Ron DeSantis is taking heat for a statement that he made. He said that people under age 50 largely don’t need health insurance. He is correct. People under age 50 are healthier than those over 50, and their premiums largely pay the freight for those who are older and sicker.
Our nation’s healthcare system gets crapped on a lot. Even though the United States has only 9% of the world’s doctors and 3% of the world’s hospitals, half of the innovation in healthcare of the entire world is being created right here in the United States. We are punching far above our weight class:
- New drug development: The US was responsible for the development of 43.7% of new molecular entities (NMEs) and has seen a surge in new drug approvals.
- Biotechnology patents: U.S. firms filed nearly 38% of global biotechnology patents from 2015–2020.
- Research funding: The US accounts for a significant share of global medical and health R&D, at around 44% of the world’s medical research funds.
- Clinical research: The US leads the world in the number of active clinical trials, supported by its advanced infrastructure and large population.
There are plenty of people who would slam the US medical field because of costs, then drag out statistics claiming that the US lags the world. In many cases, those statistics are misleading. For example, the US says that a child is stillborn if it dies before birth, but some other countries will count a child as stillborn if the child dies up to 30 days after it is born. This is important, because this means a 29 day old infant who dies does not count towards infant mortality. For that reason, use health statistics with a healthy grain of skepticism.
This means that the chief reason for claiming the US healthcare is trash is that it can be expensive. After all, we always hear about how Canada has better healthcare because it is free. Of course, you have to wait weeks to get something as simple as a CT scan or an MRI, while here in the US you can get a CT scan in less than 10 minutes, and an MRI can be done in a matter of hours.
So why do things here cost so much? Let’s use my recent trip to the emergency department as an example. My itemized bill showed that I received 5 bags of normal saline over a 12 hour period. The charge for this was a total of about $11,000. This seems a bit high for 5 liters of salt water, mostly because it is. Take a closer look, and you see a couple of things:
The saline is charged out at $35 per liter. That’s not TOO unreasonable. Then you see that there is an additional charge of about $900 per hour for “monitoring while fluid replacement is taking place.” This is how hospitals pad the bill. They give you a couple of liters early, then run in what is called “maintenance fluids” at a rate of 50 ml per hour. They then bill you almost a grand an hour for that nurse monitoring you while you got those fluids. It’s just a way that the hospital pads the bill, because that nurse is also billed to you as part of the daily room charge. They also bill $50 a day for cardiac monitoring, plus you get billed for every doctor who even glances at your chart.
Of course, insurance companies see right through this, and they refuse to pay. The hospital knows this, and in fact they plan on it. The hospital has an agreement with the insurance companies, and they actually only collect about 35% of what they bill out, on average. The hospital’s total average costs are usually equal to about 31% of what they bill. That 4% difference is the hospital’s profit.
In my case, the entire visit to the hospital was billed out at $43,000. Out of that bill, my insurance paid $2,500, I paid about $700, and the rest was simply waived away. The full bill of $43,000 is what they bill to those poor suckers that don’t have insurance. The hospital knows that what they did for me was in no way, shape, or form worthy of $43,000. The insurance company knows it, too. In fact, everyone involved knows that no one is actually going to pay that much.
Why, then, do they do it that way? Because that is what the insurance companies want. They want medical expenses to be so high that people pay for insurance out of fear. That’s the problem with US healthcare. Not the care, not the cost, but the insurance companies scaring people into buying their products through punitive pricing models.
The answer then isn’t to have more people insured- it’s to get insurance companies out of the equation, or to at least prohibit hospitals from charging the uninsured more than 20% over what insurance companies pay. Market forces will then take care of the rest. It isn’t a problem with healthcare, it’s a problem with insurance companies. If the hospital can turn a profit on what they pay the insurance company, they can turn a profit on 20% more than what the insurance company pays. There is no legitimate need to charge the uninsured 1,400% more than the insured.
