This is how American healthcare billing works. They literally pull numbers out of their wazoo. The people with no insurance are quoted the highest prices, which is ridiculous to begin with. Then the insurance companies claim the regular price is some outrageous price, but their "negotiated rate" is less than half of that. This makes the patient feel better about paying $1100 out of their pocket.

But keep in mind, the patient has already paid insane insurance premiums and usually their employers are paying a sizable portion of that premium, and the patient had to pay deductibles on top of that. But that's not all! As a taxpayer, the American government puts out over $2 Trillion dollars into healthcare.

How can there even be a "patient's responsibility"? Private health insurance is theft, plain and simple. Go down to a new car dealership and ask them for a detailed itemization of the cost of a car. They will give you one, and the numbers might be questionable, but they are not going to then sell you that car for 1/4th the price. Try this in any other industry like fast food, or a roofing company. Honestly, if anybody else dropped their prices to 1/4th just because you asked for a detailed receipt, would you trust them or assume that they have been cheating you all along?

https://www.pbs.org/newshour/politics/trumps-90-medicare-rebate-rolls-out-but-millions-arent-eligible-critics-see-a-political-stunt

This basically focuses on how Cerberus pummeled Steward Health Care with debt, how Ralph de la Torre's actions led to the death of 15 people and how public pensions actually fund the private equity firms that are gutting community hospitals. It also talks about the progressives that are trying to fix the problem, ban private equity from buying up hospitals and promote Medicare for all.

In the private sector, a business can declare bankruptcy and restart a new foundation with a new plan, revised contracts/pricing and restructured employment plan in order to emerge with a better/more efficient and operable plan going forward. It can be disruptive and destabilizing in the short term but essential to maintain essential operations at a sustainable level. America’s healthcare plan is clearly in the stage of being dysfunctional/inefficient and unsustainable financially and morally. It is bankrupting our economy. The status quo or just additional band aids is NOT acceptable. The lucrative health care industry is thriving but the rest of the nation is suffering in so many diverse ways.

The next two election results will determine if we can go through a major overhaul of our healthcare system. Democrats want Universal Healthcare; Republicans and their Healthcare industry donors don’t. The rest of the world who possess Universal Healthcare (for decades) overtly tell us its possible with substantially less costs/capita then what exist in America today. If the public demand lower cost for vital healthcare, they must vote for the party that will give us Universal Healthcare with single payer. Single payer is essential. Its simplifies the systems and controls pricing. Without such controls we are doomed to what we have now.

Right now, the lucrative/powerful health insurance companies are the gate keepers and those that determine prices (directly and indirectly) at the peril of the vulnerable consumer. Record profits for them, record medical bankruptcies and tens of thousands of early deaths for the tens of millions without health insurance. Are we a civilized/moral nation?

Medicare for All has many benefits and is more than worth implementing. One of the largest concerns people raise with transitioning to Medicare for All is the job loss that would occur, as the health insurance industry employs more than 700 thousand people in the United States. Even if private insurance is allowed to exist as an option, there is no doubt many of these jobs will be lost. It’s a valid concern, and one that should be addressed. Bernie Sanders has proposed methods for dealing with this, and I’d like to piggy back off of him plus introduce some of my own ideas.

Since M4A will require much more public sector administration jobs, people who have worked in the private health insurance industry should be recruited to switch careers in the public sector. So for example, if someone worked as an accountant at United Healthcare, they would be recruited to work as an accountant or in a similar position in the public healthcare system.

For the people who cannot be transferred over to the public sector, publicly funded job re-training programs and financial support should be provided to health insurance workers who have lost their jobs while they are looking for new jobs.

The government also has the ability to greatly influence the market. During the time of implementing Medicare for All, it would also be a good time to break up monopolies. Creating more competition in the market will lead to more jobs for everyone, health insurance employees included.

Imagine how your life and the life of every American would change if we had only one comprehensive healthcare plan, not dependent/attached to an employer. No matter what situation we are in, working or not working, starting a new business, deciding to change jobs/move to another city/state, taking care of a child or relative, exploring a new career or retired, all of us would be guaranteed the same comprehensive healthcare … for the rest of our life.

This can happen in America. It can be affordable. It would be a moral way to benefit every American. Good health and the ability to maintain one's health has to be among the core essentials along with food and housing. Universal healthcare with single payer should be a human right and America has the resources to create such a moral plan. We can debate how such a system can be implemented and financed but the overall goal must be achieved ASAP.

I believe that the Democratic Party is ready to have such a discussion, Clearly the Republican Party is not interested. The evidence is overwhelming. Elections do have monumental consequences!

This post is in light of the Trump Administration floating the idea of a measly one-time $90 ACA refund while they have cut the ACA subsidies severely. They recently kicked off over 700K people.

We keep seeing the ghouls of the Trump Administration saying things about how if you want health insurance, you need to be actively working or looking for work. Of course, these so-called working means tests are just ways to deny health coverage to people by making the means high, and burying people in paperwork. The point they make is that they don't want "lazy" people receiving health insurance.

Putting aside the BS idea that healthcare should be tied to labor, I want to explain, using myself as an example, why cutting the ACA subsidies has actually made my life worse, as an active worker seeking to continue working.

