What's driving rising business costs?

It's a combination of factors. Rural hospitals and clinics tend to be under-resourced with lack of equipment in buildings that aren't particularly nice. As far as small town, if you like it, great. However, people who are highly educated tend to like to be around others who are similarly educated and that's difficult to find in a rural town unless it's also a university town. There tends to be a lack of school options for their children and given how much they spent on their own education, they tend to prioritize this highly. There tends to be a lack of town infrastructure like good grocery stores, or theater, or museums, or other amenities. Docs also have their own medical needs and understand that those can't be met at small clinics, so they like to have access to good hospitals. Imagine intimately knowing all the ways something like childbirth can kill you and also knowing that there's not an appropriately trained surgeon in town. By the time one finishes their training, they're probably in their 30s and may want to find a partner. Options tend to be limited in small towns. On the darker side of things, foreign people are often not particularly welcomed in rural towns and this can be a particularly bitter experience for the foreign docs that are essentially forced to work there.

So, no, it's not just an urbanite out of their comfort zone. There's a whole host of issues. And, to be clear, we need people to work these jobs, but it's not particularly pleasant for a lot of them.

Here’s industry wide stats for hospitals: https://www.chartis.com/insights/hospital-margins-trend-high.... Median hospital operating margin is 1.5% in 2024. Even among the top 50 systems, the median is 2.3%. https://hospitalogy.com/articles/2025-05-29/top-50-health-sy...

> I'm also skeptical about putting the federal government in charge of establishing standards of care.

Making the government the single payer without setting national standards of care would cause costs to explode. You can’t point to other countries saving money by having single payer without reproducing their systems. Ideally, you’d have to go through some arduous bureaucracy to make a medical claim, like in the UK: https://resolution.nhs.uk/services/claims-management/advice-....

> Most state-run workers compensation and Medicaid funds are already insolvent. Until that gets resolved, no attempt at creating a single payer fund is possible.

Because the government handcuffs itself willingly by prohibiting negotiations with providers and companies on costs at all levels. Which I point out multiple times in the comment. But you're right, solvency is an issue, and a fixable one: stop giving employers tax breaks on such a critical benefit as healthcare, raise taxes on those most able to pay them, and allow the government to set rates and care standards as a baseline that employers and private insurers must compete against.

These problems aren't hard to solve, it just requires accepting such controversial thoughts as, "y'know, maybe shareholder value should come last as a matter of public health".

> Utilities are using data centers as a scapegoat - the reality is most are stuck with fiscal liabilities due to COVID along with insurance and raising prices as a result.

Got evidence of this? Because there's mounting evidence from co-ops, private utilities, and public utilities that actually, no, new DC builds are not only not paying their fair share, but also employing (sometimes illicit) power generators on-site due to being unable to acquire enough power at affordable (to them) rates.

>The big issue is the COVID pandemic era liabilities that continue to require to be paid out to this day.

You keep saying this, but my counter-point - nay, my original point - is that this existed before COVID. What might be happening in this precise moment still have ties to COVID, sure, but the fundamental systems, incentives, and structures existed long before COVID and have not been addressed.

> Becuase that's not something that dramatically impacts the bottom line in most industries - most businesses can afford increasing salaries a couple dollars an hour by reducing capex next year, reducing hours for existing employees, or moving employees to the salaried bucket.

Payroll is one of - if not the - single biggest expense in business; it's why they're all wet at the prospect of AI replacing all labor, even if it's a fever dream. Workers are already squeezed to the bone, and companies - or more specifically, corporate leaders - have decades of history of refusing to pay wages commensurate with productivity gains or cost of living adjustments. Payroll also has knock-on effects on insurance (the more workers make, the higher insurance rates need to be to cover potential insurable losses), so yeah, there's a bit of a cycle here where wages go up, making workmen's comp go up, making wages go up, etc. You can already see this in unemployment benefit caps that haven't kept pace with wage increases since the 2008 recession (MA still caps benefits at such a low amount that they can only barely cover a month of average rent - if you qualify for the maximum amount).

> The pandemic was brutal and we're still facing feeling it's reverberations to this day.

The pandemic was a blip on par with the 2008 recession; yes, there are tails to it (just like 2008), but those tails only evolved because of the underlying systems and structures that allowed the problem to escalate in the first place. Simply handwashing everything as "oopsie, pandemic happened" is dangerously ignorant of the machinations still underpinning everything going on, and represents a refusal to accept that long-term problems require long-term solutions - which in turn requires acknowledging that these problems didn't just spontaneously evolve overnight, or during a single crisis.

I presume that hundreds of billions in profit refers to money extracted over multiple years, not per year, there’s no other way it makes sense.

>and most of that is probably not even insurance related since a large portion comes from UNH's enormous healthcare provider business

Isn’t that part of the problem? There are interdependent layers in the health care industry each designed to extract as much wealth as possible.

In the case of UNH, how much money flows as an expense on the insurance side into income on the provider side? Isn’t the relative profitability between these two sides an accounting trick?

It seems strange to me that you’re saying doctor salaries are too high, yet the majority of profits come from their provider business, which is where doctor salaries would be tracked as an expense, right?

“Less than $50b/yr profit” as if that’s a small amount.

I agree that retail investors would not want to be shareholders of insurance companies, but that’s mostly because I think retail investors are just chum in the water for institutional investors and prop trading firms to feast on.

If it’s so stupid to be a health insurance shareholder, then where does that leave their senior leadership and major shareholders? They’re morons for not immediately divesting and moving into fast food, right?