The problem with the US healthcare 'system': THE INSATIABLE PURSUIT OF EVER MORE MONEY BY CORPORATIONS AND WALL ST.

That the US health system is (to quote the opening of an important book*) “broken”, is obvious to almost everyone. It’s a mess. Even calling a “system” is probably incorrect. It costs a tremendous amount of money, generally 2-4x per capita what any other wealthy country spends, and generates far worse public health outcomes (even before the wackadoodle RFKJr became Secretary of HHS) such as longevity, disability-adjusted-life-expectancy (DALE), infant mortality, cancer survival, and almost all other measures. It also is very difficult to access, just getting to see a doctor, as well as financially. This situation has long been true for the poor and much of the working class. It is getting worse as low-income people lose access to Medicaid because of cuts to ACA subsidies or because they live in a state that never expanded Medicaid, and for rural people who are both, on average, older (and thus more likely to have health problems) and poorer. Over time it has increasingly become something that affects working class people, as insurance companies raise their rates, employers become stingier with paying premiums, and, very importantly, as the power of unions has been dramatically eroded by a society concerned only with corporations making the most possible money. It is critical to remember that the health insurance benefits employed workers gained resulted from the struggles of unions, never from the generosity of corporations.

The days of “Cadillac health plans” for unionized workers are long gone, and they are finding themselves in the same pool of too many people seeking too unavailable health care at too unaffordable costs. The new Trump administration plan for the ACA will make things much worse; it may offer lower-cost plans in terms of premiums but with enormous deductibles (‘New A.C.A. Plans Could Increase Family Deductibles to $31,000’, NY Times, Feb 26, 2026). So if you get sick and need care, you’re really screwed, and if you don’t you’re paying insurance premiums for nothing!

And now even those in privileged economic positions, who have money and sometimes even personal access because they are doctors, are finding themselves struggling to access care. People can’t find doctors, especially primary care doctors like family physicians and general internists who can manage their health and the input from various specialists. When they can find them, it is hard to get an appointment. It is very difficult to talk to them, or get a message to them, or speak to anyone who works for them who has any clinical knowledge or understanding. Some people say “I have a good doctor, they respond to my calls, or I can communicate on a health portal,” but these grow fewer. I know physicians who have real difficulties! They need supplies for their insulin pumps, but the insurance companies require notes from their doctors, and it is almost impossible to reach them. I know health care professionals who have heart problems requiring them to wear machines recording their heart rhythm over time, who must wait in lines stretching out the door to see their cardiologists. This is bad, not because they are better educated, wealthier, or health care professionals, but because it is bad for everyone. These people, at least, be able to afford to get a “concierge” doctor who they pay out of pocket, but clearly this is not a solution for most folks. 

We are in the grips of a perfect storm, with insurance companies raising their rates and finding reasons to deny care, a shortage of doctors in many areas, both geographic and by specialty, especially including primary care, with doctors having such speed-up of their work that they scarcely have time to see their patients not to mention respond to calls or notes. We have federal and state governments cutting back public benefits, including not only Medicaid but also Medicare and the VA. Doctors no longer work for themselves where they can make decisions about how to run their practice, and balance work and income, but for giant hospital “healthcare” systems and private equity investors interested only in profit.

Well, you know, maybe “perfect storm” is the wrong analogy. That phrase implies that the bad situation you find yourself in is the result of several unrelated events that come together coincidentally at the same time. This is not the case in the health care crisis. While a lot of things seem to be happening together, they are all manifestations of one single thing:

THE INSATIABLE PURSUIT OF EVER MORE MONEY BY CORPORATIONS AND WALL ST.

That's it. That is 100% of the problem. A lot of effort is spent trying to transfer blame between blameworthy players, with insurance companies saying providers are too greedy, providers saying insurers don’t pay enough. And everyone blames the pharmaceutical industry and even components of that industry – drug manufacturers, giant retail pharmacies, and “PBMs”, the middlemen between drug companies and insurers – blaming each other. But this “it’s not me, it’s them” is all a load of crap. Yes, sometimes one part of the “healthcare” industry is doing better financially than another, sometimes one corporate behemoth puts another out of business, but what is never a major consideration – and I put forward it should be the only consideration – is what improves the health of the American people, as individuals and as a whole. You, the “patient”, the sick person who needs care, is the one player in this whole thing whose interests are not getting the consideration they deserve – which should be ALL of it.

