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What's driving rising business costs?

libertystreeteconomics.newyorkfed.org

31–40 of 70 posts

Re: What's driving rising business costs?

#31

We really need to switch to a National Health Service style of administration of health costs. Right now we have Medicare which makes unilateral cost determinations, and doctors and hospitals end up accepting below-cost reimbursement that because how could they turn away all the retired people, but they end up subsidizing these unilateral decisions with money from private insurance payors (namely everybody who's work…

Potentially. The issue is how do you manage solvency. State Medicaid and Workers Compensation funds were already insolvent before the 2024 election, and as such most states lack the fiscal overhead needed to fully support a fully funded single payer program today. It would end up the same way the NHS has in the UK. Vast swathes of the US are deeply fiscally troubled due to the impact of the COVID pandemic, and if tha…

Going single payer is a drastic drop in the cost of healthcare as a percentage of GDP. There’s no fiscal advantage to the current system whatsoever.

The core issue is it suddenly destroys a large number of companies and removes millions of unnecessary jobs from the economy. That’s a great deal of wealth and a great number of voters who don’t want you to save hundreds per month by making them redundant.

Re: What's driving rising business costs?

#32

We really need to switch to a National Health Service style of administration of health costs. Right now we have Medicare which makes unilateral cost determinations, and doctors and hospitals end up accepting below-cost reimbursement that because how could they turn away all the retired people, but they end up subsidizing these unilateral decisions with money from private insurance payors (namely everybody who's work…

Yes, and that national administration has to include national standards of care. The government should set cost-effective standards of care for various scenarios. Then doctors should have immunity to lawsuits as long as they followed the standard of care. You shouldn’t be able to sue a doctor and get some expert up there saying he should have run these additional tests or tried this additional treatment.

Re: What's driving rising business costs?

#33
post #30

Earlier quoted context omitted.

The dirty little not-so-secret is that we pay doctors too much in the US. To the tune of several times as much as other large developed countries, like Germany, France and England. Medical care in the US will never ever be as cheap as those countries as long as the providers here earn 2x or 3x. That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created eac…

Doctor salaries alone do not account for the hundreds of billions in profit that health insurance companies extract from us. You are right there is not a competitive market place because the US government cannot provide a universal plan for anyone. We all know the insurance companies would fold overnight as government welfare programs are extremely popular (just look at how much corporations love government welfare).…

It’s a red flag whenever someone talks about healthcare and they focus on health insurance companies and hospital administrators. It’s a sign that they’re working backwards from some ideological beef rather than looking at where the costs actually are.

Health insurance companies have profit margins around 5% or less. Hospitals are half that. A Subway franchise has a higher profit margin. That’s just not where your healthcare dollars are going.

Re: What's driving rising business costs?

#34

We really need to switch to a National Health Service style of administration of health costs. Right now we have Medicare which makes unilateral cost determinations, and doctors and hospitals end up accepting below-cost reimbursement that because how could they turn away all the retired people, but they end up subsidizing these unilateral decisions with money from private insurance payors (namely everybody who's work…

The dirty little not-so-secret is that we pay doctors too much in the US. To the tune of several times as much as other large developed countries, like Germany, France and England. Medical care in the US will never ever be as cheap as those countries as long as the providers here earn 2x or 3x. That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created eac…

The shortage of physicians has nothing to do with medical schools. The immediate bottleneck is a shortage of residency slots. Every year, students graduate from medical schools but are unable to practice medicine because they don't get matched to a residency program. (Some do get matched the following year.) This is primarily due to limited funding from Medicare, although some residency slots are funded from other sources.

https://savegme.org/

I agree that certificate of need laws should be repealed to increase competition between healthcare facilities. That only impacts some states, not the whole country.

https://nashp.org/state-tracker/50-state-scan-of-state-certi...

Re: What's driving rising business costs?

#35
post #33
post #30

Earlier quoted context omitted.

Doctor salaries alone do not account for the hundreds of billions in profit that health insurance companies extract from us. You are right there is not a competitive market place because the US government cannot provide a universal plan for anyone. We all know the insurance companies would fold overnight as government welfare programs are extremely popular (just look at how much corporations love government welfare).…

It’s a red flag whenever someone talks about healthcare and they focus on health insurance companies and hospital administrators. It’s a sign that they’re working backwards from some ideological beef rather than looking at where the costs actually are. Health insurance companies have profit margins around 5% or less. Hospitals are half that. A Subway franchise has a higher profit margin. That’s just not where your he…

If you have a fixed profit margin, the way to make more absolute money is to allow your costs to increase. Insurance companies have zero reason to negotiate prices down.

