I think the most correct and probably most discouraging answer is that American healthcare costs about what it should.

Not to dismiss your point, but the US healthcare system has one meta problem.

Complexity.

There are too many parties. There are too many bespoke party-party contract. There are too many new middle-parties being created, with their own contracts. There are too many systems. There's too much tech debt.

That's a reason improvements to the US healthcare system have generally been via HHS/CMS imposing standardization mandates ('or no Medicare payments').

But providers, facilities, and insurers (most operating on low margins) can't be collectively more meta-efficient without simplifying the system.

Single payer / Medicare for all is a critical start not because of coverage, but because of simplicity.

There are so many intractable problems with the current system simply by virtue that changing anything about them requires 100s of parties to update 10,000s of party-party contracts and interfaces.

That's the biggest source of waste in the current system: constant duplicative re-engineering.

Thanks for the recommendation.

Right, they don’t “profit” much because they pay themselves so much. The CEO of united healthcare total compensation is $60 million a year.

Where do you think that money comes from?

You could just delete united healthcare and save bucketloads of money. They don’t actually do anything anyone wants, other than extract money as a middleman.

US health insurance margins are thinner than European private insurance. Their administrative cost however are 9-10%, when in Europe (or really, France and Germany, I haven't looked elsewhere) they are 5-8%. The difference is probably in negotiating costs and audits. But that means that in total, for every 100 dollar paid, US insuree pay 4-10 dollar in efficiency+dividend that a European doesn't.

Dumb argument though when UHG owns the hospitals, pharmacy and the insurance company. They can make the "profit" of any one of them be anything they want really.

Wrong.

Health insurance company margins are meaningless. All the large insurers are actually "pay-viders", meaning they own huge (and growing) chunks of the physicians (providers) they pay out.

Go read STAT's Colossus investigative series on the myriad ways UnitedHealth Group abuses this structure. All the other pay-viders do the same.

Pay-viders can "generate x% profit" for any value of x. They control all the relevant levers, which also by coincidence eliminates any incentive in the entire system to reduce costs.

They are required by law to only make a certain value of x, and so, surprise surprise, they all make x!