 100% hit the year you have a child!). Whether you have copays or coinsurance after a deductible does not matter here. The ACA caps your maximum out of pocket at $18,400 no matter what (which, yes, is too high), so what you need to optimize for is premium + OOP for the providers that you care about.
Like, I get it, it's America, for healthcare like many other things (student loans, credit card debt, ...) it's easy to end up in a bad situation, but at some point you have to spend time understanding the game.
> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies
I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity.
> The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
As I mention in the piece, I check every year. I have no idea what subsidized plans include, but the other marketplace plans definitely do not include child birth.
I explicitly address this point:
> The Affordable Care Act (Obamacare) barred insurers from turning down applicants based on existing pre-conditions; the way insurers get around this for pregnancy and child-birth is not by rejecting pregnant applicants (illegal), but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
and
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those. All of the ones I’ve found through eHealth Insurance or Healthcare.gov never cover it - and I check every year.
Love the over-confidence though. The best outcome for me in even writing this article would be to get some internet commenter pissed off enough to find me a cheaper version of my plan. That would solve my problem immediately!
ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post.
You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf
Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.
> And "manipulating your income" is not really feasible with a pass-through entity.
I don't know if you have a CPA, but this is a sentence my CPA has never uttered.
> but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
Including...? I have never heard of this, and actually have delivered babies and worked with post-partum mothers.
Welcome to healthcare plans in Texas.
This same price gets you a platinum plan with Sharp or Kaiser in San Diego and wouldn't have those gigantic deductibles.
He moved his business from California to Texas and is now complaining about pricing problems in markets caused specifically by the lack of regulatory environment in Texas.
Why do you need to get insurance for your child to be born anyway? Isn't the hospital already insured? Isn't that kind of janky?
In America, you basically need insurance to act as a larger stronger party in the negotiation of prices with the hospital on your behalf. Without the bargaining power of the insurance company the prices you'd pay can be significantly inflated. So paying for the insurance is the slightly lesser of two evils. Supposedly. From your question it seems perhaps you live somewhere with a saner system in place. I'm envious.
I’ve been told that too. But I’ve done self pay for the last year, and every time I go to the hospital they instantly give me a 30% discount.
That makes me think they are artificially inflating prices so that when the insurance company negotiats their discount, well, it might be the same as what I pay
Birth injuries are insured by the ob/gyn, which is part of the very high cost of delivering a baby in the US (because such injuries often lead to a lot of care).
Also not a big impact on the message, but $200/mo for a phone is a bit disingenuous.
Claiming $200/month for a phone makes one wonder which numbers are valid. I'm not saying everyone needs to make a $100 phone last 5 years and use a $15/month plan, but I'm not even sure how I would get to $200/month in phone bill, even including financing an iPhone 17 Pro Max.
$200 seems valid - it comes from the linked article [0] and it includes home internet (I pay $110 / month Comcast just for home internet in Bellevue. In Seattle I paid $130 / month). Maybe Aaron could have phrased it better. (I also recommend to read the linked article as it is a phenomenally well done financial analysis.)
With $85/month service (AT&T unlimited premium with only a single line) and financing a $2,000 phone (The smaller storage version of the Galaxy Z Fold 7 at MSRP) over 18 months, you’d hit almost exactly that; you could so the same with a cheaper service and/or phone with some add-ons (e.g., while Apple Care is billed directly by Apple and so wouldn't be on a phone bill, insurance for non-Apple phones is often billed by carriers on phone bills.)
$200 doesn't seem that crazy if they are buying several phone lines. I assume he pays at the least his wife as well, so that's two. If they have home internet bundled in as well, that would easily explain that figure. All to say, AT&T. He may also have a home phone line for a fax machine. It is perhaps a bit disingenuous to bundle it all together, but it also isn't the main point of the article.
What he said was:
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
That makes it sound like this is the minimum that you have to pay to get a smartphone and service to get by in modern life.
$200/mo is definitely high for that. An iPhone 17 Pro Max with maxed out storage (2 TB) is under $85/mo for 24 months.
A Visible+ Pro prepaid plan is $45/mo ($37.5/mo if you pay for 12 months at once) if you don't use one of their frequent promo codes to get a discount.
That includes unlimited premium data on Verizon's 5 G UWB, 5 G, and 4 G LTE networks, support for a cellular smartwatch, 4K UHD video, and unlimited mobile hotspot. By "premium" data they mean no deprioritization. Visible users get the same priority as user's of Verizon's own postpaid plans.
