Comment by harpratap
3 days ago
Because insurance companies incentivize upward price momentum. The ones who innovate and bring the prices down are not rewarded for their efforts. Health inflation is higher than headline inflation because of this absence of price pressure
I sympthatise with the argument. We should test it against real world data.
Eg your argument would predict that healthcare price inflation is not as bad in areas with less insurance coverage. Eg for dental work (which is less often covered as far as I can tell), for (vanity) plastic surgery, or we can even check healthcare price inflation for vet care for pets.
Dental and vanity surgeries aren't happening in a vacuum. There are baseline costs eg. anesthesia, recovery medications, medical machinery etc which are all bloated due to the rest of industry not being under price pressure (rising tide lift all boats)
It's similar to how AI data center buildout race is raising the prices for consumer electronics in 2026 and beyond. The suppliers have no incentive to sell lower cost products to tiny niche
How does Lasik manage to drop in real price, then?
I just looked it up, and apparently health care costs for pets has gone up in price even faster than for humans.
Pets typically don't have medical insurance, and any insurance that does exist there has a radically different regulatory regime than for humans.
Since 1980 for the US:
CPI has gone up by 3.16% on average per year (x4.17 in total). Human healthcare costs by 4.9% per year (x8.96 in total). And pet healthcare costs by 6.49% (or x17.87 in total).
I suspect this has something to do with it: https://www.theatlantic.com/ideas/archive/2024/04/vet-privat...
2 replies →
The uninsured medical market is actually quite efficient. e.g. lasik surgery can actually be done for very reasonable rates with full price transparency.
Lasik has gone down in real price over the years, yes.
But dental and vanity cosmetic surgery have gone up by that metric. Dental is less covered by insurance for most people. Vanity cosmetic insurance is covered for almost no one.
Vet care for pets has gone up a lot more than healthcare for humans.
This argument doesn’t make sense to me. Insurance companies are structurally incentivized to minimize payouts across the board. They want hospital bills lower, physician compensation lower, and patient payouts as small as possible. If insurers had unilateral power, total medical spending would collapse, not explode.
The real source of high medical costs is the entity that sets the hospital bill in the first place.
The explanation is much simpler than people want to admit, but emotionally uncomfortable: doctors and hospitals are paid more than the free market would otherwise justify. We hesitate to say this because they save lives, and we instinctively conflate moral worth with economic compensation. But markets don’t work that way.
Economics does not reward people based on what they “deserve.” It rewards scarcity. And physician labor is artificially scarce.
The supply of doctors is deliberately constrained. We are not operating in a free market here. Entry into the profession is made far more restrictive than is strictly necessary, not purely for safety, but to protect incumbents. This is classic supply-side restriction behavior, bordering on cartel dynamics.
See, for example: https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...
We see similar behavior in law, but medicine is more insidious. Because medical practice genuinely requires guardrails to prevent harm and quackery, credentialing is non-negotiable. That necessity makes it uniquely easy to smuggle in protectionism under the banner of “safety.”
The result is predictable: restricted supply, elevated wages, and persistently high medical costs. The problem isn’t mysterious, and it isn’t insurance companies. It’s a supply bottleneck created and defended by the profession itself.
Insurance companies aren't innocent angels in this whole scenario either. When the hospital bill fucks them over they don't even blink twice when they turn around and fuck over the patient to bail themselves out. But make no mistake, insurance is the side effect, the profession itself is the core problem.
> This argument doesn’t make sense to me. Insurance companies are structurally incentivized to minimize payouts across the board. They want hospital bills lower, physician compensation lower, and patient payouts as small as possible. If insurers had unilateral power, total medical spending would collapse, not explode.
They absolutely do not.
They have their profit levels capped at 15% by law and regulation. That means if the insurer wants more absolute dollars of profit, prices must go up.
It also means that if they push prices down they necessarily have less funding to administer those plans, even if the needs are the same (same number of belly buttons, same patient demographics and state of health).
As you note there's also other variables, but this claim: "Insurance companies are structurally incentivized to minimize payouts across the board" is absolutely and categorically not so.
Physician reimbursement is only ~9% of national healthcare expenditures.
I tell you this with certainty as a 3rd year medical student: If physician wages go down and tuition stays as is, no one will do this. Intrinsic motivation to help people evaporates as soon as you see how enshittified healthcare in the US has become.
I do agree that medical school is far too restrictive to get into (For MD schools at least). However, if you want to make medical school easier to get into: Where will all those students rotate at for their clinical years? There aren't enough spots in hospitals to jam students in.
Stop taking aim at the people that sacrifice so much to help you. Take aim at the real drivers of healthcare expenditures: administrative bloat.
>Where will all those students rotate for their clinical years? There aren’t enough hospital slots.
This is a policy fiction. Residency slots are capped by federal law, not by hospital capacity. The Balanced Budget Act of 1997 froze Medicare-funded residency positions, and despite modest expansions decades later, the cap remains largely intact. Teaching hospitals routinely report excess clinical volume relative to trainee supply. The bottleneck is artificial and regulatory, not logistical.
>Stop taking aim at people who sacrifice so much to help you. The real cost driver is administrative bloat.
This framing collapses under scrutiny. Administrative bloat is real and well-documented, but pretending physician incentives are irrelevant requires willful blindness. Numerous studies show that U.S. physicians earn multiples of their OECD peers while delivering no commensurate advantage in outcomes. Many doctors are motivated by altruism, but many are also motivated by status, income, and professional gatekeeping—normal human incentives in a high-prestige, high-pay profession.
Further, high patient throughput is not an accident. Fee-for-service reimbursement structurally rewards volume over care quality. Seeing 20–30 patients a day is not a moral failure of individual doctors, but it does predictably lead to burnout, emotional detachment, and assembly-line medicine. Incentives shape behavior. Ignoring that is not compassion, it’s denial.
>Physician reimbursement is only ~9% of national healthcare spending.
That statistic is repeatedly used as a rhetorical shield, and it shouldn’t be. Cost systems do not fail because of a single oversized line item; they fail because multiple protected constituencies simultaneously extract rents while deflecting blame. Administrative overhead, defensive medicine, pharmaceutical pricing, hospital consolidation, reimbursement incentives, and physician compensation are jointly optimized for revenue, not outcomes.
Nine percent of a multi-trillion-dollar system is not trivial. More importantly, physician compensation is not isolated—it drives downstream costs through referral patterns, test ordering, procedure rates, and resistance to scope-of-practice reform. Treating physicians as a sacred class exempt from economic critique is precisely how you end up with a system that is unaffordable, unaccountable, and structurally resistant to reform.
If the argument is “9% is too small to question,” then by that logic no component is ever large enough to examine in isolation, which is how dysfunctional systems persist indefinitely. Real reform requires abandoning moralized narratives and admitting the obvious: healthcare costs are the product of aligned incentives across many actors, and physicians are not magically outside that system simply because the story is uncomfortable.