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They are not - the effect these prices have on the poor is an unintended[1] consequence of the true aim. Extracting the most money possible from insurance payors - honestly, if hospitals could bill "You owe us 50$ or as much of that that your insurance would cover" then they would. Nobody actively wants to impoverish the poor (except for a small number of utterly terrible people) but payors force cost pass on to their subscribers as a way to keep the costs from getting too crazy and and the uninsured get hit by the full bill that providers want to extract out of payors simply because it's impossible for them to under bill without getting hit by lawsuits.

That paragraph was an attempt to be really fairly voiced so just to follow up - this system is utterly rotten and terrible, the US has one of the worst health care systems in the world when it comes to the non-super rich - and even for them there are better options - and it needs to be fixed.

1. Edit note: Originally I used "unavoidable" here which was a poor word choice that's been pointed out below.

Also good to point out - payors actually benefit from crazy costs. Insurance companies had their profitability capped as a percentage of premiums collected[1][2]. The easiest path to profit growth is just to let claims balloon, then use that to justify premium increases.

[1] Technically it's a cap on all non-medical spending, rather than profit margin specifically. But in effect it's a cap on profits, as there's only so much overhead you can cut.

[2] https://www.aeaweb.org/research/regulating-health-insurers-a...

I think they're doing it just because they can. there are some long winded explanations about this being about the negotation process between the hospitals and insurance companies but that's no exucuse. at the end of the day, it's just unmitigated greed on the part of the hospitals.

It's politics as well. The Democratic candidate campaigning on maintaining the status quo is leading against the candidate who is campaigning on single payer. There's not much left to do when larger cohorts of voters prefer an inefficient, wasteful system (or a candidate who supports such a system). What we currently have is what people are voting for.

I've tried to make everything stated above objective in keeping with forum guidelines. Personally, I find the situation incredibly demoralizing. Perhaps the outcome of COVID-19 is a demonstration as to why healthcare needs to be fixed.

The Overton Window has slid so far to the right that such remedies are considered to be radical. Sigh.

Single payer healthcare for all has always been radical in the US. The Overton Window shifting to the left over the last decade is what has allowed Bernie to have any relevance at all.

Has it been? Those 65 and older (Medicare), those on assistance (Medicaid), and current/past military service members (Tricare) all appear to be very satisfied with their single payer healthcare.

I genuinely don't understand why this is considered a radical idea when so many citizens are happy with this public benefit. This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy.

https://news.gallup.com/poll/186527/americans-government-hea...

"Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all."

Yes, they are happy with it just like they are happy with social security income. The radical part (in the US) is suggesting that it should be available to everyone regardless of age (or veteran/military status) without any concrete plans to pay for it.

> This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy.

Then you are being willfully myopic if you can’t possibly envision people who don’t have faith in the government to not cause a meaningful regression in care by destroying the private market. You can both be unhappy with the current opaque healthcare market and not support Medicare for all.

> Then you are being willfully myopic if you can’t possibly envision people who don’t have faith in the government to not cause a meaningful regression in care by destroying the private market. You can both be unhappy with the current opaque healthcare market and not support Medicare for all.

I can't empathize with irrationality. We are at rock bottom. If you refuse the only life raft in sight in the ocean, you have only yourself to blame for the suffering you inflict on yourself and others.

National healthcare has been attempted for generations now: https://www.healthcare-now.org/legislation/national-timeline...

It's been vigorously opposed by the usual suspects, but it's not at all a new proposal.

IMHO it’s not so much that they prefer the existing system as it is that they fear the unknown. No matter how bad their existing coverage is, they worry that some replacement would be even worse. It’s a downstream consequence of the collapse of faith in our institutions - as bad as things are, nobody trusts Congress to be able to design anything better. So they cling fearfully to whatever they’ve got.

The Devil you know, etc.

I am unsure how you cultivate courage and compassion at scale, but we have never needed it more as a society. Somehow we must get from "I've got mine, f___ you" to "I've got mine, how can I help you?" Otherwise, ruin awaits us.

There's plenty of evidence that single payer polls better than Sanders. Maybe a candidate without his baggage can get it done.

No other such candidate exists at this time. EDIT: We're going to have to keep waiting for older politicians and voters to age out of the system before meaningful policy progress can be made. Sanders is the best candidate if you value single payer.

"You can always count on the Americans to do the right thing after exhausting all other options." -- Churchill

No such candidate could exist - Sanders' only baggage is being described as a socialist, they haven't dug up any moral failings or flip flopping or other BS rationales. Any candidate that embraces Medicare for All will instantly be branded a socialist by the MSM and be in exactly the same spot, but may lack the honesty and integrity that Sanders has cultivated.

What baggage? The label of 'democratic socialist'? No Presidential candidate in recent memory has been as devoid of scandal as Bernie Sanders.