The hotspot is only 15 Mbps, so you probably wouldn't want to rely on it if you have frequent or long internet outages, but I've found for the occasional short outage it was fine for email, HN/Reddit/etc, and YouTube videos.
This will be massively more than enough to cover the smartphone hardware and service needs for everything probably 99% of the US population needs to get by, at $130/mo.
Note that includes getting a new top of the line iPhone every 2 years. With a more modest phone and keeping it for 5 years we are looking at more like $60/mo.
I pay that at least much for my family, hence why I used it
I think he's quoting that from the other article, not necessarily computing it himself. I think that article was about the cost of broadband + smartphones.
We pay ~$100/month for 1G broadband (I realize this could be lowered somewhat), and ~$100-120 for 5 phone lines for the family (AT&T prepaid). I'd like to see you make a household with multiple lines + broadband work for less than $100-125.
And that's not even that hard - I know some people spend $300+ JUST on their phone plans, in addition to broadband. And then if you factor in amortized cost of phone replacement? It's closer to $200 than to $50 for example, IMHO.
$200 seems to include home internet (which I think everyone needs these days to function). The $200 quote comes from the linked article [0] (speaking as a former financial analyst, this is an amazingly well done financial analysis). Maybe Aaron could have phrased this better.
A lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that. But the situatuon is a lot like student loans, colleges know they can charge more because the government will lend 5-6 figures to just about anybody, so the colleges do so. And once that person is educated, you can't just "take back" the education if they don't pay. Same deal with healthcare, government subsidizes it for most of the population in lots of ways, healthcare providers know this, they increase prices to match. And you can't just take back the surgery to fix that broken arm or undeliver the baby. There's not a single silver bullet that will fix everything, but there are definitely concrete changes that can be made to improve the situation. One of them would be to make people healthier. I know, easier said than done. But by God it would make health insurance cheaper. Same way in that if everyone was a safe driver, we'd all be paying less in car insurance. Another way would be to remove that regulation or rule or something that makes it so like a hospital can't open too close to another hospital. Another would be to just, train more doctors! What I'm trying to say is, just as the problem is multi-faceted, the solution must necessarily be as well.
> but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper.
I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans can then negotiate for much better prices and refuse the kinds of insane charges we're seeing. The cost of plans would also drop because prices would be spread out over every taxpayer. Having primarily a single provider for insurance would make everything easier and less expensive for hospitals and doctors offices too.
The billions in profits private healthcare companies rake in all comes at the expense of everyone else one way or another and they have every incentive to make as much money in profit as they can. Without that excess fortune in profits being skimmed off and stuffed into pockets a government funded insurance plan which covered everyone could get the job done taking in closer to what it actually costs to deliver the services we want and no more.
You don't need the insurance industry sticking their dick in most of the business they do. Insurance is for the foreseeable but unforecastable, not for routine things.
The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem
> Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it
It’s more they know insurance won’t pay for it, and negotiate discounts based off the “retail” price. Although at this point it’s gotten so ridiculously convoluted and cross-subsidized that I doubt even the insurance company or hospital knows what the actual paid amount for a Tylenol will end up being until months after the fact.
> I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
Did we discover a new kind of monopoly perhaps? It’s not quite full blown corruption as there still (for now) exists a somewhat adversarial relationship between insurance and hospitals. However, at the same time, they seem to be pulling each other into the abyss, and our society is the victim.
Pretty much every healthcare business unit - hospitals, pharma, insurance, and so on - are deeply consolidated. It spread like contagion, as anyone who didn't consolidate got their margin eaten. The sum of all those different vectors pulling on the same market is one unified message: "rape the consumer for all they're worth"! Because that's the only source of margin left, and everyone's got hungry shareholders who only make money when the business accelerates profit.
> It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that.
But there are other things we could do that we don't.
For example, right now we have the expectation that insurers are going to "negotiate" with providers to determine the price, and then you have to use the providers your insurance has negotiated with, but who actually wants this? When you as a retail customer want to buy a pair of shoes or a piece of exercise equipment, do you call up all the manufacturers and try to haggle with them? No, they list their prices on their websites or sell them through retailers that do the same and then you choose based on who has what you want for the best price.
So make non-emergency healthcare work like that. Require them to publish their prices. Then the insurance company doesn't tell you where to go or negotiate with anybody, they only tell you how much they pay, which might be e.g. 90% of the second-lowest market price in your area, equivalent to a 10% deductible. Then you go to a website that lists every provider and their price, pick where to go and pay the difference yourself.
