Anecdotally, nonpayment is a much bigger problem than lawsuits. I remember listening to the CEO of Carle, a large Central Illinois healthcare chain, talking about this, and saying that "we expect to collect 60 cents of every dollar we bill".

It's a revenue optimization problem -- the goal is to collect the most revenue overall. Set prices too high and people/insurance goes elsewhere, too low and you leave money on the table the org could use to cross-subsidize non-payers.

> "We expect to collect 60 cents of every dollar we bill"

you have to be careful with that statement since it can be a clever way of talking about what insurance agrees to pay with the chain versus the "retail" rate the doctors charge.

my father is a general practitioner and I was always amazed when he started saying about 25 years ago that he wouldn't let me become a GP if I had gone into medicine. and this article covers all of his concerns well.

malpractice is a big part of the issue and it varies state to state. for example, in pennsylvania malpractice insurance is amazingly expensive. and people sue all the time, which is sad unless it is gross incompetence, since every doctor I've met is trying their best.

so what you're saying is no matter how the healthcare system is designed, the healthy (or maybe just wealthy?) always end up paying for the rest?

In practice, this is exactly what happens. Many hospitals have a mandate not to deny treatment, so many people come to the hospital (especially to the emergency room, where care is known to be more expensive than non-emergent settings) and simply don't pay after the fact.

I don't know how to solve this, or whether it's fair, but it's pretty universal if you talk to people in healthcare billing.

I've read that malpractice insurance is a few thousand dollars a year and the premiums have been going down.