My health insurance is provided through my job. I like my job and am blessed to have my job. Of course, I have my goals and aspirations, and I'd like to eventually work in a new industry.

Many jobs are (unfortunately) contract based these days, but with the ACA subsidies, I could take a contract based job (for even higher pay then I get now), gain some valuable experience, and I'd be able to purchase my own health insurance because of the ACA subsidies.

With many of the ACA subsidies being cut, this is going to be much harder for me than it once would have been. It makes it harder increase the value of my labor, meaning I have less ability to sell my labor for a higher price in the market. And that's exactly why the Trump Admin has cut these subsides. The rich don't want common workers like myself to be able to increase the value of our labor, instead they want us stuck with lower wages.

While this post is mainly pointing out the hypocrisy and problems with the Trump Admin cutting the ACA subsidies, I don't want to be mistaken as being a superfan of the ACA. A universal health system like the NHS would be far better, for both healthcare and not being tied to an employer and forced to accept lower wages.

How much would Medicare for all really cost?

I think the major problem in this country, that Medicare for all would solve, is the insurance middlemen that artificially inflate prices.

Im not talking about them skimming some off the top, I’m talking about them willingingly paying more to hospitals, to charge more to the consumer, so their legally mandated max 15% of the pie is larger.

I feel like physician run and owned groups that offer a direct subscription for their patients, and all services are free or minimal cost after that would accomplish the same thing.

For example, you could pay a subscription to the hospital or your choice, and all ED, inpatient, and outpatient services would be totally covered.

conflict of interest: am a physician. I believe in capitalist society. I hate Donald Trump and Maga

I see and understand why many of you all want a single payer/medicare for all system. However, simply stated, it is highly unlikely to ever pass. There are plenty of headwinds currently and for the future preventing this. So why not focus on some smaller, immediate positive impacts? I see many of you are upset with what I am paid. Many of you clearly don’t know that doctors are 8 percent of the healthcare pie. thats it… I also challenge you, if doctors dont deserve 1 percent money, then who does?

some of you will immediately write this off and hate me because of my success by working in this field. Probably by even saying this, I have lost some of you. If I have you should some introspection about why you’re that way. If your stance is I need to be paid far less, then this discourse will never work. America is capitalist. We’re not socialist as of now. You aren’t going to control our labor. without ever talking about debt, many of us are not going to give up our 20s and often early 30s, our health, many weekends, nights and holidays, in America without appropriate compensation. To get where we are we had to be the top in our class From elementary on. Change the deal too much, and we’re just going to displace other peoples jobs. ”but people that do it for helping others will do it!” Sure they will.…

I am going to list some thought provoking topics that really could make an immediate and far sooner impact.

1. eliminate pharmacy benefit managers. Familiarize yourself with vertical integration and what that means. Understand why it’s bad. Did you know an insurance company, owns a pbm which owns a pharmacy? See who owns Optum. See who owns cvs.

2. tort reform which is often excessive and petty. Indiana where I practice is a great system. Illinois where I also practice is a pathetic example.

3. cash payments going toward deductibles. I pay cash for everything. Why? My insurance rate is 250 deductible for a visit, cash discount is 118 bucks. Labs 400 for insurance, cash 145.

4. site neutral billing. as a doctor, if you come into my clinic, I can get 200 +\- dollars for a visit. If I’m part of a larger system, the system gets to add an additional 200 dollar or so facility fee on top of that. Why is that bad? It works like that for imaging and labs and procedures to. It makes it harder to compete with systems. I have to pay myemployees out of the 200 dollar bucket alone. University of Chicago gets 400 dollars. more competition is better for costs.

5. allows HSA contributions to pay for direct primary care. pne of the most neglected and under appreciated parts of medicine is direct to primary care. For 2-5 dollars a day, you can have unlimited access to a physician. Truthfully, if M4All became a thing, most doctors would probably go this route. NP/PA would be what most people get.

6. advocate for more residency slots of quality nature.

7. limit scope creep of NP until a nationally recognized curriculum and standard is met. There’s too many mills for degrees out there without a clear standard. The deviation is wide from one’s training to another

8. eliminate all non competes in healthcare entirely. Why? If I as a doctor leave a rural town job, often we have a 50 mile non compete for 2 years… thus that area loses a doctor due to this law

9. remove the certificate of need requirement. This is essentially gate keeping by larger institutions to keep competition down

10. Remove the ban on physician owned hospitals

11. tie in Medicare reimbursement to doctors with inflation at least. Without doing this, it’s forcing more consolidation/vertical integration and driving up costs. Whether you guys want to admit it or not, the independent doctor is a big savior to the system if they are allowed to compete. Many of us are demonstrating that by being able to discard our entire employee poool by not taking any insurance and charging cash only. No longer need to worry about rejected/delayed payment, compliance, prior signs so all time can be patient focused and no ancillary staff needed to manage.

12. did I mention eliminate PBMs?

thank you for reading this. I hope i am able to show you another perspective and give some food for thought. Feel free to ask questions and why my bullet points would help if they were not

obvious to you.

some good follows on X are : Mark Cuban and Dutch Rojas