Suddenly they all have the incentive to publish the best price, because that's what most people are going to pick, and then you have an actual market instead of the existing opaque bureaucracy of corruption.
> that regulation or rule or something that makes it so like a hospital can't open too close to another hospital
You're referring to certificate of need laws, but it's worth pointing out that they're not universal. More than a dozen states have repealed them (or don't have them) and everywhere I've looked, there's strong evidence that their removal has increased healthcare access, which has put downward pressure on cost of service
> Another would be to just, train more doctors!
Bill Clinton placed a cap on GME funding in the 97 Balanced Budget Act, freezing the number of residency slots that the federal government would provide funding for, so this effectively froze the number of residents there could be, which effectively limits the number of doctors possible
Christian healthcare sharers do precisely this. By restricting services and the population addressed (your pastor or priest must sign off on your application), everything's extremely affordable. In particular, as we don't drink, do drugs, use contraceptives etc. we don't pay for coverage of them or their side effects. Obesity's also less of an issue.
There's also the trick of telling the hospital you'll pay "in cash" and getting a 10x lower bill from the hospital, then getting that reimbursed/covered by your private or alternative insurance.
> Christians don't drink or use contraceptives?
They're talking about a very particular sort of pseudo-insurance plan.
https://en.wikipedia.org/wiki/Health_care_sharing_ministry
They can and do exclude whole swaths of what normal health insurers have to cover. They don't even have a legal requirement to pay out at all.
https://www.nbcnews.com/health/health-care/health-care-cost-...
> Beyond restricting maternity coverage, many groups’ policies state that they won’t reimburse for prescriptions, routine doctor’s visits, contraceptives or mental health or substance use services. Coverage for medical conditions that predate someone’s membership is often excluded, as well. And health care sharing ministries aren’t required by law to limit out-of-pocket costs or maintain large cash reserves to cover members’ bills the way insurance companies are.
Pastor won't sign off (unless you come to an agreement).
So are you still allowed real wine at communion then? A bottle of beer after working on your car all day? I know some christians who preach "100% dry", others are more relaxed. Some are fine with contraceptives (including many Pentecostals, which is how I was raised), quite a few overweight people, etc. And they're just as christian as you are.
It sounds like you're going for the "unlikely to need it" plans, which go broke when you actually get sick..
> So are you still allowed real wine at communion then?
I've run into folks who claim "wine" was a mistranslation of "grape juice", and some denominations don't use wine.
https://en.wikipedia.org/wiki/Eucharist
"The elements of the Eucharist, sacramental bread—either leavened or unleavened—and sacramental wine (among Catholics, Anglicans, Lutherans, Eastern Orthodox and Oriental Orthodox) or non-alcoholic grape juice (among Methodists, Baptists and Plymouth Brethren), are consecrated on an altar or a communion table and consumed thereafter."
I would think using contraceptives is not in the same category as drugs or liquor, though.
The majority of spend is in the last few years of life. A man dying of a stroke during the night at age 50 is much cheaper to the system than the same man living to 90 having fought cancer for 10 years.
I'm not advocating against health nor preventive care, however they don't decrease costs nearly as much as you'd expect.
"If insurance covered brake pads they'd cost more" is an old mechanics quip. The principal agent problem just fucks the cost and incentive structure of anything insurance covers.
This is why it's unwise to send "routine" things through the insurance model.
The cost inflation started with pharmaceutical companies buying each other out and increasing the cost of drugs. Then the hospitals consolidated so they could get better negotiating power with pharmaceutical companies... and also, raise their prices to insurance companies. Who then also had to consolidate to preserve margin.
The idea that cost inflation is downstream of subsidy is... well, it's not entirely wrong, but it's also propaganda written by the people doing the inflation. The government can't distribute economically effective subsidies if industry is conspiring to eat the subsidy and hold the consumer hostage to get more. In an unconsolidated market, the underlying actual costs don't change beyond the increased demand. Consolidation transfers the subsidy premium away from the customers, who can't consolidate. You can't give a bullied kid more lunch money.
"There's not a single silver bullet that will fix everything" idk, it seems like eliminating the profit motive from healthcare would resolve all kinds of problems.
Suppose you want to remove the profit motive from healthcare.
