It is 1% of all US federal tax revenue. It is not insignificant.

Also, insane that your health plan costs as much as the average citizen's share in all federal taxes (which also include corporate taxes, tariffs and whatnot).

> Also, insane that your health plan costs as much as the average citizen's share in all federal taxes (which also include corporate taxes, tariffs and whatnot).

That's pretty typical for a quality health insurance / month.

Good health care plans in America are expensive. My employers have always broken out how much they are contributing towards my health insurance each month, ~$1000 is typical.

Looked, since we just did insurance elections- my semi-monthly cost is $580 and the company's is $735 for my family HSA plan. $280 of that is the cash contribution to the HSA, which will get spent, since all costs except checkups go directly against the deductible.

But removing the HSA contribution, that is $600 a month by myself, for the premium and $1470 by the company.

And it’s because healthcare costs that much. Lots and lots of cover your ass liability insurance and credentialed people to pay for.

As is often said, 33% of US health care costs are the overhead from billing.

I always admire the efficiency of dentists, somehow they can get an instant quote from my insurer as to exactly how much is going to be paid for.

Eye doctors are the same way. No nonsense, "here is what it costs, here is what your insurance pays, here is what you owe us."

I can have a little of of sympathy for insurance cos though, I once had a podiatrist bill my insurance $2000 for work that he obviously didn't do, and another doctor I visited recently either accidentally or purposefully submitted what was plainly the wrong billing code to the insurance company.

Veterinary service is interesting, pretty much the exact same medical technology, but the billing is up front, and they even offer package discounts on tests!

> somehow they can get an instant quote from my insurer

Because dentists are doing routine work. Doctors like to charge for each and every little thing, rather than by time like most professionals do. So each diagnosis, each procedure, each conversation can have different costs which can't be known up front. If a doctor wanted to provide you the codes they will be using, they easily could. They simply choose not to, to give them the freedom the charge whatever later on, in case they are able to based on what happens during your visit.

I love the "new patient" charge code, which is utilized anytime you change to a new doctor. How the hell that differs from a regular "consultation" code for a yearly checkup is beyond me. The same time is spent analyzing and talking to you, the content of the discussion is the same. Surely, the doctor doesn't remember you from last year anyway so they need to spend time going over your notes.

And yet, you get the honor of paying an extra $150 to $250 simply for talking to a different doctor.

>Because dentists are doing routine work.

To some degree. On the other hand, I had a crown a few years back and the temporary would not stay on. I lost it 2 or 3 times. (Like actually lost.) Pretty sure he lost money on that one.

I don't disagree. But when things are often not covered by insurance or when coverage is very partial, providers find they have to often give an upfront price.

Same thing with contractors for many types of jobs (or software consultants)--though there are pros to fixed-price vs. hourly.

Pretty sure the billing morass goes in each direction, with the insurance companies demanding that providers say what they did to get paid.

It originates with the CMS, Centers for Medicaid and Medicare, sets the codes and there’s a committee of doctors that assigns relative value units to different types of work (“RVU”s). It’s all very complicated and opaque.

The US has this crazy amalgamation of taxpayer funded healthcare and private insurance funded healthcare where the each entity is trying to exert maximum pressure to either minimize expenses or maximize income, and it’s in a constant state of flux.

Thinking about the amount of man hours that are wasted on this endeavor resulting from a desire to not simply provide everyone a simple taxpayer funded system is disheartening.

Last year ~6 million people were eligible for unemployment. The fact you are flaunting your entire family's healthcare costs and using the entire US population of adults, retirees and children to justify the theft of 36 billion dollars is concerning.

Not flaunting, just a fact. Not justifying just showing the math.

The cost spread across 1/3 of USA population is $360/yr - still way less than the health care cost.

My point is simply that this fraud burden is a much smaller fish

Every time. Every single time there is somebody totally okay with fraud if it relates to a program he is otherwise in favor of.

Can't you just spell out, "UC is good, but fraud is bad, so let's eliminate the fraud, even if it's a mere XY billion dollars." It does not require any internal contradiction to think that way.

Retail stores, banks, corporations, all price in fraud and risk. It's a matter of trading cost of enforcement vs. impact to core mission vs. money recovered.

Some level of fraud in a social welfare system is absolutely acceptable, if tightening controls to eliminate the fraud would mean that otherwise eligible people didn’t receive benefits they qualified for, or even if it meant that accessing those benefits became much more onerous. I don’t doubt that $36bn is too high, but this kind of analysis is almost never present in these articles and politically in this country the spectre of fraud is usually used as an anti-welfare cudgel