The growing trend, which is the proof of all of this, is the “vertical integration” of the components of the system. This means that the same company is the insurance company, the provider, the drug supplier. It feeds itself sucking out your money at every turn while denying you the care that you need. Several recent posts on the “Health Care Un-covered” substack detail aspects of this, including ‘The Economic Exploitation of Independent Physicians by Insurers’, and recently ‘2025: Big Insurance’s $1.7 Trillion Year’ which shows that while they ARE making these outrageous amounts (from YOUR pocket, whether directly in premiums, co-pays, and deductibles or premiums paid by your employer in lieu of higher wages) the bosses THEY answer to, the sharks on Wall St., are harassing them to do more, charge more, deny more care, because it isn’t enough; they aren’t making enough  profit! They need more!

I said at the beginning of this piece that “almost everyone” realizes that our healthcare system is a mess, and I think this is true. Certainly, those profiting from it, all those insurance companies and health systems and private equity companies and drug companies, know it. They love it. They’re making out like bandits, one might be tempted to say, if only bandits could begin to compete with them in cupidity, heartlessness, and immorality.

The truly infuriating thing is that our governments are in the practice of enabling them, of enhancing their power, of increasing their profits (see, for example, the gargantuan efforts to move US seniors out of traditional Medicare, an efficient and cost-effective single-payer plan to Medicare Advantage, which puts them back at the mercy of insurance companies; see for example Medicare re-enrollment: Time to consider being dissatisfied with a new plan!, Oct 25, 2025). Most legislators and their health pundits who are not the out-and-out-on-the-take corporate enablers that characterize the Republican party are the somewhat-less-but-really-still-on-the-take corporate enablers of the Democratic party!

We regularly hear from even somewhat progressive (not to mention the right-wing) think tanks and academics and legislators that it would be impossible to change the system to truly benefit the health of the American people, and not the pockets of big corporations, even though it has been done in every other wealthy (and many less wealthy) countries in the world. The key change here is to take the profit (or most of the profit, or the possibility of generating ever more profit) out of the health system. The problem is simply NOT that people use “too much” health care and cost too much money; the problem IS simply that insurers and big health systems and Wall St. and drug companies MAKE too much money and are taking the money we pay for health care out of health care!

The only people who are going to speak for the health care needs and interests of the vast majority American people are those people themselves. Demand of your politicians that they commit to single-payer improved and expanded Medicare for All, demand that they pursue policies that actually get more primary care doctors out in practice by decreasing the payment prejudice for subspecialists and banning completely the corporate practice of medicine.

And if they don’t, vote them out!

 

*Joshua Freeman, Health, Medicine, and Justice: Designing a fair and equitable healthcare system, Copernicus, 2015.

Pay primary care more: Kennedy may be getting this one right!

I have recently written strong criticisms of Secretary of Health and Human Services Robert F. Kennedy, Jr. and his positions on a number of issues, including most importantly vaccines (see RFK, Jr.: The Secretary of Health and Human Services is Dangerous to Your Health!). Not only is he wrong about vaccines being dangerous, he is in fact creating major danger by discouraging their use. The polio vaccine essentially eliminated a disease that was a major scourge in the US as well as the rest of the world, as did the measles vaccine. Many other vaccines protect our children – and adults – from other serious viral diseases like influenza, COVID, mumps, chicken pox, rubella, shingles, and human papillomavirus (HPV) which causes cervical cancer, as well as bacterial diseases including diphtheria, tetanus, pertussis, and Hemophilus influenza b. The last is something most people have not heard of, but early in my career was a major cause of morbidity and death in infants and young children from meningitis, pneumonia, and epiglottitis, which caused their throats to swell rapidly and choke off their breathing. Many others have articulately expressed this concern, including the pediatrician Perri Klass in the New York Times. While these diseases affected people of all social classes, they were more prevalent among the poor and minority groups such as the people I cared for at Chicago’s Cook County Hospital. Indeed, research has demonstrated tremendous benefits from vaccines on the health of children and other populations that go far beyond just the decrease in the specific diseases that they target to decreasing all-cause mortality!

Kennedy is wrong about many other things, if not all of as of such immediate potential danger as urging people to not get vaccinated. These include nonsense like suggesting that people who eat right and exercise won’t get disease, that raw (unpasteurized) milk is better for you, and that “natural” is always better (which, even if we could agree on a definition of “natural”, it isn’t). One recent example is his arguing for Coke to use “natural” cane sugar rather that high-fructose corn syrup, both of which are sugar and have calories and in large amounts are bad for you.