If doctors would still get paid above-median wages, you would still have a profit motive. Their lobbyists would want to limit the supply of doctors or simply lobby to have the government pay them high wages, to require that things be done by a doctor instead of a nurse, etc. Likewise the drug companies would lobby for the government to pay them more for their drugs, and when the government is captured then that's what happens. The same problems we have now; you haven't solved anything.
If doctors would get paid a lower wage but still have to attend 8 years of medical school, there wouldn't be a profit motive, but then there would be a shortage of people willing to become doctors, patients would have to wait a long time to get an appointment as they do in places like France, etc.
The profit motive isn't the problem, that's the thing that causes anyone to want to (and be able to) provide healthcare. The problem is the corruption. You have to stop limiting the number of medical residency slots and allowing drug companies to patent trivial changes to preexisting things etc.
Unfortunately, most of what you suggest would get in the way of many people making a lot of money.
The first sentence is your answer. The third word even.
The healthcare market. MARKET
Healthcare shouldn't be a market. That's why you're paying $40k.
I have the opposite viewpoint, and I lean heavily progressive in most of my views.
Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices.
Healthcare doesn't function as a market, to our detriment.
Healthcare doesn't function as a market because the nature of it is largely at odds with the principals of an efficient marketplace and perfect competition. Not to mention the tens of billions of dollars being pocketed by middlemen every year.
In some places, free market healthcare is great. Dermatologists, dentists, chiropractors, things like that. And part of the reason it's great is because you get to shop around and people fight for your business.
In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.
In those places, free market healthcare is great because they don't have healthcare practitioner cartels and can pay their doctors middle-middle-class salaries instead of investment banker salaries
If you're talking emergency medicine and old age care, yes, it's not able to function as a market.
Hence why the US already has government healthcare that covers almost half the population (Medicaid and Medicare cover the old, young, disabled, veterans, and poor people).
However, the place you give birth is, in the vast majority of cases, something people do like to have agency over, especially given the 9 months of heads up given by nature.
If healthcare weren't so perversely incentivized by the twisted triangle of regulated public/employer/private systems and their interactions, I would argue this is something that could be a functioning market.
Like Universities with their endless ability to raise prices due to the US government guaranteeing student loans of any size to anyone, a big problem in healthcare is there being no anchor to reality due to the principle-agent nightmares of the current regulated system.
In Europe, when you give birth it is not a luxury experience with a doctor of your choosing in a 4-5 star level private room where you're sent home with a big basket of freebies. If all Americans had to pay directly out-of-pocket (as Europeans de-facto do via taxation), you can bet reality would set in quick.
"billions"
lol..
Dr Evil in the time you've been in cryostasis...
> Prices are entirely hidden
Recent legal changes have made pricing more transparent. In 2020, the federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. This limited the expenses for emergency care when out-of-network and a few other things, but even more exciting is that hospitals and insurers are now required to publish a comprehensive machine-readable file with ALL items and services. They have to provide all negotiated rates and cash prices for the services and include a display of "shoppable" services in a consumer-friendly format. The machine-readable files are impractical to process yourself for comparison shopping (picture: different formats, horribly de-normalized DB dumps), but many sites and APIs have emerged to scrape them and expose interfaces to do so.
Sorry, I'm not going to Google "cheap MRIs near me" when I'm bleeding out on the floor having an emergency. Healthcare is not expensive because you can't see how much a doctor visit costs, it's expensive because that's how a lot of people make a lot of money, and they get very upset when that is threatened.
Most medical care is not an immediate emergency. If I could compare MRI prices and it would impact how much I pay (either as an insurance copay or out of pocket) I would absolutely do that. But I have no opportunity to do that so there is not price feedback like there is in a market.
When you're having a medical emergency, you can't exactly go online and start price shopping.
Nor should it strive to be a market. Healthy markets can only exist where demand is elastic. If the choice is between dying to kidney failure or enduring life-crushing medical debt, you bet I'm going to do anything it takes to get that transplant. And therein lies the problem: You *cannot* have healthy markets in healthcare. Period. Demand for healthcare is fully inelastic. Anyone arguing the opposite is either profiting off the status quo or woefully ignorant of economics.
I think this is actually an opposite problem. For kidney failure in particular, you can check the insane amount USG spends on end stage care. The demand for healthcare at the limit exceeds any reasonable supply. Healthcare spending across counties goes up pretty much with disposable income. There are massively expensive interventions that could give someone close to death few extra months.
Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.
Sounds like you are looking at it from a consumer's point of view.