What we currently have is what people are voting for

We have something similar with respect to climate change policy in Australia - most people in polls and surveys claim to want more aggressive mitigation policies, yet they will just not vote for it.

A complex web of fears and other factors seems to have caused a sclerosis in most of the liberal democracies, and any significant change from the clearly dysfunctional status quo is almost impossible to bring about. Polities that can't respond to changing circumstances are not going to fare well & we clearly have deep troubles in our very near futures.

I don't think it requires any more than an indifference towards the welfare of others from those who believe they can afford any kind of healthcare they would ever need while simultaneously pursuing a minimal tax bill.

It isn't intentionally designed, just a side effect of the system as it exists today. There are two ways to bring healthcare costs down in America:

1. Insure everyone — no exceptions (by the government or through private insurance)

2. Let hospitals (and ERs) deny care to those that can't pay

Since neither of them is happening anytime soon, Advil is going to keep costing $50.

No. Cost per outcome is still higher. More is wrong.

I don't see how #1 solves anything. The biggest issue which leads to all the cascading effects is the hospitals can charge a ridiculous amount for goods and services, with some hospitals charging more than 1000% more than what the government thinks they should (https://www.theatlantic.com/health/archive/2015/06/hospitals...).

I had a colonoscopy done a year ago and the prices pre-insurance ranged anywhere from $7000-$16000 depending on the location, all within network. I ended up paying just $1300 because of my insurance with a couple hundred covered by my HSA account. Why is there such a drastic price difference between places? Why are hospitals and other care providers that have a monopoly over an area able to act like a monopoly and have complete control over pricing?

Everything else is just a 2nd order effect.

The reason hospitals charge more is (1) they need to recoup the cost of the services they are otherwise providing for free and (2) they have no leverage to negotiate with insurance companies and drug manufacturers. Having a national or privatized healthcare system that covers everyone will greatly help with both of them.

> I’ve seen $50 being charged for a pill of Advil - first hand

A paper plant was having a problem with their mill. They brought in a consulting engineer to help them with the problem. He took a look at the machine and after a few minutes, drew an X on it in chalk. "Hit it there with a hammer". It worked!

"How much do we owe you?"

"$10,000"

"That's absurd! I can't pay you that for literally 2 minutes of your time! I need a detailed invoice."

The engineer wrote up an invoice:

chalk mark $5 knowing where to put it $9995

=========

The patient in your example did not pay $50 for an Advil.

There is a lot wrong with US healthcare, but this isn't it. It's about misaligned incentives.

It’s pathetic you’re defending this, and terribly evident you have never had to live in poverty in the states.

It’s also patently, blatantly false. I paid $740 to see the doctor to identify I needed an Advil.

I paid $50 for the Advil!

Your post literally incited a large amount of rage in me. Defending people like Martin Shkreli- which the pharma industry is full of - or the medical industry itself’s rape of the lower class - is pathetic, selfish and just straight up wrong.

EDIT: I’m unsure, as well - how I was unable to downvote this comment.

eh? I grew up in poverty on public assistance and didn't have a decent job until I was 25. I've been hungry. etc etc. I know about being poor, ok.

I also didn't defend the behavior. Get out of your personal shell and re-read it.

You paid 0.05 for the Advil. You paid $49.95 for everything else that goes along with it, when you get an advil at an advanced medical care facility. You would understand that if you comprehended my post.

Do you realize that when you go to any store and buy a coke for $1.50, you are only paying maybe .25 for the soda (incl. the bottle it comes in)? .75 or so is shipping and .50 is to the retailer. Every product has non-production costs associated with it, and that is what you pay for when you get a $50 advil at any kind of medical facility.

No. I paid $740 for the rest. I paid $50 for the pill.

You would understand if you could get beyond defending this pathetic system. Sad and shameful.

There is no excuse to mark up a pill $49.50 beyond raping the poor. That is all. Ten dollars? Sure. $49? No. Just no.

Disgusting, shameful and a horrible abuse of human life.

Almost not worth arguing here.

What Martin Shkrelli did was price gouging (qualitatively, not legally, and he went to jail for securities fraud, not price gouging). In those specific circumstances, that's evil.

A $50 Advil is not price gouging. That's the cost of getting a pill -- any pill -- at any kind of medical facility. The overhead costs are exceptional. Single payer healthcare alone would probably shed 50% of the cost, before price bargaining even comes into play, as the billing involved is insane. Inventory control, yes for an Advil, brings high costs. A nurse being paid $50/hr vs a store clerk at $5/hr (neither exact numbers; just making a point) also brings high cost.

There absolutely is a reason to charge $50/advil. And that reason boils down to misaligned incentives. I won't bother to go into detail because you aren't listening.