34 Comments
Grumpy51 · October 22, 2025 at 6:54 am
I’ll throw the term “scam” in the mix. NO ED can tell me what my bill is going to be BEFORE signing in to the ED, even for the “basic fee.” Nor can MOST hospitals tell me what a knee replacement is going to be BEFORE I have it done.
People get upset with the first “bill” they receive but fail to understand terminology. Your first “bill” is specifically NOT a bill but an EOB – Explanation of Benefits, and in fact specifically states NOT A BILL. So what is an EOB?? This is a breakdown of what charges you incurred minus various discounts and agreed-upon payments between provider (generically here, such as hospital, lab, X-ray, etc, your actual doctor bill will come later) and insurance company. So why does the hospital charge so much?? Because each insurance company has THOUSANDS of plans and doesn’t know exactly how much they’ll pay until deep dive by the insurance company. And insurance pays a “usual and customary or billed, whichever is LOWER”. Ever played poker?? Do you leave part of a won-pot on the table??
The way to play the “insurance scam” is to “bill” exhorbitantly high charges. This prevents the “lower” being paid. Since reimbursement can be anywhere from 7% (TriCare) to 40% (UHC) (numbers accurate back in 2000s, I have no clue now), we charged HIGH to collect everything insurance would pay. So on a $100 office visit (HATE that term, we ain’t “visiting”, you’re receiving a professional evaluation), we would see anywhere from $7 to $40.
It’s important to understand that a company doesn’t really negoatiate with an insurance company for reimbursement rates. My experience has been – “this is what we’ll pay you.”
Go back to the old days when insurance was between you and the insurance company. And when you had to pay SOMETHING to be seen (EMTALA was a 100-lb sledgehammer used on a 20-lb problem). There are still ways around but with the emphasis on “customer satisfaction” (EVER seen a happy drug-seeker or ER patient??), hospitals, for the most part, no longer require payment. By law, you are entitled to a MSE (Medical Screening Exam) to ensure no emergency is present (see EMTALA), and NO monies can be discussed before this. BUT, once no emergency is determined (by a medical professional), a facility can come in and ask for payment before further treatment is given. Lawyers have made this impractical though.
Stefan v. · October 22, 2025 at 6:56 am
If we paid the quacks for keeping people healthy, 90% of the industry would disappear and the rest would be able to do their jobs.
However…..the demonics temporarily running this planet like things the way they are, and would like to futher “improve” things to suit them.
Divemedic · October 23, 2025 at 4:58 am
Keeping people healthy requires that the people comply and go along with what the Dr recommends. That means diabetics can’t eat candy bars and donuts and take their meds. It means that people have to stop using meth, heroin, and other drugs.
It means eating healthy foods.
Blaming the doctors for unhealthy behaviors isn’t the way forward.
EN2 SS · October 25, 2025 at 6:33 am
My wife had MS. We were referred to a more “knowledgeable doctor”, read quack. He came in, did his job, made his recommendations and left the room. Before we could get her ready to go, he had forgotten to ask a couple of questions, so came back into the room and asked them. When I went to checkout and pay the bill, they attempted to charge me for TWO visits. Which did not go over very well.
Matt · October 22, 2025 at 8:08 am
My wife has been a frequent visitor at the Cleveland Clinc cancer center for the past 5 years. I was suprised at the amount of Canadians there. Other foreigners also.
As for innovation she received CAR-T Therapy for lymphoma. Doc said she probably had this since 2018 or 2019. It was the hail mary for her. So far so good.
I have insurance Thank God. Over the past 5 years the cost was crazy.
SiG · October 22, 2025 at 8:15 am
You’ve done some truly great analysis of several financial problems, and I’m fairly sure I’ve commented on how one of the problems with healthcare is that it’s not a free market. Buyers generally don’t have even a rough idea of what the cost should be and can’t shop. I’ll get statements like you describe for your visit, with a starting point of $42k and the total actually paid by you and your insurance wasn’t even 1/10 of that (3200 vs $43,000 is closer to 1/13). When my car or my coffee maker breaks, I can find out what fixing or replacing it will cost, and it’s never overpriced by 13x.