But there turns out to be one area where Kennedy and I seem to agree, which is the need to take concrete action to increase the number of primary care physicians. Lots of people, including politicians, healthcare providers, and health policy experts, express concern about the shortage of primary care, but have done nothing to address the real cause of this problem – that primary care physicians (and the nurse practitioners and physician’s assistants working with them) get paid a lot less than do physicians in other specialties. Kennedy appears to be doing something other than wringing his hands. On several occasions I have written about the RUC, the AMA committee that decides how to divide up the pie of Medicare dollars among specialists by deciding how much each thing doctors do is worth relative to other things that they do. (Changes in the RUC: None.. How come we let a bunch of self-interested doctors decide what they get paid? July 21, 2013, Doctors' incomes and patient coverage: both need to be more equal July 26, 2014, and most recently, Not enough primary physicians OR Nurse Practitioners: It's the money, stupid!, June 27, 2024).

Not to get too technical, there is a set amount of Medicare dollars and the RUC decides (or recommends to CMS, which almost always accepts those recommendations) how many physical exams, say, are equivalent to one gall bladder surgery, considering (theoretically) both difficulty and time. This makes a tremendous difference in physician income and, I would argue, specialty choice by medical students. And, over the years, the amount of time it takes for doctors to do some things, particularly procedures, changes. Colonoscopies used to be estimated to take an hour and a quarter, but now are routinely done in 30 minutes. Cataract surgeries take a fraction of the time that they once did. This can result in physicians billing for more procedures than the model assesses as possible in a day. In contrast, the time it takes for a physical exam, or to listen to an interpret a person’s story, hasn’t changed significantly. The composition of the RUC, according to the AMA, represents all specialties, but its membership has a low proportion of primary care doctors – five of the 32 seats. Unsurprisingly, then, specialist-performed procedures are valued more highly than cognitive work. And, very important, these rates (relative value units) do not affect only Medicare payments – virtually all insurers pay based upon Medicare rates, so it is the whole health system! Prior to this new regulation, alternative models for allocating payment have been developed, such as this 2025 publication from the National Academies of Science, Engineering, and Medicine (NASEM).

So, now, maybe, a change. The NY Times reports that, buried in an 1800-page HHS regulation, are proposed changes in the RUC methodology that would benefit primary care. This would be real action! In addition to reassessing these relative values, the action would also look at the current practice of reimbursing more for the same procedures done in a hospital than in a doctor’s office, a major way that hospitals make money. And, for those who think “of course it costs more to do something in a hospital”, this is a technicality; it simply means that the hospital owns the practice or clinic. So two, say, skin biopsies performed in similar doctor’s offices across the street from each other are now reimbursed at very different rates if one is owned by a hospital. This is absurd and inequitable, and getting rid of it makes terrific sense!

The diffusion of medical services to people and communities is primarily driven not by the health needs of the populations in different areas but by the potential to make the most money for health care providers. These are largely, and increasingly, hospitals and health systems, as well as enormous insurance-company and private-equity owned practices rather than individual or small group physician-owned practices. So, we get enormous hospital campuses and medical facilities in major cities and wealthy suburbs and little or nothing in poor neighborhoods and rural areas. This should change. The only reason for decisions about what healthcare services to provide and where to provide them should be the health needs of people, and not on how much profit can be made.

The new HHS regulation will be a big step in this direction if it redirects Medicare (and thus all insurer) funds to primary care, and does not preferentially favor hospital-owned practices. To the extent that he is responsible for it, Kennedy should be congratulated. However, while it is a big step, it is not a solution. The next, necessary, step is a universal health insurance program where every single person is covered and covered by the same system, and where establishment (and closure) of health facilities, and the services that they provide or do not, is entirely based on the health needs of the people. Of course, there will be a lot of resistance – highly paid specialists will resist the proposed HHS reimbursement changes, and the institutionalized powerful insurance companies and other big players who are making lots of money from “healthcare” will oppose more comprehensive changes. Indeed, they already are, with highly funded social media campaigns against universal health care.

We are glad for this first step, but we need to keep fighting to get a comprehensive health program – like those of every other wealthy country!

What is the problem with Primary Care? The US health system!

