Tag: Single payer

ENDING SURPRISE HEALTH CARE BILLING COSTS LOTS OF MONEY

The 2020 No Surprises Act set up an arbitration process so patients didn’t get huge surprise medical bills. The result was profits for corporate capitalists and huge health care costs and waste. Patients pay for this through increased premiums with no improvements in health care quality or outcomes.

SUMMARY: The federal No Surprises Act was passed in 2020 and set up an arbitration process where insurance companies and providers would negotiate the payment for out-of-network charges so patients didn’t get huge surprise bills. What happened is a classic example of how for-profit corporate capitalism creates huge costs and waste in our health care system. Ultimately, patients are paying for all of this through increased premiums, while the cost of our health care system spirals upward with no improvements in quality or outcomes.

(Note: If you find a post too long to read, please just skim the bolded portions. Thanks for reading my blog!)

(Note: Please follow me and see my blog posts on Bluesky at: @jalippitt.bsky.social. Thanks!)

You probably remember the surprise health care billing problem that made headlines in 2019 and 2020 where patients were getting huge bills for “out-of-network” medical services over which they had no control, such as in the emergency room or for anesthesia or radiology. As a remedy, the federal No Surprises Act was passed in 2020 and set up an arbitration process where insurance companies and providers would negotiate the payment for out-of-network charges, so patients didn’t get huge surprise bills.

Although the Act did succeed in keeping patients from getting surprise bills, what happened is a classic example of 1) how for-profit corporate capitalism dominates and has corrupted our health care system, and 2) how the lack of a single payer system wastes time and money. With a single payer system, the surprise billing problem would never have happened in the first place because there would be no such thing as “out-of-network.”

The arbitration system created to “solve” the surprise bill problem has become another layer of bureaucratic waste. It has created two new sets of middlemen, arbitrators and consultants, who manipulate the system to maximize their own profits on the backs of our already expensive health care system. [1]

The arbitration system primarily has huge insurance companies on one side who want to pay less for medical services. On the other side, in many cases, are private equity-owned medical staffing companies trying to maximize billings and profits. The No Surprises Act instituted an arbitration system using an independent dispute resolution process (IDR).

The in-network rate for medical services is supposed to be used as a guideline for determining payments, but it is not a mandated standard. Policy makers estimated there would be 20,000 arbitration cases a year nationally, based on experience with a similar system that mandated in-network rates as the standard.

However, in 2025 there were 2.2 million arbitration cases and payments were triple those of the previous year. Providers won roughly 85% of the cases and some outrageous payments were made. For example, there were 25 payments for over $10 million each for procedures that had an in-network cost of $100 to $2,000.

One of the new middlemen, the arbitrators get a flat fee per case and took in $1.3 billion. Given their flat rate, they have a perverse incentive to want to stimulate more cases as the only way to increase their revenue. The way to incentivize more cases is to make high payment awards that create an incentive for providers to file more cases. These high payments establish precedents that are cited in subsequent cases, so the payment awards just spiral upward. By the way, five of the certified arbitrators have private equity backers.

The other new middlemen are consultants to providers and their private equity owners. One of these consultant companies, HaloMD, filed 20% of all the arbitration cases and earned over $1 billion in fees in 2025. These consultants, of course, have an incentive to maximize the payment awards and they brag about getting eight to thirteen times the typical in-network payment rate for their clients.

The insurers are fighting back in unusual ways. Across the 2.2 million cases in 2025, in roughly one million cases they simply gave up and defaulted to the providers’ requests. In another 380,000 cases, they offered to pay $1 or less. Clearly, they are not participating in the arbitration system in good faith. It appears their strategy is to fight in court to get cases thrown out en masse rather than having to fight case by case – although the No Surprises Act bans judicial review of individual billing disputes. Or their strategy may be to have the arbitration system spiral so far out of control that the insurers can argue in court that the whole system should be thrown out. A piece of the court-based strategy may be to delay payments. In some cases, providers are reporting that insurers are simply refusing to pay. A trade association for emergency medical services providers has reported that about 60% of awards were not paid within the 30-day period mandated by the No Surprises Act.

Ultimately, patients are paying for all of this – the outrageous payments for the services and the billions of dollars of administrative overhead costs. Individual patients aren’t getting huge surprise bills, rather we are all paying through increased premiums for our health insurance. And the cost of our health care system spirals upward with no improvements in quality or outcomes – just more capitalists making more money. (See this previous post for a more general overview of how capitalism has corrupted our health care system. See this previous post for how a universal, single-payer health care system would save lots of money and lives.)

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday post here.

[1]      Dayen, D., 8/13/26, “Congress face-plants on surprise health care bills,” The American Prospect (https://prospect.org/2026/08/13/congress-trump-no-surprises-act-health-care-bills-insurance/)

UNIVERSAL HEALTH CARE SAVES LOTS OF LIVES AND MONEY

SUMMARY: A universal, single-payer U.S. health care system could save over 100,000 lives and $1 trillion every year. However, because capitalism has corrupted our health care system, which now puts profits before patients, the potential benefits, both in quality and in savings, won’t occur unless the corporate giants in the system are broken up or strongly regulated. Six corporations dominate Big Medicine with over $2 trillion in revenue and $34 billion in profits in 2025.