Insurance has lost its purpose in life, which was risk reduction. Now buyers seem to just expect they’ll get insurance and insurance pays it all no matter what. Not to mention that Obamacare was oversold as fixing everything. A large number of people said the “Affordable Care Act” was going to collapse in a few years and here we are at year 13 seeing stories that it’s collapsing.
A perfect example I keep seeing on TV is for a type of insurance people get to pay for their car’s mechanical problems. They have the mandatory pretty saleswoman, in this case former professional race driver Danika Patrick and they end with the statement like, “next time your car breaks down who’s going to pay; you or the insurance company?” They completely leave out what the insurance costs and what the odds are that you could have paid for most repairs by saving up your insurance premiums. If you come out “ahead” on that, it means the people who didn’t file a claim paid for your car repairs.
Sorry, but insurance is nearly constant PITA. An OK idea gone bad.
Steady Steve · October 26, 2025 at 6:04 pm
And most of the time just doing proper maintenance will avoid the more costly repairs. I’ve never had to do transmission work or internal engine repairs on any high mileage vehicles I’ve owned. Timely fluid and filter changes are a must.
Texas Dan · October 22, 2025 at 8:31 am
Additive to the concept above, hospitals should be able to collect interest over time for payments from the non-insured but at something like prime plus 2-3%. Critically, you have to chuckout the illegals accessing the system with no intent on ever paying and the risk adjustments work out fine.
Anon · October 22, 2025 at 10:20 am
How in the world is that pricing scheme delta between insured/cash payer is in any shape or form ethical, moral or legal?
Anon
Will · October 22, 2025 at 10:23 am
Big Pharma claims that all the research and development is the reason for very high drug costs in the US, yet they sell in other countries at heavily discounted prices. What say you?
Steve · October 24, 2025 at 2:31 pm
You are both correct. It depends on how you look at it. The 800# gorilla is that Congress made reimportation of drugs illegal, so that critical feedback loop, that you can get it cheaper from France than from Walmart, was short circuited. Repeal that, and prices drop overnight. But so does R&D. No more drug development for rare conditions. Those people are just SOL. The important bit is we go into that decision process eyes open.
Tsgt Joe · October 22, 2025 at 10:28 am
I dont have the blue cross statement in front of me but IIRC the hospital, when I sprained my ankle billed $11,000 and bluecross paid $660 for an ED visit. Dont know if 11k was the regular or snowbird rate.
Joe · October 22, 2025 at 11:20 am
My Gall bladder went on the blink about 10 years ago. I showed at the E.R. about 2am on New Years day pretty darn cold because I was too messed up to dress up well and the temp outside was below freezing. Went through a multitude of tests and the finally decided it was Gall Bladder. The final bill was $110,000. Sounded real high to me. Anyway, My cut was $2500 which they let me make payments on. While negotiating the payments I noticed that insurance was going to reimburse the hospital at about ten cents to the dollar. I told them I’d pay them off on the spot if I could get the same deal. Didn’t work out.
Dan · October 22, 2025 at 11:31 am
You left out the fact that hospital charge those who pay as much as ten times mark up to pay for all he care they are LEGALLY MANDATED to provide to people who don’t play a dime. Many of them being criminal alien invaders. I know first hand that more than 25 years ago UC Davis Medical Center ER in Sacramento only collected about 12 cents for every dollar billed. And a HUGE percentage, a majority, of the patients they treated were indigents and illegals.
TRX · October 22, 2025 at 12:01 pm
> This is important, because this means a 29 day old infant who dies does not count towards infant mortality. For that reason, use health statistics with a healthy grain of skepticism.
—
Similar hackery goes on with murder rates between Britain the the US. Britain only counts convictions for murder, while the US counts deaths by murder. That causes, ah, certain differences in the totals per capita.