What is wrong with primary care in the US? Shall I count the ways? Medscape details a number of them in its recent article, citing much of the data provided in the Commonwealth Fund report “Mirror, Mirror on the Wall” which I discussed in my last blog post, Our health system: Not equitable, not effective, and not even efficient. Bad business!, (March 4, 2022). The spoiler answer is: what is wrong with primary care in the US is the US health care system – how it is designed, how it is implemented, the purposes for which it is intended, and the intrinsic corruption of it. If the primary care portion of the US health care system is in particular disarray, it is because it is the (relatively) poor stepchild of a system that is all about making lots of money for corporations, particularly large health systems, insurance companies, and the vendors of drugs, devices, and equipment. The way our health system is currently structured is to feature those parts of it that generate this money, rather than those that maximize the people’s health, and under our current reimbursement system primary care is not in the game. Thus, it is unsurprising – if incredibly depressing – that our primary care sector performs poorly on the metrics assessed by Commonwealth (and reported on by Medscape), because they are looking at different markers, that is, how it meets the health needs of our people, and a robust and effective primary care capacity is critical to that. If only they would look at corporate profit they would see how well the health system, by neglecting primary care, is doing!

What is primary care and what are primary care doctors? They care for all the issues that a person has, not limited to disease, organ system, procedure, etc. They care for people with as-yet undiagnosed problems, with undifferentiated conditions. They provide care over time, and consider the physical, mental, and social conditions affecting a person. They provide care in the context of a person’s family and community. Any issue that is affecting a person’s health, or that they think is, is fair game to bring to a primary care doctor, who will try to diagnose and treat it, referring if necessary. In a coherent and effective health system, they continue to be involved with the person, even after referral or hospitalization. The characteristics of primary care, and the reasons for its benefit to people and to society are discussed most clearly by Barbara Starfield, MD, in many papers including this one. I like to think that while the relationship between primary care doctors and their patient is defined by the relationship, not the disease, or procedure involved. Family medicine, unlike even other specialties in primary care does not even limit its practice to certain age groups. But even these doctors are being relegated to practice only part of what they could; few deliver babies, most don’t do hospital work, and a large number do not care for children.

But few of us have seen such a physician lately, still less with a “full scope” practice. There are not enough family physicians or other primary care doctors in the US. There are not enough to meet the primary care needs of our people, nor to adequately perform the role that primary care should play in regard to specialists – that is, assessing a patient, determining if they can be treated by the primary care doctor, and if not referring. Otherwise subspecialists spend a lot of time caring for things that could have been done by a primary care physician. Or missing problems that are outside their specialty focus when people directly self-refer. And it is not only in the US; in parts of Canada, there are such shortages of primary care doctors (there they are virtually all family physicians) that consideration is being given to a new profession, possibly called associate physicians. In the US, much primary care is delivered by nurse practitioners and physician’s assistants. Some of them do excellent work, but they are also hampered by the same constraints as those primary care physicians face – excessive workload, assembly line production, (relative) underpayment, and a perverted reimbursement system.

To the extent that the move to non-physicians is driven by the fact that they cost less because they earn less money, any such effort is doomed. Nurse practitioners are increasingly being recruited by hospitals and subspecialty physician groups where they can earn, as do the doctors in those specialties, more money. This has overwhelmingly already happened in the case of physician assistants. The answer to the need for more primary care is simple: PAY MORE MONEY. Pay them as much as, or almost as much as (70% would probably do it) other specialists. There are a lot of students, residents, doctors, nurse practitioner and physician’s assistant trainees who would like to do primary care, and would be good at it, but are dissuaded because they can earn WAY more in another specialty. It is not that complicated; virtually all reimbursement for health care in the US is based on Medicare rates; private insurers pay some multiple of what Medicare pays. So all that has to happen is for Medicare to completely revise its reimbursement schedule so that primary care is paid a lot more, and interventive procedural specialty care less. Don’t increase the size of the pie; reallocate!

Sadly, the reallocation (under both Republican and Democratic administrations) has been instead to increase the privatization of Medicare, effectively enhancing corporate profits rather than quality health care. The Medicare Advantage program, while it can be good for some seniors, is being touted as the greatest thing since sliced bread by many in Congress, although it is heavily subsidized and saps funds from Traditional Medicare (TM). MedPac (not a “political action committee”, but the official group convened by Congress to make recommendations on Medicare) has raised serious concerns about the program, which essentially cherry picks healthy seniors, gives them low cost benefits, and eschews sick people while getting more money from Medicare. As I have written before (Direct Contracting Entities: Scamming Medicare and you and bad for your health!, Feb 7, 2022), a program called Direct Contracting Entities (DCEs) was developed to push even those who have chosen TM into corporate controlled profit centers. And now, after DCEs have received criticism in Congress, they haven’t been abandoned, but re-branded as REACH, essentially the same model.

