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>I've told you that for 5 years whenever you suggest that physicians are responsible for the massive US costs. There's 3 key perverse incentives wrt costs:
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I've suggested (among a lot of other things) that MD's were in bed with big pharma and I still that that that's true.
At least here in Hamilton, NJ, the MD's I see just don't make enough money from their practices so they have to find other ways to pay the rent. Last year I had a pretty serious health bout (happy to say that I won) and my MD spent a lot of time with me in the hospital.
I saw what Medicare paid him and I make more money doing a couple of simple SSRS reports than he did while saving my life.
That needs to be fixed.

Insurers, as you point out, have a perverse incentive. The more hospitals spend the more they make.
As I've pointed, hospitals have become money pumps for political hacks.
The CEO of a local hospital was formerly a dem political leader here in Mercer county. That's the norm now.
I hate to bang away at Michelle Obama, but she was just the tip of a huge iceberg.
Medicare for all, if done properly, could squeeze billions out of that system.











>1) The ACA capped profits at 20% of premiums. So as long as costs are increasing, insurers can wring their hands and raise premiums to raise their already enormous profits at a rate rendered moral in law, without regard to affordability or even any sales or business effort. The normal price controlling function of the insurer is eliminated.
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>2) US facilities can claim fees according to their demonstrable cost of service, not a market price. This encourages/excuses over-capacity and inefficiency, since if you build a 500-bed facility that only ever has 100 patients because there are 2 other facilities in a town that only needs one, all the facilities get to distribute all their servicing costs across their actual patient utilization rather than offering deals or innovating or going broke as any normal business would. Insurers tolerate this cost model for obvious reasons- it drives high costs so insurers get to wring their hands and raise premiums, see 1) above.
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>3) In proper insurance, you have to underwrite and put aside enough $ to cover reasonably predictable future costs- fires, earthquakes etc. In healthcare, once the patient reaches 65 when the big costs usually start to bite, that liability is transferred mostly to the taxpayer. Thus underwriting turns into an effort to avoid expenditure via pre-existing exclusions, denials and cancellations of contract. The ACA correctly sought to prevent that via guaranteed cover but then strangled the attempt with too many cop-outs for compulsory participation without which you can't have guaranteed cover- or else people wait for expensive sickness to sign up. Result = an increasing spiral of costs with no normal constraint.
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>Situation = every vested interest to raise costs with no normal market constraint- until the insurers start losing $ because only sick people ever sign up, so they close the plan.
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>>>Let's lock up some of these hospital execs.
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>You could, but that could be rearranging deck chairs on the Titanic. To control costs, you need the payers focused on market prices and normal competitive constraints. Say what you like about single payer (government) health schemes- but they tend to focus on costs and sensible rationing to avoid shareholder (taxpayer) rebellion. Ironically, that's one of the reasons why there's a $47T Medicare deficit = cowardly representatives kicking known costs down the road in the interests of another term. So if you want to look at it another way- maybe focus on shareholders, meaning the taxpayer for Medicare/Medicaid and the shareholders of the health insurers.
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>If you do go for single payer, for heck's sake build in shareholder (citizen) participation from the get-go and shout out that every healthcare system needs rationing of one sort or another! Let the shareholders experience the dilemma of higher premiums/taxes or accepting that every imaginable need cannot be met straight away, or even at all.