The US "market" is between the drug companies, hospitals, practitioners' groups, insurance companies, and government.
They are the ones that have market participation, the patient's not involved with that, their primary duty is to provide justification for the transaction.
>Healthcare doesn't function as a market, to our detriment.
So true, but even worse than that, the market that is there is predatory to a cumulative detriment worse than when simply dropping the ball makes things go wrong :\
In economics 101 one of the first things they teach you is supply and demand, and inelastic goods. Food and healthcare are the two main examples of inelastic goods, where demand is heavily disconnected from supply. There are of course nuances (you can eat just beans and rice, or do the bare minimum of healthcare/medicine to survive), but both are not things you have a lot of choice to consume or not.
"Healthcare shouldn't be a market. That's why you're paying $40k."
I see your drill down to fundamental issues and I raise you:
Pregnancy is not a sickness. Hospitals are for sick people.
If we reserved hospital birth for women and children with actual medical problems we would allocate resources much more judiciously.
An added benefit: not exposing otherwise healthy (and capable) women to an almost universally disempowering and disenfranchising birth-industrial-complex that seems designed to engender fear, self-doubt and pathological outcomes.
Pregnancy can turn bad (10% of first-time pregnancy, might be higher in country with high obesity rates). In that case, the faster you are with the anaesthetic and the C-section, the better. Also, hygiene. Also, ombilical cords around the newborn necks. Also, the maternities in my country are great (the one we have left at least).
Yes but hospitals are an essential part of Enumeration At Birth.
Government loves anything that assists its people-tracking machinery. It will never ever ever discourage pregnant women from doing something that would make reliable Enumeration At Birth more difficult.
Hospitals are also quite good for giving birth, because human bodies are extraordinarily bad at giving birth.
As fun as it sounds to go back to 25-50% infant mortality, I would prefer we keep this in hospitals and do cesarian sections and other interventions when necessaru.
Will somebody please think of the children !!?!?!?!
My scheduled C-section (which my insurer likely didn't question me about because I was 40 and have other health issues) plus three-night hospital stay was about 5,000 EUR, all paid by my health insurance (private, so I know that 5,000 was the "retail" price), in a fairly prosperous part of Germany.
Not that the German health system isn't facing down some of the same demographic issues the rest of the well-off world is, but comparing wait times for specialists now that I'm on public (more like, very strictly regulated) insurance with my dad back in Texas on a combination of Medicare and supposedly good supplemental plan, I'm still in a better situation.
A strong public/heavily regulated independent insurers system gives the private insurers enough competition to keep prices in check.
Plus, I don't know of an insurer here, public or private, who also owns clinics or employs physicians, and they don't own pharmacies.
The corruption is so entrenched and so out of control, the only way out of this mess is for regular people to just stop using the health care system. Yes, there's no alternative, and yes, it means living a riskier life. It sucks, and it's not what we want to hear, but they can only charge us if we show up and purchase the product, and that's the last lever of power we can wield.
I've discussed just opting out of health insurance altogether and doing CrowdHealth with my wife, thinking along these same lines.
I'm a single contractor and can't really justify it. It saves me about 8k per year and this would be a bronze plan through MediCali if I got it. People would say "well what if you get a cancer or something" and yea that may be true but in that instance not only would I be out that premium but also the deductible and it won't even cover everything so maybe I'm actually better off stacking cash until the inevitable.
I'm right there with you - this is a case study in "perverse incentives." There is zero benefit to "paying into the system" to be had under the current model. Better to chance it and then sign up for a plan at the last minute since insurers can't deny you based on pre-conditions.
Regular people are already not using the healthcare system to a large degree. But it's not a realistic ask in perpetuity. If someone gets ill enough, they will get healthcare or they will die.
"Healthcare too expensive? Have you considered dying?"
Sorry, what are you going to do when you get into a car accident and they rush you to the hospital? Assuming you're even conscious. "No, I'm voting with my wallet!" flatlines Come on.
What if we used our collective power to fix the system? (Up to and including replacing it with something that works for the majority, and not the minority.)
If you were rushed to the hospital you'd be treated: https://www.cms.gov/priorities/your-patient-rights/emergency...
So to summarize: a. you're paying that for health insurance, not for the birth of the child. If you, your wife, your children had any other diseases then those would be covered as well. This is a significant benefit. b. all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.
How come other countries have better healthcare at lower real costs? Basically every developed nation has better healthcare outcomes than the US. All other nations have cheaper healthcare.
