A lot of the reason hospitals have to charge so much is that they take massive losses on uninsured people in emergency rooms. Medicare for all means they don't have to treat anyone for free.

▲ mirzap 3 hours ago | parent | next [-]

They are not taking any losses; they just charge the regular price with a very tiny profit margin. US healthcare costs are heavily inflated. Insurance is a scam that lets the rich get richer. All insurance should be non-profit.

We all contribute to the pool at a time when we don't need it so we can use the money when we do, not to make CEOs or stockholders rich. That is how an insurance pool should work. Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary.

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qwytw an hour ago | parent | next [-]

> All insurance should be non-profit.

Aren't their profits regulated regardless? If all insurance companies became non profit and let's say total prices dropped by 3-5% that still wouldn't change the situation dramatically?

There are many factors, e.g. amongst other things American doctors are better paid than just about anywhere else in the world.

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gizmo686 2 hours ago | parent | prev | next [-]

It doesn't matter what they charge if the patient doesn't pay it; which is what often happens with uninsured people showing up at the ER.

> Any excess money at the end of the year should be moved to the pool for the next year, not as a bonus on CEOs' 100m+ salary

Under the ACA, excess money in the pool must be rebated to policy holders. In practice, this worked for a few years, but eventually insurance companies ended up increasing cost in order to increase the absolute amount they were allowed to keep. Maybe this is still good (more claims approved), but it is counter productive to the goal of reducing healthcare costs.

	▲	nradov 22 minutes ago \| parent [-]
		It often happens with insured people showing up at the ER as well. Many patients don't pay their bills, either because they can't afford it or are just deadbeats. As overall healthcare costs have increased, insurers and employers have shifted more costs to plan members through higher deductibles / co-pays / co-insurance. So hospitals end up with a lot more bad debt, and this in turn causes further price inflation.

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Georgelemental 2 hours ago | parent | prev | next [-]

No. Under EMTALA, hospitals are required to treat anyone who shows up to the ER regardless of ability to pay; this is an unfunded mandate.

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nradov 29 minutes ago | parent | prev [-]

I'm not necessarily opposed to making all health plans non-profit, but that's kind of a red herring. Many of the largest insurers, like most Blue Cross Blue Shield Association members and EmblemHealth, are already non-profit. They generally don't charge plan members any less than their for-profit peers.

▲ smallmancontrov 2 hours ago | parent | prev | next [-]

No, this absolutely does not explain the US's wildly off-base per-capita expenditure because uninsured people still go in the denominator of the per-capita figure! I'm sure the per-insured-capita figure is worse but that's not what we are comparing!

Americans are constantly trying to exclude uninsured people from their statistics (and, worse, from the care itself) but the comparable countries don't do this so it is utterly ridiculous to propose that the correct statistical comparison is one in which the US excludes the undesirables while other countries don't.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

    Total health spending per capita in PPP$
    
                    2024    2023    2022
    United States   14,885  13,818  12,898
    Switzerland      9,963   9,301   9,089
    Norway           9,393   8,909   8,533
    Germany          9,365   8,503   8,652
    Netherlands      8,436   7,615   7,517
    Austria          8,401   7,697   7,700
    Luxembourg       8,087   7,173   6,854
    Sweden           7,871   7,364   6,977
    Ireland          7,813   7,027   6,748
    Belgium          7,750   7,178   6,906
    Australia        7,469   7,015   6,907

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Scoundreller 2 hours ago | parent [-]

The fun part is when you break those numbers down between government and non-government expenditure. You’ll find that US governmental spending on health care per capita is higher than every other country’s entire (gov and non-gov) spending per capita.

https://www.oecd.org/en/publications/health-at-a-glance-2025...

	▲	BobbyJo 29 minutes ago \| parent \| next [-]
		Could this be because US gov healthcare spending takes place mostly via Medicare, which is specifically for people 65+?
	▲	stackskipton 38 minutes ago \| parent \| prev \| next [-]
		In that link, government/compulsory for the United States seems to indicate times when an insurance company covered it. Voluntary/Out of Pocket is when insurance company wasn't required to cover and did or person paid out of pocket. Even if it's US Government only per capita with people the government insures, it makes sense it would be so high because only people on government insurance are the poor/disabled AND old. Two groups that have extremely high utilization.
	▲	qwytw an hour ago \| parent \| prev [-]
		That number seems hard to believe? Specifically that non government spending would be this low. Presumably "compulsory" includes way more than direct government spending. https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locat... According to the world bank it's closer to 40:60 (government spending still being the majority). So that puts it behind Switzerland but still more than combined spending in just about any other country.

▲ tptacek 2 hours ago | parent | prev | next [-]

That claim is at odds with the working paper's methodology, which gets a good chunk of the $1T in savings it discussed by assuming very sharp cuts to practitioner compensation.

▲ cwmoore an hour ago | parent | prev | next [-]

A lot of the rest of the reasons are carrying the deadweight of administering regulation, and dancing with the existing and prospective malpractice suits that randomly benefit the system sometimes, but always cost everybody, and warp the practice of medicine and patient healthcare experiences.

	▲	nradov 20 minutes ago \| parent [-]
		So what's the solution? Some states have already limited malpractice liability but that hasn't done much to hold down costs. When patients are harmed by preventable medical errors they should be compensated.

▲ pstuart 2 hours ago | parent | prev [-]

It also means that emergency rooms can be used just for emergencies and ongoing and preventative care can happen in clinics. Cheaper to operate and preventing preventable emergencies lowers the load.

	▲	analog31 an hour ago \| parent \| next [-]
		Here's what happens in my locale. If you show up in an ER, they quickly decide whether you need emergency care, or regular urgent care, delivered in the same facility. And medicine is anything if not statistical, so they know the amount of each kind of service that they need to plan for.
	▲	cwmoore an hour ago \| parent \| prev [-]
		Usually tied to employer coverage contracts, and with strictly limited menu of offerings for patient health needs.