> The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?
Insurance companies are definitely lying (their execs are paid tens of millions) though it should be noted that the US system greatly limits the ability to spread insurance payments on health populations, so it makes sense that the population using medical services is a larger share of the insured population, and thus has to pay more.
Anyway more generally the administrative overhead of US healthcare is absolutely enormous e.g. as of 2017[0] it was almost 35% of medical expenses, versus 17% in Canada (up from respectively 31 and 16.7 in 2003).
> [Administrative costs per capita in the US versus Canada are] $844 versus $146 on insurers' overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs.
So the admin overhead in the US (v Canada) is:
- 5.78x on insurance
- 4.76x on hospitals
- 2.07x on nursing homes, home care, and hospices
- 5.34x on physicians
Importantly though you did not list drug companies in there.
Drug costs are completely out of control in the US (some generic and out of patent drugs have seen price increases of 80x in a decade), and AFAIK modern treatment regimens tend to include a lot more different drugs.
At the hospital level, aside from the administrative overhead above, as an other commenter notes there is also the issue that because it's not a single-payer public health system hospitals have to compensate for indigent ER clients by billing more to, well, people who can pay.
Then of course there's the issue that because all the incentives are fucked under the US system it's being used the least efficient way possible e.g. medical costs are sky-high, so people can't have a GP, so they can't take care of their conditions until those go south, at which point they go to the ER which is the most expensive and least efficient medical service center.
And then the ER's job is to stabilise them, but they still don't have any more money to pay for long-term treatment than they did before having to go to the ER (less, really), so they can't follow through, so they degrade again, and back to the ER.
[0] https://pubmed.ncbi.nlm.nih.gov/31905376/