The main cost driver in medical care is provider (nurse, doctor, etc.) wages, not bureaucracy or drug prices (though they're frequently cited). I have tired of posting sources for the statistics, but they are very easy to find.
From what I've heard from doctors online, a large chunk of their time is basically spent just coaxing insurance. They waste time figuring out what they can and cannot bill, tailoring that to every patient, and constantly keeping records of everything. I think, for many doctors especially in small practices, treatment is a minority of their time.
Obviously, paying someone 300K a year to sit on a 1 hour peer to peer explaining why they think they should do a surgery is just bad business. But, we do it, and I think a lot.
Exactly. You can believe the "main cost driver in medical care is provider (nurse, doctor, etc.) wages" all the live long day, until you realize they too spend a lot of their time dealing with bureaucracy. The true cost of bureaucracy cannot be accounted for by simply tallying the number of bureaucrats and their salaries.
So, let's look at UnitedHealth Group; do they deliver health care?
If there were single payer, what would their role be in the healthcare delivery process?
Apparently they made 2.3 billion in profits on 113 billion in revenue in Q3 of 2025. How much of that friction would evaporate if they weren't in the healthcare delivery infrastructure.
Compare UPS or FedEx to USPS; the first two companies are profit-seeking, yet very competitive with the 'public-oriented' (and legally privileged) USPS. Having the government in control does not necessarily lead to better value.
They are very competitive in the places where most people live, but the USPS delivers to many more places that the others do not, and still maintains cost competitiveness.
This turns out to be a decent analogy to healthcare: insurance companies do not provide the coverage, universality and simplicity that a single payer system would; instead, you'll get something like insurance coverage networks providing spotty and inconsistent care.
Either approach has upsides and downsides, but single payer, universal coverage for basic and emergency healthcare seems like a no-brainer.
I've lived in cities where the city ran the utilities; they were generally way cheaper than the utilities from PG&E.
The USPS is obligated to deliver letters at the same cost to everyone in the country, and they do a pretty okay job at it -- I've certainly had horrid events from UPS and FedEx, and those guys get to just pass the crap delivery tasks off to USPS if they don't like it.
Lots of old people in the USofA seem to like their government run medical insurance, same with people in the VA system.
The Doge crew spent months looking for fraud waste and abuse and I don't see any big law enforcement results from all the fraud they found, and I don't see anyone crowing over all the waste they curtailed.
It's possible that the world's more complex than you imagine, and that sometimes people just do their jobs (IE the bureaucrats) and hard problems get solved.
Now, tell me again, what part of the health care system is UnitedHealth? What critical problem do they solve?
$2.3 billion is nothing in a $5 trillion system. Doctors make around $500 billion in the US. Their wages are much more significant than insurance profits.
$2.3bn is profit after subtracting costs. Doctors charging time to deal with bureaucracy needed by insurance adds to the costs that are already factored into the revenue. Single payer wouldn't just eliminate the profit, but also those costs.
That's 2.3 billion in ONE QUARTER of 2025, on a revenue of 115 billion. In a quarter. There are four quarters in a year.
$5 trillion is how much is spent in all of healthcare in the USA for the whole year.
UnitedHealth's revenue was $500 billion (and net profits is 10 billion) for the year. For one insurance company. There are 6 that each have more than $80 billion per year in revenue. This isn't to mention the billing departments for each hospital, the claims processing providers smaller doctors need to enlist, the endless hours interacting with insurance companies, etc.
And tell me, please, what specific healthcare outcomes are driven by insurance companies?
Insurance companies are instrumental in ensuring that useless procedures arent performed. Over use of service is one of the biggest reasons for inflated costs in our healthcare system. Now to be clear I would prefer a medicare for all system implementing that, but under m4a doctor salaries are still a major issue that need to be addressed.
Basically all healthcare spending in the US goes through insurance companies, Im not sure why you have a problem with that. Under m4a medicare would spend trillions a year, would you be complaining about that too? Large profits would be a problem, but that doesnt exist. Our healthcare system is rotten top to bottom, insurance is part of that but imo it gets way too much blame for existing in the system the government has created.
Insurance companies basically mirror the reimbursement policies put in place by medicare. I'm sure most providers would gladly take lower reimbursement from a single provider over the chaos and pain driven by insurance companies right now.
Basically every provider does not take medicaid so I suspect you are wrong about that. Again Im not happy with the insurance situation, I just think its barely top 10 in terms of problems with our healthcare system. The bureaucracy is required because of our horrible fee for service payout system. Without getting rid of that m4a would still requires an army of billers because republicans would constantly be screaming about the government being scammed(and they wouldnt really be wrong, healthcare providers do tons of wasteful procedures and the bureaucracy is the only thing slowing that down(recent example I came across, currently we wake up obgyn's to perform emergency medically required abortion services at the hospital even though abortions can be done with a pill and the nocturnist can safely oversee the whole thing, no need to wake anyone up. This is only done so providers can charge us more money. This shit is happening constantly over and over again every time providers can find ways to nickel and dime us and patients have no choice)). We dont actually need single payer to get rid of fee for service so really I think private insurance is an orthogonal problem to the billing army.