Don Curton · October 22, 2025 at 12:30 pm
I know we’ve had that conversation here before and I completely agree with the above – the system is ridiculous and younger healthier people don’t need insurance, or nearly as much insurance. I’d argue that the old catastrophic plans still make sense. But in a very real way, I’d rather know up front that a routine procedure will cost $3500, write out a check for the full amount, and then get treated. No insurance, no padded bill, just straight up here’s the bill and thank you for your payment.
Dirty Dingus McGee · October 22, 2025 at 2:28 pm
Try figuring out Medicare math. I’ve had it for about a year now and gave up trying to understand the way it works. Bill is $100, Medicare paid $21.37 your balance is $3.79.
Anonymous · October 23, 2025 at 8:15 am
original medicare pays 80% of the medicare allowed amount once you meet your annual deductible, which goes up each year. the fee schedule is publicly available and searchable on the cms website.
Henry · October 22, 2025 at 2:37 pm
Another reason hospital list prices are artificially inflated is because for tax purposes they write off patients who can’t pay based on the list prices and not the typical negotiated price paid by insurance companies
Steve · October 22, 2025 at 3:09 pm
The big reason insurance companies want it that way is they are limited by regulation as to their profit margins based on the bill. I have no idea what the margin is anymore. Let’s say it’s 10%. If they got a bill for $10k, they are allowed to keep $1000 over their costs. But if they get a bill for $43k, they get to keep $4300 over costs, even though they wrote off $33k of it.
@HomeInSC · October 22, 2025 at 3:53 pm
I know how it works. Six physicians in the family. What pisses me off us the lack of honesty from all quarters that makes the chicken dance of bullshit necessary.
C · October 22, 2025 at 4:28 pm
It definitely boils down to market forces. If you want it fast then it isn’t going to be cheap. Which is why my outpatient CT scan costs $500 and my emergency CT scan costs $5000.
DMLMD · October 22, 2025 at 4:53 pm
That is spot on. You see the same thing in private practice.
Jester · October 22, 2025 at 7:18 pm
I find the insurance model itself is due to the high cost that they flat out state it will take if you dont have it. And I also agree that it’s absolute BS to charge the uninsured a different, higher rate for services than the insured. I’ve been told however the cost to the uninsured is a ball breaker due to the hospitals making up the “losses” for what insurance companys pay. I know for a fact that a lot of those costs are also to make up for the illegals or the people that present to the ER, etc with out ever having an intention on paying. Essentially, theft when you get right down to it. But at the end of the day some of the stuff like your implants, your bandages depending on the type you need are not cheap either. Having worked the logistical side of a VA Hospital which buys most of everything though prime vendors or though large scale contracts some of the things just are not cheap. Saline bags, yeah pretty cheap. Some of the advanced wound care dressings that run hundreds of bucks a pop at the whole sale rate? Paying that Nurse or Dr. who themselves are paying off the education that allowed them to treat you? Paying for the building to be built? Maintained? Even running a non profit takes money. The VA leads in a lot of innovation and that itself is paid for by taxpayers. Simply put the US healthcare system subsidizes the entire world with medicine and treatments. We figure it out and share it, the rest simply benefit from the system and can then subsidize the treatment.
Honk Honk · October 22, 2025 at 9:34 pm
Too big to fail, we’ll just print more until all are wealthy.
Those medical professionals will work for free for the good of the collective.
Pass the bong comrade don’t Bogart.
MW · October 23, 2025 at 6:35 am
I still remember when you paid for most of your medical procedures out of pocket. That was 1955. Physicians were still making house calls, too! Insurance was for the big ticket procedures.By the way, with all these advancements in medical science, why is life expectancy starting to decline in the U.S.? Also, a lot of under 50 year olds are overweight & out-of-shape.