America is not special, we've just brainwashed our less-observant citizens into believing that solutions the entire rest of the world uses will never and can never work here. There's nothing special about our population or economy that would prevent accessible healthcare. The only thing standing in our way is healthcare companies who want their 6000% cut of every procedure and politicians who will do literally anything to give billionaires another dollar.
As someone who has lived in several countries, I do not believe every developed nation achieves better healthcare outcomes than the United States. Many European countries, as well as Canada, offer some form of universal coverage with free general treatment but waiting times for appointments and procedures can vary widely. That said, I still think universal healthcare is preferable, as these systems tend to prioritize urgent cases effectively and ensure that emergency treatment is fully covered for free.
I think, it's only the Asian countries who have got cheap, easy, and effective healthcare where you can not only get appointments quickly but you can get treatment for cheap too but their emergency services are not always as streamlined as those in more developed systems. There is no clear overall winner. Some places excel in certain aspects. Others perform better in different areas.
When I went to Canada, I talked to someone who said the Canadian government will subsidize trips to the US for certain treatments because it's not available at all in Canada or has insane waiting times. It's one data point, I know, but generally I think it's true that quality and availability of care in the US is much better.
I’m a Canadian and I’ve worked in health care.
This is only done for very specialized treatments where the province (they run the health care delivery) doesn’t have the treatment and/or the American resource is closer than a Canadian treatment location.
For example Nova Scotia will send some complex paediatric cases to Boston. They could send them to Toronto, but Boston is closer. Same with Manitoba but they use Minneapolis.
Canada is only 40m people and almost half that is in one province. The smaller provinces simply don’t have the population to justify having every possibly medical bell and whistle.
Point is when province sends Canadians for US treatment is isn’t actually about better quality as not all provinces have the same in house capacity and often the next largest city with such capacity is an American city.
> So you are bearing the full cost of extremely high quality health insurance in a western country.
Overinflated imaginary cost*
There is no way that a medical consultation of 15 minutes actually cost $32k. Examples like this are aplenty, but only from the US. My favourite one was an itemised bill for birth that included a $1k for skin contact with the newborn.
> extremely high quality health insurance in a western country
(Sigh...) Let's put some facts.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
No. The original claim was "all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.":
1. The quality is high.
2. The OP pays the full price.
1 is incorrect. The OP is paying a lot, but is getting the same subpar quality healthcare as everyone else. He differs with people without money in only one thing: the latter don't get the full access to the subpar health system. The system itself is the same and its general quality is well indicated by the core metric of the infant mortality.
The health system is subpar and there is absolutely no reason why such a system should cost that much.
Many countries have financial incentives provided to its citizens to have children. Requiring half of a citizens median salary to be given to a faceless middleman to provide this service seems untenable. I cannot imagine a society that does this would be able to survive.
When your country is led by a person who seems to find children and marriage inconvenient, you're bound to see that mentality propagate throughout everyday life
Nearly 2 in 5 Americans are covered by Medicare or Medicaid. TANSTAAFL. The other 3 bear the burden. At some point Atlas shrugs and decides welfare is a better deal.
The amount of money the US Government pays just for that 40% should be enough to cover all 100%. We know this is possible because it happens in other countries, which have shorter waits and more coverage since that talking point keeps being brought up despite collapsing in the face of reality.
The quality of health care in the US is significantly higher than anywhere else in the world.
Whether that quality is necessarily (or good) is debatable, but we are getting something for the money.
You also are just completely wrong in your main point. We cannot provide the same efficacy of healthcare as we are now for 60% less. We are the richest country in the world, labor costs more here than other places.
>The quality of health care in the US is significantly higher than anywhere else in the world.
Yeah, I'm gonna need a citation for that. Because it sounds like a health insurance propoganda rather than the actual truth.
> The quality of health care in the US is significantly higher than anywhere else in the world.
Simply not true.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
> The quality of health care in the US is significantly higher than anywhere else in the world.
Do you have any evidence of that?
It is also significantly more expensive: https://ourworldindata.org/grapher/life-expectancy-vs-health...
Expenses are definitely higher, and doctors and hospital CEOs and med school CEOs do drive nicer cars and have bigger summer dachas, but I can't say the same about quality. Six month waits for a specialist, every PCP and shrink you'd want to visit not taking on new patients, ER wait times comparable with other developed nations, worse overall outcomes...
