Healthcare Facts You Probably Didn’t Know

Beyond the stacks of paperwork, picture this: the Duke University hospital system has 957 beds and employs more than 1,500 billing clerks. 38 The Cleveland Clinic maintains over 3,000 insurance contracts, and each contract contains negotiated prices for over 70,000 services. 39 This means Cleveland Clinic has 210 million different prices for the services delivered in its facilities. 

38. Uwe Reinhardt, “Where Does the Health Insurance Premium Dollar Go?,” JAMA 317, no. 22 (June 13, 2017): 2269-70,

39. Herbert Wiedemann, “Cleveland Clinic Letter to CMS Re: Outpatient Prospective Payment System Proposed Rule,” September 26, 2019,


America is the only advanced nation with a health insurance system that crumbled in the face of COVID-19?  In most other countries, every single citizen kept their health coverage throughout the pandemic. In the United States, millions lost their health insurance along with their jobs as a deadly contagion spread all around them. 7

7. National Center for Coverage Innovation at Families USA, “The COVID-19 Pandemic and Resulting Economic Crash Have Caused the Greatest Health Insurance Losses in American History,” July 17, 2020,


Costs are high because healthcare does not have the fundamental characteristics of a market good, but we still buy and sell it in a marketplace. The resulting market failures keep prices high, and the marketplace itself imposes enormous administrative costs on the system.  Poor and uneven access to care is an obvious consequence of treating healthcare as a consumer product: you receive as much care as you are willing and able to pay for, and the result is that millions go without needed care.  We’re sicker than our peers elsewhere in the world partly because our medical marketplace rations care according to income and fails to make investments that would keep us healthy over the long term.  Our fragmented medical marketplace is also exhausting to navigate, eroding the experience of care for everyone involved. 1

1. “Medicare for All: A Citizen’s Guide” by Abdul El-Sayed & Micah Johnson


Do You Agree?

The most important questions in health reform are not technical. They are questions about our values: who deserves healthcare, whether healthcare should be treated as a consumer product or a public good, how the costs of sickness should be shared.  2

2. “Medicare for All: A Citizen’s Guide” by Abdul El-Sayed & Micah Johnson