Dirtperson Steve · October 23, 2025 at 9:01 am
When I was working on my MHA, later changed to MBA, I wrote a paper with a thesis that in order for healthcare to get less expensive it had to get more expensive. What I was saying, and backed with facts, was that insurance had driven up the cost because we were no longer bearing the 1st dollar of expenses. That was right around the time tailored high deductible plans were born and later mostly killed by Obama.
At the time small employers had discovered that by getting a high deductible plan and putting the deductible amount in an HYSA for the employee they could spend less for better insurance while employees would have money to cover all or most their deductible before insurance kicked in. Employees also had incentive to take care of themselves and watch their HYSA grow.
Bear Claw · October 23, 2025 at 12:47 pm
That under 50 over 50 stat is a feature not a bug.
Bear Claw · October 23, 2025 at 9:59 pm
Simple solution, let the companies compete across state lines. But there’s rules/laws preventing that!! Duh, goobermint rules supported by lobbyists. Commerce cabinet can change it back.
Himself · October 24, 2025 at 9:35 am
Back in the day, my mom would call health insurance ‘hospitalization’. It was there in case you had a medical emergency that made you go to the hospital. Otherwise, you simply paid your doctor. Even when I was a young man, I’d write a check to the doctor for a visit. Hell, even when I had a plan, It would be the weekend until I realized I couldn’t tough it out any more and I’d go to the doc-in-a-box and pop my credit card.
Somewhere along the line HMOs popped up, and employers started offering them. Didn’t take long for the whole ethos of healthcare to be someone else should pay for my misfortune.
I’ve always said, health insurance should be like car insurance. You can get it from any company offering it, and insure what you need insured, then pay for it. Even though I’m an older gentleman, I’d be happy to pay for my meds and doctor visit. We mandate that you need auto insurance, and if you don’t have it you have to pay when you wreck. They want free healthcare? Setup free clinics. Let the pay to play crowd do it’s thing.
Thomas Sowell had the best reply to someone complaining about a hospital visit – Didn’t you get your own room, or only have one roommate? In other countries, you’d be in a ward with beds lined up, and wouldn’t see the doctor as often as you do here.
@HomeInSC · October 24, 2025 at 9:49 am
https://rumble.com/v70q13q-dc-lobbyist-says-the-shutdown-is-about-protecting-insurance-companies.html
I don’t agree with her on the price controls a caps but I think she is onto something
Anonymous · October 24, 2025 at 3:20 pm
I had my first heart attack at age 49 (am 65 now) in 2009. Turns out being born without a right coronary artery is tough on your body. The bill was $61K, I paid $1,500, the insurance company paid $9,000, and the two hospitals wrote off the rest.
I feel lucky. My cousin born 13 years after me was born without the artery from her heart to her lungs. She was a blue baby and had open heart surgery at Texas Childrens Hospital at three days of age, spending several months there in recovery. She had another open heart surgery at age 11 to patch the patch. She is still alive and doing ok, not great.
Unknownsailor · October 24, 2025 at 11:30 pm
You can call our “health care” system many things, but a free market is NOT one of them.
“The hospital has an agreement with the insurance companies, and they actually only collect about 35% of what they bill out, on average.”
This, right here, is ILLEGAL. It is collusion to set pricing, and has been illegal for over 100 years.
So is billing customers differently for the same service.
No one goes to jail, from either the hospital or the “insurance” agencies, despite pretty open and shut cases for violating Federal law.
No other industry is allowed to operate like the health care industry does.
Want to see what a real free market hospital looks like? Look up the Surgery Center of Oklahoma. All procedures priced up front, all included. They don’t take insurance payment, they bill direct. THAT is what free market health care looks like.
Token Canadian · October 25, 2025 at 9:03 am
> After all, we always hear about how Canada has better healthcare because it is free. Of course, you have to wait weeks to get something as simple as a CT scan or an MRI
It’s worse than that.
If not life-threatening, waits for an MRI can be – routinely – over a year in Canada.
Comments are closed.