3 Reasons (1) Administrative costs are astronomical (~25%). Next highest countries are ~10-15%. Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. - Mitchell Tsai

(2) U.S. spends more than other countries on many of the same things; e.g. (a) drugs (b) doctors services (c) equipment - Mitchell Tsai

(3) Americans receive more medical care, not so much in terms of doctor visits [much fewer], but heart attack victims are more likely to get open heart surgery. In Ontario, Canada, 11 hospitals do open heart surgery. Pennsylvania has roughly the population of Ontario and it has 60+ hospitals that do open heart surgery. - Mitchell Tsai

There's so much waste in the system -- our best guess is that about a third of medical spending is not associated with improved outcomes. - Mitchell Tsai

Really what we're doing is two things: one is on the demand side trying to make people smarter consumers, and the second is on the provider side, eliminating the monetary incentives to do more testing and procedures. Instead, let's move to a system that says, "do what's appropriate, make the patients better and you'll get rewarded for it." - Mitchell Tsai

Increasingly, I believe insurers will make you pay more for care that you want to do that's not medically necessary. - Mitchell Tsai

Comment: Under Obamacare ANY state can opt out if they can provide a better plan for their citizens by 2017. Vermont is going Medicare-for-all. - Mitchell Tsai

Comment: Agree, we need to eliminate unneeded and costly support personnel. Case in point, a recent visit to a local hospital for a routine blood test involved seeing a receptionist checking for order request, fasting status, then told me to wait for the next clerk checking my I D, insurance cards and status, then told me to go to the blood draw section. A clerk checked and confirmed ny name and test request, told me to wait for next blood draw tech. Tech checked my I D and name, took the blod sample and finally sent me home. Total time about 30 min, longer when busy. In Taiwan with a national healthcare system and electronic record keeping all my medical history and insurance status is on a credit card viewable by a nurse practitioner. She can match my symptoms against my prior conditions and if needed send me on to a dr if needed. Or else advise me to adjust my current medicines etc and to return if not improved. You can see why their healthcare costs are 6% of GDP, ours 16% and rising. - Mitchell Tsai

Comment: Why does healthcare cost so much in America? I'll give three reasons of my own, that are much more significant than his. (1) government subsidy of professional education (2) accounting regulations written by and for healthcare mega-corporations - namely, government endorsement of third party price collusion (as opposed to standard, free-market price negotiation between producers and consumers) (3) direct government intervention in the health insurance market - Mitchell Tsai

Comment: What's missing from this is that you're not telling everyone the cost of crime violence in that "we spend more on healthcare" figure. "The average cost to treat one gunshot victim at Loyola: $540,447. A stabbing victim: $245,652." - abc news "The average victim of a serious gun injury suffers physical and mental aftereffects for 20 years or more, according to Sager. That means the treatment for a single bullet wound can approach or exceed $1 million over the remainder of a victim’s life, depending on his or her age." - Boston dot com "Among the entire population 18 and older, 1.6 million people were hospitalized for overdoses in 2008, at a cost of $15.5 billion, and half of these hospitalizations involved alcohol overdoses, " adds Dr. Hingson. - NIH study - Mitchell Tsai

http://www.nbcnews.com/health... In 2011, chronic illnesses account for 84 percent of costs overall among the entire population, not only of the elderly. Chronic illness among individuals younger than 65 years accounts for 67 percent of spending, - Mitchell Tsai

>>> This is one of the best short summaries of the major costs of US healthcare (most articles focus on 1 or 2 minor/medium issues). It doesn't touch on one of the big ones (1A) a small minority of people use 60-90% of the healthcare - who are they, and how can we improve their lives & decrease costs. It's also politically safe and doesn't look at the political reasons behind (1-2-3) Profit agendas of AMA, doctors, phamaceutical firms, insurance companies and those groups power to affect government decisions - Mitchell Tsai

An obvious one, the more you charge the more money you make? - Todd Hoff