(Note: If you find a post too long to read, please just skim the bolded portions. Thanks for reading my blog!)

(Note: Please follow me and see my blog posts on Bluesky at: @jalippitt.bsky.social. Thanks!)

A reformed U.S. health care system providing universal coverage could save over 100,000 lives and $1 trillion every year according to a study from the Yale School of Public Health. A universal U.S. public health insurance program, such as Medicare for All, would save over $1 trillion a year even after including roughly $300 billion for the additional care received by currently uninsured or underinsured people. [1]

The five major sources of savings are:

  • Reduced administrative overhead. At least 15% of U.S. health care spending, about $800 billion annually, is administrative waste. Peer countries and Medicare spend 1% to 4% on administration.
  • Lowered drug costs due to regulation and negotiation of drug prices.
  • Reduced fraudulent billing from for-profit entities working to maximize profits.
  • Fewer emergency room visits and hospitalizations due to earlier and less expensive treatment of medical conditions.
  • Standardized and capped prices for health care services.

Universal health insurance would, of course, undo the coverage cuts and other health policy changes implemented by the Trump administration since 2025. This alone would prevent about 51,300 deaths a year. Universal comprehensive and affordable health coverage would benefit the over 45 million adults who are underinsured – where deductibles and co-pays make needed care unaffordable. This would save another 29,600 lives a year. Finally, universal health insurance would, of course, insure the uninsured saving an estimated 33,300 additional lives. So, in total over 114,000 deaths per year would be averted.

The Yale study builds on and confirms estimates in a less comprehensive 2020 study that concluded that a single-payer, universal health care system in the U.S. would save at least 68,000 lives and $450 billion a year. [2]

However, capitalism has corrupted the U.S. health care system. The pursuit of profits has become the priority, rather than care for patients. Costs are high and growing fast, while outcomes are poor. (See this previous post for more details.) Big corporations (aka Big Medicine) dominate health insurance, drug manufacturing, hospitals, and doctors’ practices. Middlemen skim off profits at many points in the system. Private equity firms (vulture capitalists) pocket profits at the expense of patients, doctors, and others. Practitioners are burned out and leaving clinical practices in record numbers leading to shortages of doctors in primary care and many specialties, especially mental health. [3]

Therefore, a universal, single-payer, Medicare-for-All type system won’t achieve all its potential benefits, both in quality and in savings, unless the corporate giants in the health care system are broken up or strongly regulated. [4]

Six corporations dominate Big Medicine: huge insurer / provider conglomerates UnitedHealth, CVS, and Cigna, along with mega-wholesalers McKesson, Cencora, and Cardinal Health. They are six of the fifteen largest corporations in the U.S. They have been built by mergers and acquisitions over the last 16 years; only one of them was among the fifteen largest corporations in 2010. They had over $2 trillion in revenue and $34 billion in profits in 2025. For example, McKesson, Cencora, and Cardinal Health are the three largest wholesale drug distributors, controlling 98% of the market, giving them, as middlemen, monopolistic leverage over drug manufacturers, providers, and consumers. (See this previous post for more on corporate consolidation and concentration in health care.)

Big Medicine now employs 80% of doctors. This exemplifies the major changes in our health care system since the early 1980s when 80% of doctors owned their own private practices. Big Medicine (as with big retailers and big tech) also pushes manufacturing  of drugs and medical supplies to low-cost sources overseas. This makes supply chains brittle and results in shortages if there’s any disruption.

For patients, Big Medicine means unaffordable coverage, doctor shortages and long wait times, longer trips to doctors and hospitals, administrative barriers to care and payments, worse health, and medical debt for 40% of American adults. For doctors and other practitioners, it means decreased pay and benefits, increased pressure to produce billings, decreased time with patients, delayed payments for services, and worsening working conditions. Big Medicine has pushed both patients and practitioners into frustration and anger, and, as a result, only 28% of patients trust the health care system and practitioners are leaving the field at unprecedented rates.

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday post here.

[1]      Kristoffersen, M., 8/13/26, “Universal health coverage could save $1 trillion and 114,000 lives every year, Yale study projects,” Yale School of Public Health (https://ysph.yale.edu/news-article/universal-health-coverage-could-save-one-trillion-dollars-and-114000-lives-every-year/)

[2]      Galvani, A. P., et al., 2/15/20, “Improving the prognosis of health care in the USA,” The Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/abstract)

[3]      Freer, E., & Harper, M., August 2026, “Break up Big Medicine: A health care agenda to restore power to patients and practitioners and save families $6,000 a year,” American Economic Liberties Project (https://www.economicliberties.us/wp-content/uploads/2026/08/AELPHealthcareAgenda.pdf)

[4]      Dayen, D., 8/27/26, “Health care reform needs more than universal coverage,” The American Prospect (https://prospect.org/2026/08/27/health-care-reform-universal-coverage-medicare-for-all/)