I would like to see DOGE look into the medical field itself, and not just Medicare and Medicaid since Healthcare itself is the base cost of both. I'm sure there's plenty of fraud and waste in Medicare / Medicaid but inefficiency, lifestyle..etc could be much bigger imo

Shocking stat of the day:

Social benefits reflect nearly HALF of the US government's expenditures.

Social benefits as a share of $7.1 trillion government spending hit 45% in 2024, near an all-time high.

This percentage has surged by ~10 points since 2000.

During this period,… pic.twitter.com/3c7Sai8NXo

— The Kobeissi Letter (@KobeissiLetter) March 5, 2025

Definitely Not A Cop said:

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Not really sure this is the right board for this.

To not get too political, I don't think there is anything that can be done unless human behavior changes. For one thing, using your insurance to pay for a doctor visit for simple things like having a cold has completely insulated the healthcare industry to be able to charge insurance companies whatever they want. It's similar to home insurance rates skyrocketing with the games that are played by roofing guys anytime a big storm comes through. It becomes this double edged sword where the roofing guys are charging so much because they know they can get away with that now you almost have to use insurance to afford a new roof.

Not to knock great roofers, I know Jason does a great job here. My point being is that the health care industry has been corrupted mostly by human behavior that has allowed costs to rise unchecked.

If everyone used car insurance every time they wanted new tires, I would expect tire prices to increase astronomically as well.

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I think this topic is about as business as it gets, the future of capitalism

I think there's things that can be done. The cost of health has to come down



Healthcare itself has gotten more expensive. That's the root cost of M&M

I think a lot of the jump in Healthcare costs was in thr 80s and 90s and that shows up in this graph under Medicare and Medicaid

I can see AI and genetics helping bring costs down. Even basic stuff like a single computer format that all medical records go into vs having to tell someone or check boxes of entire medical history.

My wife has a lengthy medical history and unless you do your own homework theyre gonna miss big things. I think AI could be a huge help here but medical history needs to be accessible from any Drs office you walk into

besides working on some of the fraud and bloat. you're not realistically going to see any major cuts in Medicare & Medicaid (unless you want to bring back the idea of death panels).

The reimbursement rates they pay to providers is barely enough to cover the costs of a community practice. In other words, there's not a whole lot of fat to trim there.

Dan Scott said:

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Trigger warning this is going to come off bad

End of life care needs to be looked at. The cost to keep somebody alive for a few more months while their quality of life is severely diminished makes no economic sense. According to ChatGPT, 25% of Medicare expense is on the last year of life. When I need helping my own ass, I'd rather not live anymore.

I kinda view fighting death as a sin. Once the big guy has called your number, don't fight it. If you're a believer, why delay paradise to stay here and be miserable for a few more months.

I'm still young and healthy so maybe I'd change my perspective if I were old or sick bits that's my opinion

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I agree it needs to be looked at


IMO a fair perspective is the difference between postponing death vs extending quality life.


At the end of the day though that's going to be a very long and even a cultural debate that could go on for a long time.

jamey said:

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Dan Scott said:

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Trigger warning this is going to come off bad

End of life care needs to be looked at. The cost to keep somebody alive for a few more months while their quality of life is severely diminished makes no economic sense. According to ChatGPT, 25% of Medicare expense is on the last year of life. When I need helping my own ass, I'd rather not live anymore.

I kinda view fighting death as a sin. Once the big guy has called your number, don't fight it. If you're a believer, why delay paradise to stay here and be miserable for a few more months.

I'm still young and healthy so maybe I'd change my perspective if I were old or sick bits that's my opinion

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I agree it needs to be looked at


IMO a fair perspective is the difference between postponing death vs extending quality life.


At the end of the day though that's going to be a very long and even a cultural debate that could go on for a long time.

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I think the debate would be pretty quick if patients knew the cost of service and had more skin in the game.

Of course even getting transparent pricing is very, very challenging and medical professionals have ethical standards that may run contrary to market principles.

We consumers see the price of bad bank debt through credit card rates. But we have no idea how much bad medical debt is out there and we have no information how it the market would price it.

I like the push for high deductible and HSAs

Anything that puts inserts capitalism into medical cost is good.

Not politically correct but it's the ultimate in girl goes to a mechanic and gets dupped. But we get dupped by a system that's inefficient because there's no market impact. It's almost like government work

And even worse, you go to these hospitals and they have these lavish rooms. Our local ER has a swanky waiting room. In the 70s you shared hospital rooms with a curtain in between patients.

