Healthcare spending in the news

The economics of U.S. healthcare aren’t simple.

That’s why 95% of the chatter misses the point.

Everything boils down to three questions most patients can’t answer:
  1. What’s the price?
    → You don’t know.
    → Your doctor usually doesn’t know.
    → The hospital often doesn’t know until 90 days later.
  2. Who pays?
  3. Who eats the loss if you can’t?
Let’s fix the nonsense, one claim at a time.

Myth: “Insurance companies don’t take risk—reinsurers do.”

Reality: Primary insurers collect $4.5 TRILLION in premiums and keep the float. Reinsurers touch maybe 12% of that for tail-risk only.

Price transparency? A 2021 CMS rule forced hospitals to post prices. but did they? Result in 2025:
  • 70% compliance
  • Files are 100,000-row CSV monsters
  • Cash price for an MRI can be $400 at an imaging center or $6,800 two miles away at a hospital-owned facility.
You literally cannot shop while unconscious in an ambulance. Vertical integration is eating the system alive. For example, UnitedHealth owns:
  • the insurance company
  • the doctor’s office
  • the surgery center
  • the pharmacy
  • the PBM
  • the claims processor
They steer you in-house and mark everything up 300–500%.

Transparency alone won’t fix it. Even with perfect prices, you’re still screwed by:
  • 70% of U.S. counties have ≤2 insurers
  • 37 states still have Certificate-of-Need laws that block new hospitals
  • 340B hospitals buy drugs for $0.09 and bill insurance $9,000
  • EMTALA forces ERs to treat everyone (good!) but pays them nothing (bad!)
What actually works? Singapore, Switzerland, and the Surgery Center of Oklahoma prove the combo that slashes costs 70–90% overnight:
  1. Real-time, machine-readable price transparency
  2. Reference pricing + HSA-qualified plans
  3. No facility fees for outpatient work
  4. Antitrust hammers on megamergers
  5. Cash markets for everything elective
Until we do those five things, most policy “debate” is just theater.

Bottom line: You can’t manage financial risk when the price is a state secret.


@Life is Golden
 
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