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Comment by fluentmundo | Hacker News Reader

a) You must not have read the piece: "the bills are high because of who is paying them"; "insurance companies spend some eighteen cents for every dollar they collect in premiums on administration costs: 'marketing, determining eligibility, utilization controls (e.g., prior authorization of particular procedures), claims processing, and negotiating fees with each and every physician, hospital, and other health care workers and facilities.'"

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18% is surely not the whole issue with inflated medical bills. If medicine in the US were only 18% higher than elsewhere, we'd all call the problem 'solved'.

The author doesn't say that's the whole issue. He also says the private system drives hospital consolidation, which in turn gives them higher bargaining power to demand higher prices. My point was, OP is wrong that the author "does basically nothing to interrogate why prices are high."

That is not an argument, it is an assertion that offers no real explanation whatsoever. An argument would connect who is paying to the high prices, this article fails to do that.

The 18% overhead of insurance companies, just like the overuse of care argument rebutted in the article, does not explain the high relative cost of care in the US.

Of course it is part of the explanation. That administrative overhead — the bureaucratic army it pays for and marshals as a lobbying and negotiating tool — encourages hospital monopolization, which gives providers greater bargaining power, driving up prices.

Yes, but per the article itself it only explains 18% of cost. And overhead is never going to be zero, so you can maybe, what cut that in half? At best? That's not even close to explaining the discrepancy between US per capita spending and other countries.

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