Re: What's driving rising business costs?

#36

We really need to switch to a National Health Service style of administration of health costs. Right now we have Medicare which makes unilateral cost determinations, and doctors and hospitals end up accepting below-cost reimbursement that because how could they turn away all the retired people, but they end up subsidizing these unilateral decisions with money from private insurance payors (namely everybody who's work…

The dirty little not-so-secret is that we pay doctors too much in the US. To the tune of several times as much as other large developed countries, like Germany, France and England. Medical care in the US will never ever be as cheap as those countries as long as the providers here earn 2x or 3x. That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created eac…

No, they are not paid too much. There's a lot of incorrect assertions here, so it'll take a lot to work through them.

Physician pay depends on specialty, but it can range from the low $100kish mark for pediatricians to $500-750k for certain kinds of surgeons. Family medicine tends to be around $200k. However, this amount ranges vastly by market and top pay often goes to those willing to work in more rural hospitals because no one wants to. For example, pay in NYC for physicians is appalling low compared to the rest of the U.S. market. In addition, certain systems have hard caps. For example, the VA hospitals cap physician pay inclusive of bonus at $400k. This is documented and you can in fact just look up a random doc at the VA with one of the many federal pay search tools.

While some doctors can make more, it typically because they own a practice and that increased pay comes from good old fashioned capitalism. Meaning, they tax the amount their nurses, NPs, medical assistants, etc. make just like all businesses make money per head on their employees. Whether you believe this is right or wrong is up to you. However, this is not any different that someone who runs, for example, a yard care business. More accurate pay can be found by those who work directly for large hospitals.

Next, the cost of medical education in the United States is vastly higher than other countries. Right now, medical school will cost you somewhere from $400-600k. This is in addition to whatever debt accrued during undergraduate. Further, medical school applications are highly competitive, so students often accrue additional debt by completing a masters in something like public health prior to entry to medical school. This means that someone may have upwards of $750k of debt when they finish medical school, but they still have somewhere between 3-10 years of residency and fellowship before they make attending money. During this time, the debt accrues interest and balloons.

Now, once you become an attending, you're still not good and expenses are vast. Shift work can vary from something like 7 12-hour shifts in a row for intensivists to 14 shifts in a row for hospitalists. Note, just because it says its a 12-hour shift doesn't mean you work 12 hours. They still need to chart and bill and if it's busy, that may be another few hours after the shift is over. In some remote clinics, an ER physican may work 7 24-hour shifts in a row. That may sound absurd and unsafe and it likely is, but it's the reality of the work. If someone is working that schedule, they have increased expenses to just, frankly, live. On the low end, it's very difficult to cook in that environment, so you have to buy a lot of premade food. On a more expensive end, having children on this schedule is extremely difficult. You either require a spouse that doesn't work or you need something like a night nanny. If you're working 12 hour shifts, you must sleep at night and you can't be up to take care of a baby otherwise you run the risk of killing someone the next day. Unless you're paying someone under the table, current nanny rates in large markets are about $20-25/hour. Insurance rates are also high. I don't mean malpractice either. Generally speaking, one needs to carry disability insurance because if one gets into a car accident and breaks their magic hands, there's no way to pay back that debt otherwise. These policies are thousands a year. That's just the start. They pay a large amount of money to buy their time back because they don't have it.

Next, there's a myth about limiting residency slots in order to increase pay, at least recently. I will not defend the AMA and some of they took, especially in the 1990s. Here's the 2025 residency match data:

https://www.nrmp.org/match-data/2025/05/results-and-data-202...

The number of offered and filled slots is on page 2 (or 13 depending on how you count). Some specialties filled all of their slots. Where the U.S. vastly lacks is pediatricians, family medicine, internal medicine (who can work like family medicine if need be.) Pediatricians had 147 unfilled slots. Family medicine had 805 unfilled spots. Internal medicine had 357 unfilled spots. These spots can be filled by people who graduated from U.S. medical schools, island medical schools, Mexican medical schools, or a vast array of other foreign medical schools. However, they're not filled because they don't have the applicants. That's not medical school collusion. That's the hard reality that medical school is extremely expensive and the training is extremely long.

Now, how do other countries handle things? One, their medical school is not as crushingly expensive. Two, places like Europe cap the number of hours a physican can work. If you want to pay American physicians less, you'd need to blow out their medical school debt, reduce their hours, and offer better benefits. Until then, no, really, they're not overpaid.

