US healthcare is expensive because prices aren’t real and complexity is profitable. Hospitals and pharma have monopoly power, insurers add massive administrative drag, and nobody sets hard price limits. ~25–30% is spent on billing and paperwork alone. Hospitals consolidate into regional monopolies. Drug companies charge whatever they want. Insurance act as a middleman for routine care instead of risk protection. Outcomes don’t justify the cost. The system is optimized to extract revenue, not deliver care efficiently.

Fixing it doesn’t require utopia: cap prices for common services and drugs, enforce antitrust to break hospital monopolies, standardize billing nationally, and let Medicare (and others) negotiate drug prices. Shift insurance back to catastrophic coverage while covering primary care publicly, and cut hospital admin while paying clinicians more. These are boring, proven levers that haven’t happened because every inefficiency has a powerful lobby defending it.

I expect in 10 years most health insurance premiums will just be used to travel to either Canada or Mexico to get treatment. The United States will no longer have a functioning healthcare system (not that it’s anywhere near functioning today)