The problems with primary care are not with the clinicians. The problem is with the corporate model that seeks to limit the practices of the clinicians and speed up their work so they cannot provide the benefits of primary care. The key part here is being the core person who knows about you and your family and manages directly or in conjunction with others all your care. It cannot effectively happen if you are seeing different doctors in every setting, and no one is responsible for YOU. This is much different from being the person who orders the tests or prior authorizations. Family physicians and other primary care doctors and clinicians need to have the time to spend with the patients, getting to know them, getting to know them well enough that they are trusted by their patients, who may then reveal the Pandora’s box of complicated, difficult-or-impossible to solve problems that physicians dread to hear about and corporate employers hate to pay for. You can’t get to these, not to mention begin to solve them, in 15 minute visits. Often you can’t really begin to solve them at all, since they are based in the overall circumstances of life that people find themselves in, what are often referred to as the "social determinants of health" -- their income, jobs, education, housing, food, safety, and discrimination for starters. But they need to be revealed.

This is scary to corporate types, who want to continue to do what they do – generate big bucks by hiring procedural specialists to care for well-insured or rich people for big reimbursement.

Why do we have to wait so long to see the doctor? It's all about the money...

I have seen a number of articles describing the difficulty of getting doctor’s appointments in the era of COVID-19. In many parts of the country it was difficult to get a quick appointment even before the pandemic, but it has become much worse. I hear from friends in a several different cities that they cannot get into their doctors offices for weeks or, commonly, months. This is not OK for routine care; it is certainly not ok when something urgent, or relatively urgent, or even a little bit “needs to happen before I get really sick” is going on. A recent article in the Wall Street Journal by Devorah Goldman (‘The doctor’s office becomes an assembly line’, December 30, 2021) describes a woman who came to her father’s Brooklyn office from New Jersey because she couldn’t get an appointment for 8 months!

There are Emergency Rooms, of course, but waiting (frequently for hours!) in them increases your risk of acquiring COVID infection. And, as in “regular” times, they should be for emergencies, not for care for chronic diseases or minor acute disease. Of course, if you cannot get regular care for your chronic disease, it can become an emergency. And, as I have written before (Emergency services, COVID, and the health system: Your life could well be at risk, Jan 19, 2021), when you have an emergency, like a ruptured appendix, waiting in an ER for hours is also very dangerous, and the more “non-emergent” people waiting the more likely this is to happen. There are Urgent Care Clinics, but these have their own issues: they can only take care of a limited (and variable by location) menu of problems, most of which are those your mother used to take care of, and they may not take your insurance (if you have it). Also the prices and profit margins are very high.

So why are the waits so long, and what can be done about it? Goldman’s emphasis is the takeover of physician private practices by hospital systems and large groups; she notes that, according to the AMA, 75% of physicians owned their own practices in 1983, but by 2018 it was 46%. This is part of the problem; even if an individual physician is compassionate and caring, the big corporation they work for probably is not. Another part is the maldistribution of physician specialists. Studies of efficient and effective health care systems indicate that 40-50%+ of physicians should be in primary care, seeing people for most problems, providing continuity of care for a patient panel, and diagnosing “undifferentiated patients” (those who do not have a specific diagnosis) and caring for them or appropriately referring them. In the US, however, it is less than 30% and dropping. Quite reasonably, subspecialists want to see people with the problems that they know how to take care of; this works well when they are referred by family physicians and other primary care clinicians, and much less well when people have to self-refer, essentially having to diagnose themselves. Such direct self-referral also backs up the subspecialist practices with patients whose problems could have been well taken care of by a primary care clinician (not everyone with a heart needs a cardiologist!) making it more difficult for those with complicated or rarer conditions that need the subspecialist’s care to get in. Medicare’s reimbursement method figures prominently in Goldman’s article; she identifies ways that it tends to give preference (i.e., pays more) to large, and especially hospital-owned, medical groups. And, of course, since COVID the demand for care has gone up, and the number of clinicians available (because of sickness and overwork) has gone down.

