How to Build the Most Expensive Healthcare System in the World

If you ever wondered how America ended up with the highest healthcare costs on earth, imagine two people sitting in a room trying to design the most dysfunctional system possible… and recreating ours.

Alex: If I wanted to create the most inefficient and costly business imaginable, I’d just copy the U.S. healthcare model.

Jordan: That bad?

Alex: Worse. Step one: make the service essential for survival. When customers die without you, demand will always be strong.

Jordan: Great for business. Terrible for everyone else.

Alex: Next, partner with pharmaceutical companies. Have them pour billions into drug development, require years of testing, then reward them with twenty years of monopoly.

Jordan: Manufactured scarcity.

Alex: And encourage constant TV ads convincing people they need every new drug. Demand goes up. Prices go up. And nobody can compete.

Jordan: Effective… and disturbing.

Alex: Then tell hospitals to buy every shiny new technology—surgical robots, scanners, AI systems. Promise that these will reduce costs.

Jordan: But they don’t.

Alex: Of course they don’t. The manufacturers set the prices, hospitals can’t shop around, and patients aren’t told the price anyway. Everyone’s costs just rise.

Jordan: And nobody knows what anything actually costs.

Alex: We make sure of that. Bury prices behind insurance contracts, billing codes, prior authorizations, and hidden fees. If a patient asks, we say, “It depends,” and then send a surprise bill later.

Jordan: So how do people even afford this?

Alex: They don’t—unless we force them to buy insurance. Healthcare is so expensive that one emergency can wipe out a family. Insurance becomes mandatory by economic threat.

Jordan: But the insurers want profits too.

Alex: Exactly. Now we have two massive industries taking cuts from every medical interaction. And for those without employer coverage? Push them into government programs.

Jordan: So taxpayers fund the whole inflated mess.

Alex: They do. But here’s a twist: hospitals merge into huge regional monopolies. They buy out independent practices until patients have no alternatives.

Jordan: Fewer choices, higher prices.

Alex: See? You’re learning. And we also restrict the supply of doctors—huge medical school costs, limited residency slots, and endless training requirements.

Jordan: So the cost of entry is sky-high, and supply stays low.

Alex: Exactly. And then we create a billing bureaucracy so complex it requires armies of non-medical workers—billers, coders, compliance staff, insurance negotiators. All overhead. No care.

Jordan: That alone sounds like a system collapse waiting to happen.

Alex: It's fuel for the fire. And don’t forget PBMs—pharmacy benefit managers. The invisible middlemen who quietly manipulate drug prices behind closed doors, skimming off rebates and fees.

Jordan: More hands in the cookie jar.

Alex: Many hands.And then we incentivize volume through fee-for-service reimbursement. More tests, more scans, more procedures. Doctors practice defensive medicine just to avoid getting sued.

Jordan: And each lawsuit makes the whole system more expensive.

Alex: Exactly. Medicare and Medicaid underpay, so hospitals charge private insurers two to four times as much to make up the difference.

Jordan: Cost-shifting on a national scale.

Alex: Beautifully inefficient. And then there's end-of-life spending—massive costs in the last months of life, powered by fear and advanced technology.

Jordan: And chronic diseases?

Alex: A never-ending revenue stream. Prevention is unprofitable. Dependence is profitable.

Jordan: Hard to believe it can get worse.

Alex: Oh, it can. Fraud.

Jordan: Fraud?

Alex: Massive fraud. In every part of the system. Phantom billing, unnecessary procedures, falsified Medicare claims, billing for services never delivered, inflated charges disguised as “complexity.” Billions vanish through waste and outright deception. And since audits are expensive and lawsuits lengthy, fraud becomes just another cost baked into the system.

Jordan: That’s sickening.

Alex: And the last piece: population pressure. Millions of new people—legal and illegal immigrants—enter the healthcare system with limited means to pay. The system absorbs the cost, and hospitals shift those losses onto insured patients.

Jordan: So those who pay get charged more to cover those who can’t.

Alex: Precisely. And the political conversation around immigration keeps the focus on emotions instead of the financial reality—which is perfect for maintaining the system’s bloat.

Jordan: This is… astonishing. I didn’t realize this many forces were working together.

Alex: That’s the brilliance. Not one villain—just a web of incentives that all drive costs up, never down.

Jordan: So the system is expensive by design.

Alex: Exactly. If we wanted affordable, efficient healthcare, we would have built something entirely different.

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How do we get out of this mess?

People will interpret this dialogue through their politics:

• The left will say the answer is Medicare for All.

• The right will say the answer is getting government out of healthcare.

But the real problem isn’t left or right. Our system is neither a free market nor a national system—it’s a dysfunctional hybrid where every incentive pushes costs up.

Other countries keep prices lower because they control the whole system. We can’t simply copy them, and we can’t return to a pure market when prices are hidden, insurance is tied to employment, emergency care is mandatory, and subsidies shield consumers from cost.

The only path forward is to fix incentives—not expand ideology.

Your practical action is simple:

When you evaluate any healthcare policy, ask one question: “Does this make prices visible and incentives aligned, or does it hide cost and shift it to someone else?”

If it hides cost, it will raise prices—no matter who proposes it. If it increases transparency, competition, and accountability, it will lower costs—no matter who takes credit.

In the end, the enemy isn’t the left or the right.

It’s the incentives that make healthcare expensive—and the politics that keep us blind to them.