And the medical industry does not use computers and internet for perfectly clear and accurate and up to date medical records


I use to work in a lab and saw some pretty blatant fraud so there's some of that too. For example sending blood glucose test across the country without spinning it down. Cells eat the glucose and you get a result that's incompatible with life and it happened regularly. Nurse would say, oh he had not eaten yet. That's why glucose was 7, 8 hours ago

Definitely Not A Cop said:

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I do think we would be better served as a whole if insurance covered gym memberships, not your daily cocktail of drugs.

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It would be good if there was some way to prove a healthy lifestyle and get premium discounts for that, kinda like the Apps you can download to record you're driving for a discount on auto insurance


I do agree with RFK on the chemistry we eat in processed food. It should be looked into.


I like the law that out calories on fast food menus, things like that. Awareness is a big factor. I have no idea what they teach about health and fitness in public schools but the old food pyramid was basically upside down


Healthcare costs are a big problem and there's no one thing that's gonna fix it

Dan Scott said:

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Trigger warning this is going to come off bad

End of life care needs to be looked at. The cost to keep somebody alive for a few more months while their quality of life is severely diminished makes no economic sense. According to ChatGPT, 25% of Medicare expense is on the last year of life. When I need helping my own ass, I'd rather not live anymore.

I kinda view fighting death as a sin. Once the big guy has called your number, don't fight it. If you're a believer, why delay paradise to stay here and be miserable for a few more months.

I'm still young and healthy so maybe I'd change my perspective if I were old or sick bits that's my opinion

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Your post reminded me of when my two brothers and I would take turns taking my mom for her chemo and later, her iron treatments, at what I called Jiffy Lube. I would sit in the waiting area with my laptop doing tax returns during the 3 or 4 hours she was in the back.

One day (and then several other times when I was sitting there) an ambulance pulls up (no siren, but maybe flashing lights). They get this old man out of the back on a gurney and wheel him into the building. He was pretty deteriorated. I would guess he was over 90. Looked like around 100 pounds, and I never saw him move, never saw him blink an eye, not once in the 10 or 12 times I saw him brought in. He looked like a dead man with his eyes open. I think his situation is exactly what you are referring to.

There was another patient, this beautiful gal, probably around 20 years old, whose appointment coincided with my mom's several times. I would think about someone so young and then someone as old as that man, both of them probably going to have their lives taken away from cancer. Her with so much in front of her, and he with so little. It upset my system.

tysker said:

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jamey said:

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Dan Scott said:

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Trigger warning this is going to come off bad

End of life care needs to be looked at. The cost to keep somebody alive for a few more months while their quality of life is severely diminished makes no economic sense. According to ChatGPT, 25% of Medicare expense is on the last year of life. When I need helping my own ass, I'd rather not live anymore.

I kinda view fighting death as a sin. Once the big guy has called your number, don't fight it. If you're a believer, why delay paradise to stay here and be miserable for a few more months.

I'm still young and healthy so maybe I'd change my perspective if I were old or sick bits that's my opinion

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I agree it needs to be looked at


IMO a fair perspective is the difference between postponing death vs extending quality life.


At the end of the day though that's going to be a very long and even a cultural debate that could go on for a long time.

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I think the debate would be pretty quick if patients knew the cost of service and had more skin in the game.

Of course even getting transparent pricing is very, very challenging and medical professionals have ethical standards that may run contrary to market principles.

We consumers see the price of bad bank debt through credit card rates. But we have no idea how much bad medical debt is out there and we have no information how it the market would price it.

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Yeah, it's such a black box and that is a huge part of the problem.

I remember about 6-8 years ago all 3 of our daughters and my wife tested positive for strep (all were at the pediatrician, so they all go tested quickly and it was pretty reasonable). I was going to get tested when I got home from work and called the doctor to find out how much it would cost - they told me it depends on the insurance (they had my insurance, but couldn't say). I called insurance, they said it depends on how the office codes it. I called the office to ask how they'd code it and they wouldn't tell me because they said depending on how things went it would be coded differently.

It'd be like buying a car if you didn't see the sticker until after you had taken possession of the vehicle.

And it leads to more expensive care because when people don't know what the costs are, they'll avoid getting things taken care of when they're easier to fix and cheap and instead let them turn into big expensive issues.

It will never change though because money talks and the current system has massive lobbyists and donors.

In my non-expert opinion, the biggest drain (no pun intended) has got to be obesity and all related complications that come with it (diabetes, heart disease, COPD, cancer, etc). Until the people who choose to be unhealthy are the ones paying for it, they are going to continue to make terrible choices. We are on the way to bankrupty by subsidizing the population's slow suicide.

If you want to bring the costs down, you have to start pulling the middle men out.

Aetna, UHC, etc. All those profits they make? They are making off the gov't.