Many other articles claim to provide the reasons for this problem, and some even have proposed solutions, but most of them examine only one aspect of it. I am reminded of the old Indian story about the blind men and the elephant, each touching a different part of the beast and thus presuming, based on contact with the trunk, the tail, or a leg, that they knew what the whole elephant looked like. Often this is influenced by the agenda of the writer and whether (like, e.g., Goldman) they get their information mainly from groups like the AMA (“oh, for the days of physician-owned private practice!”), hospital associations (“consolidation is good!”), government agencies (“reimbursement policy is governed by competing needs”), or academics, think tanks, or nonprofits like the Commonwealth Fund, Kaiser Family Foundation, and Pew Trusts, often with their own biases. To me, it is clear what the whole elephant looks like, what is the common factor in this equation, what can be seen behind all of the decisions that have led us to where we are (and continue to make it worse) and, by implication, could show us the way out: Money. Corporate profit.

We live in a profit-driven capitalist society. More than that, we have moved well beyond simple “Adam Smithian” capitalism to what Noam Chomsky identifies as “gangster capitalism”. In this stage, merely making money is not sufficient – the only goal becomes to make ever more money, by any and every means possible, no matter who, or what is destroyed. This includes people, animals, plants and the earth itself -- it hurts, screws, destroys, even though neither those who control it nor their descendants could ever spend it all. Fewer and fewer people control more and more and it would be naïvete to assume this is not the case in health care.

Virtually all the systemic bad things (as opposed to the much less common individual error) in healthcare derive from corporate owners’ efforts to make more money, and to game the system to maximize profit. While huge practice groups owned by hospitals or investors could operate more efficiently to improve both the quality of and access to care for patients, they don’t since they are interested in squeezing every dollar of profit. Conversely, small physician-owned practices couid do better than they do, but often, in pursuit of income, do not care for significant portions (poor, uninsured, badly insured) of the population. Explicitly for-profit (as opposed to ostensibly non-profit, but still fixated on making as much as possible) healthcare entities, whether large hospitals and hospital systems or more ‘niche’ services like dialysis, physical therapy, and long-term care, are the worst. There is certainly plenty of blame to go around – healthcare systems blame insurance companies for not paying them enough and insurance companies blame healthcare systems for demanding too much, but both are seeking to earn money for themselves, not to ensure all people get the highest quality health care.

Pharmaceutical companies are notoriously rapacious. For example, see Aduhelm® (FDA approves Alzheimer's drug against the recommendation of its scientific panel. Be very concerned, June 21, 2021); every (60 million!) Medicare recipient’s Part B payments will now rise $11/month so some Alzheimer’s patients can receive this drug that, though probably ineffective, costs a huge amount (now, graciously, reduced to only $28,200/year!). It was approved by the FDA over the recommendation of its scientific advisory panel in a move completely reminiscent of the fraudulent labeling of Oxy-Contin® described in the film “Dopesick”, which I recently discussed ("Dopesick": The story of the marketing of killer opioids will really make you sick. Don't trust any of them!, Dec 7, 2021).

I have often advocated for a single-payer health insurance system, such as Medicare for All. The advantage of this would be that 1) everyone in the US is covered, and 2) everyone in the US has the SAME coverage, The second is not a minor point, as it means that the educated and powerful will make sure it works, also helping the disenfranchised and disempowered. A universal health insurance system (or something comparably effective) is necessary, but not sufficient. Medicate for All needs to be an improved and expanded Medicare, as described in the bills introduced by Sen. Bernie Sanders, Rep. Pramila Jayapal and others.(See this good analysis by Sen. Sanders on the “Vulgarity” of the US health system.) It must be expanded to cover not only everyone but everything (mental health, dental, vision, hearing, long-term care) and improved to cover them completely without co-pays, co-insurance, deductibles. This will eliminate the flaws Goldman describes in Medicare payments.

Since we already spend 2-3x as much per capita on health care as any other wealthy country, including premiums, deductibles, co-pays, government benefits, and the profits and administrative costs sucked out of the “healthcare” pool by insurers and providers, we don’t even need to tax the richest a lot more to pay for it. We just need to spend it on actually providing healthcare! Not that we shouldn’t make the billionaires and corporations pay at least their fair share of taxes; we can use that money to providea adequate housing, food and education to all our people – really, the biggest factors in health.

Don’t get distracted by the circuses and diversions created by those with a profit-motivated dog in the fight. Profit has little place in healthcare. Obscene profit has none.