Health care costs are soaring. Blame insurers, drug companies and your employer

Headline and “who to blame” framing

• Many find the article’s “blame your employer” angle misleading or clickbait: employers are themselves squeezed by hospitals, drug companies, PBMs, and insurers.
• Some insist government policy is the root cause (overregulation, ACA structure, tying insurance to employment), while others say that’s assumed background and the more interesting question is the proximate drivers (prices, market power, admin layers).

Market structure, price opacity, and incentives

• Strong agreement that U.S. healthcare is not a real market: prices are hidden ex ante, vary wildly, and patients can’t meaningfully comparison shop, especially in emergencies.
• Many anecdotes of “quoted” prices being meaningless, surprise bills months later, and codes changing after the fact. Even high‑deductible plan members often only see costs after care, not before.
• Some argue price transparency and high deductibles would discipline spending; critics note the U.S. already has unusually high cost exposure among rich countries yet still has the highest costs.
• Several point to insurer incentives (medical loss ratio, vertical integration) that actually reward higher total spending. Administrative overhead and billing complexity are seen as huge cost multipliers.

Insurers, providers, and middlemen

• One camp emphasizes middlemen (insurers, PBMs, billing departments) and hospital monopolies as primary drivers; doctor pay is a relatively small slice of total spending.
• Another camp argues physician supply is artificially restricted, inflating wages and contributing significantly to high prices.
• There is back‑and‑forth over whether doctor income or administrative layers are the bigger problem; no consensus emerges.

International comparisons and wait times

• Many note other OECD countries with more regulation and single‑payer/monopsony purchasing achieve roughly similar outcomes at about half the cost.
• Others highlight serious access and wait‑time issues in Germany, Canada, Poland, etc.—but multiple U.S. anecdotes show long waits for specialists and “concierge” primary care are already common.
• Integrated systems like Kaiser (and Canadian provincial systems) are cited as functioning better than fragmented U.S. networks, but still capacity‑constrained.

Workforce, training, and role of NPs/“gatekeeping”

• Some propose drastically lowering barriers to becoming a doctor or promoting experienced nurses into doctor‑like roles; opponents stress the complexity and liability of medicine.
• Nurse practitioners and physician assistants are seen as de facto responses to physician scarcity; physician lobbies are described as resisting further expansion of these roles.

Lifestyle, inequality, and broader political economy

• A minority blames American lifestyle (obesity, diet, end‑of‑life spending), but others counter that market structure, monopoly power, and inequality are far more important cost drivers.
• Investor‑owned hospitals catering to wealthy, well‑insured patients and shedding poorer ones are described as a central dynamic, aligned with rising inequality.