Maybe the top 0.5% is getting better care, but I really wouldn't shed a lot of crocodile tears for them.
Citation definitely needed.
Ive been to doctors in different countries including the USA. Theres nothing special with general practitioners with the USA.
Or if you end up in China, you can get blood panels for like 10RMB, MRI for 30RMB, and damn near automated to boot.
Go to Mexico for dental work. What costs you here $30k costs you $2k, and they take your insurance.
The US citizens are being gouged, because our government has been bought out by corporate interests who bribe, err, campaign donate to both parties. And thats across every economic activity. Medical is just an egregious one, alongside academics.
> The quality of health care in the US is significantly higher than anywhere else in the world.
Source, backup your claims.
Health outcomes are WORSE than most other developed countries and that's the only statistic that matters here
> The amount of money the US Government pays just for that 40% should be enough to cover all 100%
This is true as long as the following changes are made: 1) wages for healthcare workers are scalled back ~50%, 2) many drugs and medical procedures are not longer covered (a good example is CAR-T for cancer or drugs for rare diseases).
In Australia 5 out of 5 people are covered by Medicare, and 5 of them bear the burden. (at some point in their life. assuming they become a tax payer, which seems likely for most.)
On top of that, 53% pay for Private Health Care as well.
https://www.health.gov.au/topics/private-health-insurance/re...
On top of that many things that are 'not urgent' you have to pay for yourself.
I have recently paid over 20K for back surgery. Prior to the back surgery I could barely walk. This was deemed 'not urgent' and had I would have had to have waited at least 18 months for surgery via Medicare.
I also have private health cover.
So, it's important for non-Australians to understand, our health system is far from a panacea where taxes pay for everything.
Currently 778 K Australians are waiting for 'elective surgery' .
What percentage of Australian society is net-positive tax payer? That’s your real number, not this pretend 5 out of 5 as you claim.
More info on Australia from a quick search.
- Public hospital birth is about $0-1k USD.
- Private hospital with health insurance: $2-3k USD
- Private without insurance: typically up to $13k USD
There's no way that's true - include the employer side payroll taxes. Whether PPP or nominal my napkin math gives me 40% more tax payable in Australia
Edit: I'm too dumb to know whether to include superannuation as a tax or not so I'm not sure if I'm right or not.
From the top:
Health spending in 2023–24
In 2023–24, Australia spent an estimated $270.5 billion on health goods and services– an average of approximately $10,037 per person. In real terms (adjusted for inflation), health spending increased by 1.1%, or $2.8 billion more than spending from 2022–23.
In 2023–24, health spending accounted for 10.1% of the gross domestic product (GDP) in Australia, approximately 0.2 percentage points higher than in 2022–23.
From the bottom:
In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out‐of‐pocket fees — this is almost double the amount contributed by private health insurers.
There is concern that vulnerable groups — socio‐economically disadvantaged people and older Australians in particular, who also have higher health care needs — are spending larger proportions of their incomes on out‐of‐pocket fees for health care.
A 2019 study identified that one in three low income households are spending more than 10% of their income on health care.
There's little to no public advertising of prescription drugs, cheap generics are widely available from federal scale bulk negotiation deals.
Health outcomes are greater life expectancy than the US, national scale cancer survuival rates are better by a few percentage points (IIRC - they are close but higher).
Australia has long had an innate "we're all in this together" society built on individualism. It's not great, it's not perfect, but the first instinct is generally to look after our own - across the board.
When I was in the USA just paying for things like a GP and a single specialist didn't seem outrageous coming from Australia.
If I worked in the US, I would have health insurance and would be paying lower out of pocket costs than I would in Australia. Combined with the higher salary and cheaper housing that's a pretty good deal.
Edit:
We allegedly have universal healthcare but that doesn't cover any actually competent specialist (need private healthcare for this) so paying $400 for 25 minutes of a psychiatrist every 2 months and $95 for 7 minutes of a GP is common.
It was likewise striking how few of America's slave owners thought that slavery was such a sweet deal that they should be enslaved. It's not always true, but it should always give you pause if you find yourself insisting that other people have it too good and yet you've been careful to ensure that you'd never have to trade places...
Related: Car Seats as Contraception https://www.journals.uchicago.edu/doi/10.1086/731812
> We estimate that these laws [mandating safety seats] prevented fatalities of 57 children in car crashes in 2017 but reduced total births by 8,000 that year and have decreased the total by 145,000 since 1980.