Why are we still paying them to manage medicare? We pay a premium to insurance companies for managing medicare (upwards of 20%) for what? They say they do it better than the gov't can do, but if they can, then the premium should have gone down (or away) since the 90's, not increased.

Also, the medical industry greases things to ensure nothing is done. While I agree that doctors and other front-line providers of healthcare should be paid a wage commiserant with training and 's*** dealing-with', administrators shouldn't be knocking back more than a doctor actually providing care.

Unfortunately to fix the system, it will probably have to be broken first. And when that happens, a lot of people are going to die. And the overall life expectancy of people in the US will go down for a long time until things get rebuilt.

~egon

Not sure the final bill that the government will pay... but one of my employees lost her dad recently (88 years old). He went downhill over the course of a month and was in/out of the hospital multiple times. His total EOBs was well over $1 million and still flowing in... just makes me think - what the **** are we even doing?

The Collective said:

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Not sure the final bill that the government will pay... but one of my employees lost her dad recently (88 years old). He went downhill over the course of a month and was in/out of the hospital multiple times. His total EOBs was well over $1 million and still flowing in... just makes me think - what the **** are we even doing?

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You're not wrong, but anyone asking if it is reasonable to spend millions to add a small bit of time (with terrible quality of life), is labeled as pushing for "death panels" and good luck with rational conversation at that point.

I was taught that 80% of a persons lifetime cost of care was incurred in the last 12 months of their life.

Those fancy rooms are there because patients demanded it and how they feel about their room impacts our quality scores which in turn affects our ratings with Medicare and the health plans.

Fraud and abuse exist but are not a major driver of the Medicare and Medicaid programs: it's the demand for services. De jure instead of de facto rationing in the answer but there is no appetite for it as a society and to be fair no country has really figured it out.

while it's a large number, I've never seen anything close to that.

25% is probably not too far off though.

I think fraud and corruption are likely to be found in Healthcare in general, just like thr government and M&M


I also suspect the biggest cost is simple inefficiency and waste because the government, M&M and Healthcare in general don't work in a truly free market forcing efficiency thru competition like the commercial world. I bet it's a solid 20% of total cost is inefficient waste

P.H. Dexippus said:

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In my non-expert opinion, the biggest drain (no pun intended) has got to be obesity and all related complications that come with it (diabetes, heart disease, COPD, cancer, etc). Until the people who choose to be unhealthy are the ones paying for it, they are going to continue to make terrible choices. We are on the way to bankrupty by subsidizing the population's slow suicide.

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I'm not either but I came to post something like this to the first reply… because I think it's kind of right… but so much more money is used in obesity related health problems. Graph America's obesity rate against the Medicare/medicaid spending… they go up at a really similar rate through time.

I agree behaviors have to change. There's something up with Americans though and just wanting more and it is costing all of us.

Diggity said:

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besides working on some of the fraud and bloat. you're not realistically going to see any major cuts in Medicare & Medicaid (unless you want to bring back the idea of death panels).

The reimbursement rates they pay to providers is barely enough to cover the costs of a community practice. In other words, there's not a whole lot of fat to trim there.

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Everyone in both parties have committed to not cutting any healthcare costs aside from obvious fraud.

Unfortunately, we are pissing in the wind on this topic.

P.H. Dexippus said:

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In my non-expert opinion, the biggest drain (no pun intended) has got to be obesity and all related complications that come with it (diabetes, heart disease, COPD, cancer, etc). Until the people who choose to be unhealthy are the ones paying for it, they are going to continue to make terrible choices. We are on the way to bankrupty by subsidizing the population's slow suicide.

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Agree that this is a big problem, but I think that it will take a societal effort to fix it. Like we need to tackle food the way we tackled cigarettes.

JDCAG (NOT Colin) said:

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The Collective said:

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Not sure the final bill that the government will pay... but one of my employees lost her dad recently (88 years old). He went downhill over the course of a month and was in/out of the hospital multiple times. His total EOBs was well over $1 million and still flowing in... just makes me think - what the **** are we even doing?

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You're not wrong, but anyone asking if it is reasonable to spend millions to add a small bit of time (with terrible quality of life), is labeled as pushing for "death panels" and good luck with rational conversation at that point.

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I would be devastated to know I worked my whole life, was responsible with money, to help pass down wealth to my future generations in my family, only to have it all wiped out in a couple of months of terrible quality life.

I have told my family. When it's my time, I'd rather just go off in the wilderness / most remote place in the United States and go, even if I struggled for a couple days starving and in pain. Anywhere but a hospital or nursing home. Worst possible places to die IMHO.