If you want to start pointing fingers, try the vertical integration of insurance companies, pharmacy benefit managers, and hospitals. I don't have the numbers readily available, so I'll stop here. But, really, it's not the docs.

Re: What's driving rising business costs?

#37
post #33
post #30

Earlier quoted context omitted.

Doctor salaries alone do not account for the hundreds of billions in profit that health insurance companies extract from us. You are right there is not a competitive market place because the US government cannot provide a universal plan for anyone. We all know the insurance companies would fold overnight as government welfare programs are extremely popular (just look at how much corporations love government welfare).…

It’s a red flag whenever someone talks about healthcare and they focus on health insurance companies and hospital administrators. It’s a sign that they’re working backwards from some ideological beef rather than looking at where the costs actually are. Health insurance companies have profit margins around 5% or less. Hospitals are half that. A Subway franchise has a higher profit margin. That’s just not where your he…

Show us the data. You want to make the claim, bring the evidence.

Re: What's driving rising business costs?

#38
post #33
post #30

Earlier quoted context omitted.

Doctor salaries alone do not account for the hundreds of billions in profit that health insurance companies extract from us. You are right there is not a competitive market place because the US government cannot provide a universal plan for anyone. We all know the insurance companies would fold overnight as government welfare programs are extremely popular (just look at how much corporations love government welfare).…

It’s a red flag whenever someone talks about healthcare and they focus on health insurance companies and hospital administrators. It’s a sign that they’re working backwards from some ideological beef rather than looking at where the costs actually are. Health insurance companies have profit margins around 5% or less. Hospitals are half that. A Subway franchise has a higher profit margin. That’s just not where your he…

That is no longer true. What we have historically referred to as “health insurance” companies responded to ACA margin limits by becoming sprawling behemoths whose rampant self-dealing makes such profit margin calculations meaningless.

Re: What's driving rising business costs?

#39
post #34

Earlier quoted context omitted.

The dirty little not-so-secret is that we pay doctors too much in the US. To the tune of several times as much as other large developed countries, like Germany, France and England. Medical care in the US will never ever be as cheap as those countries as long as the providers here earn 2x or 3x. That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created eac…

The shortage of physicians has nothing to do with medical schools. The immediate bottleneck is a shortage of residency slots. Every year, students graduate from medical schools but are unable to practice medicine because they don't get matched to a residency program. (Some do get matched the following year.) This is primarily due to limited funding from Medicare, although some residency slots are funded from other so…

That's not true. You can look at the residency match for 2025 here:

https://www.nrmp.org/match-data/2025/05/results-and-data-202...

While many specialties are fully filled, we need pediatricians, family medicine, and internal medicine docs. They're generalists and where the largest shortage is. There were 147 unfilled slots for pediatricians, 805 for family medicine, and 357 for internal medicine. They don't have the applicants; it's not the slots.

Re: What's driving rising business costs?

#40
post #37
post #33

Earlier quoted context omitted.

It’s a red flag whenever someone talks about healthcare and they focus on health insurance companies and hospital administrators. It’s a sign that they’re working backwards from some ideological beef rather than looking at where the costs actually are. Health insurance companies have profit margins around 5% or less. Hospitals are half that. A Subway franchise has a higher profit margin. That’s just not where your he…

Show us the data. You want to make the claim, bring the evidence.

shimman claimed

>hundreds of billions in profit that health insurance companies extract

yet no request for evidence?

Here's data for medical loss ratios:

https://www.kff.org/private-insurance/medical-loss-ratio-reb...

https://www.oliverwyman.com/our-expertise/insights/2023/mar/...

Here are the sub 5% profit margins for the publicly listed insurers. On the same website, clicking on the "Revenue & Profit" tab will show you that all of the health insurers, combined, earn less than $50B of profit per year, and most of that is probably not even insurance related since a large portion comes from UNH's enormous healthcare provider business.

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

https://www.macrotrends.net/stocks/charts/CVS/cvs-health/pro...

https://www.macrotrends.net/stocks/charts/CI/cigna-group/pro...

https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...

https://www.macrotrends.net/stocks/charts/HUM/humana/profit-...

https://www.macrotrends.net/stocks/charts/CNC/centene/profit...

https://www.macrotrends.net/stocks/charts/MOH/molina-healthc...

The above obviously does not include the many millions of Americans covered by non profit insurers, such as Kaiser Permanence, Providence, Cambia, and the various Blue Cross plans.

Here are the 5 year returns for the above businesses compared to SP500:

https://i.imgur.com/S8bNSM2.png

Suffice to say, you would not want to be a shareholder of a health insurer.

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