What is the US healthcare system actually optimizing for?: Single-payer advocates

Nine hours

That’s how long my kid waited in the ER with a broken arm. We have insurance. Good insurance, actually — the kind with a $6,000 deductible my employer calls premium.

Americans spend $12,500 per person per year on healthcare. Canadians spend $5,900. Germans spend $7,400. All of them live longer than we do. All of them have lower infant mortality. All of them cover everyone. We leave 30 million people uninsured and another 40 million underinsured and we still spend more. The math isn’t complicated. The politics are.

The trillion-dollar paperwork

A third of what we spend goes to administration — billing, coding, prior auth, claims, appeals. This isn’t healthcare. It’s a bureaucratic apparatus for deciding who gets denied. The Thompson shooting didn’t surprise anyone who’s fought an insurance company for a procedure their doctor ordered. You can’t run a market in something people need to survive. You don’t comparison-shop during a heart attack.

The market defenders say we’re buying innovation. We’re also buying 900-bed hospitals with 1,300 billing clerks. And the innovation argument assumes the only way to fund research is through the most expensive consumer healthcare system ever built. The NIH exists. Public funding produced the mRNA platform. The market scaled it. Both things are true and neither requires a $4.3 trillion administrative apparatus.

Where we concede ground: Wait times are real. Canadians wait longer for elective procedures. We don’t love that.

What would change our mind: US admin costs dropping below 15% of total spend without a structural payer change.

Read the full synthesis: What is the US healthcare system actually optimizing for?