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Individual health plans sold on Michigan's Affordable Care Act exchange will jump 16.7% next year
LAST week Anthem Blue Cross of California announced it was hiking health insurance premiums for some customers by 39%. According to a Department of Health and Human Services report released yesterday, that followed recent requests for rate increases of between 13% and 40% by insurers in Connecticut, Maine, Michigan, Oregon, Rhode Island and Washington. At the same time, insurers are covering fewer and fewer people; the top six insurers dropped 2.2m customers in the first nine months of 2009. While the country's economy was shrinking and workers were being laid off and losing their coverage (or being shunted into government-provided coverage), these private insurers' profits rose dramatically.
(The ACA has since put a lid on insurers' profits with medical loss ratio requirements, but not so much on provider costs.)
The decline in the number of small businesses offering health insurance began long before the new law. In 2011, 38 percent of American companies with fewer than 50 workers provided health insurance, down from 47 percent a decade earlier...
It's also interesting to read a 2004 paper from The Heritage Foundation. Yes, that Heritage. The one that promulgated many of the ideas in the ACA. Among other things, it advocated using tax credits, noting: "Unlike a tax deduction or tax exclusion, which favors upper-income workers, a tax credit provides either the same level of assistance to each recipient or even more help for lower-paid individuals."
This form of "circularity" shows up in many places.
I finds this circularity to be true with regard to my aging comprehension. As I get older I find myself knowing more and more about less and less until I know everything about nothing."
Don't sweat it bee. Likely, none of this matters anyhow.
Your robo-comment reminds me of a robo-call I received today from my healthcare provider.
It went something like this:
"Mr bee your are receiving this automated call so that we can provide you with the most up to date information regarding your most recent health screening test results. We have good news and we have bad news to report as a result of these tests."
Then there was a pause.
"Press 1 for good news and press 2 for bad news."
Obviously I was ready for the good news first so I pressed 1.
The robo-voice joyfully announced, "The good news is you have 24 hours to live!"
Wow! That was the good news! I quickly pressed 2 wondering what news could be worse than this.
The robo-voice lamented, "We regret we were unsuccessful in reaching you yesterday."
To put this in perspective, here are a few articles from ancient times (pre-ACA):
The piece missing is that in those ancient times the Gov't didn't spend about 1 Trillion $ to set up a web site, nor did the Gov't/taxpayers/Chinese and other debt buyers/future generations pay for subsidies.
If you want the ACA to work you must be willing to pay more for it so those that can not afford it can have it. If you don't we will be working towards a two separate systems that is currently beginning i.e. doctors not accepting ACA plans. All people will be required to pay for ACA plans. But those that can afford it will buy private plans that will be accepted by the doctors. Then we go back to ancient times - some will have good health care (pay for private plans) and those who have a lesser form of it (ACA only). You see that now where Canadians on waiting lists or denied care come to the USA for care.
The piece missing is that in those ancient times the Gov't didn't spend about 1 Trillion $ to set up a web site, nor did the Gov't/taxpayers/Chinese and other debt buyers/future generations pay for subsidies.
The former is a sunk cost and thus seems irrelevant to a discussion of ongoing costs. Is your point that having a website (regardless of its initial cost) should affect the cost of medical services?
Subsidizing people to get health insurance is not a cost without economic benefits. For example, it reduces the cost of providing care to the under and uninsured through ERs and through hospitals in general. Thus the ACA gradually reduces Medicaid and Medicare DSH government payments from 2014 to 2020.
If you want the ACA to work you must be willing to pay more for it so those that can not afford it can have it.
If you want universal health care, you must be willing to pay more for it, whether it is delivered via ACA or any other mechanism. However, that universal health care reaps a measure of offsetting economic benefits as well as social benefits.
Regardless of whether coverage is universal or not, regardless of whether one looks at ancient times or the current regimen, provider costs were and are soaring. That was my original point. (If anything, costs have been rising more slowly the past few years, though due to a variety of factors.)
If you don't we will be working towards a two separate systems that is currently beginning i.e. doctors not accepting ACA plans. All people will be required to pay for ACA plans. But those that can afford it will buy private plans that will be accepted by the doctors. Then we go back to ancient times - some will have good health care (pay for private plans) and those who have a lesser form of it (ACA only). You see that now where Canadians on waiting lists or denied care come to the USA for care.
Guy walks into a store, looks at prices, tells the shopkeeper the same item is on sale for 20% less down the street. Shopkeeper tells the guy to go buy it there. Guy responds: I can't, they're sold out.
That's not to say that the more one (or society) is willing to pay, the more/faster/better the service one receives. Virtually no system is going to change that. (Even banning going outside the system wouldn't matter, as it would just give rise to a black market.) Yes, getting good care under ACA can sometimes be a challenge, and that needs to be addressed.
We had a two tier system before ACA (e.g. concierge medicine), and we have one now. But how many cancer patients really need Sloan Kettering? The objective is to make what's available to all good enough and fast enough that spending extra for more/better/faster is viewed as a luxury, not a necessity.
The piece missing is that in those ancient times the Gov't didn't spend about 1 Trillion $ to set up a web site, nor did the Gov't/taxpayers/Chinese and other debt buyers/future generations pay for subsidies.
The former is a sunk cost and thus seems irrelevant to a discussion of ongoing costs. Is your point that having a website (regardless of its initial cost) should affect the cost of medical services?
A cost is a cost no matter what you call it. The total cost of the ACA is what the individual pays, subsidies and all other costs. Parsing it does not change that.
Subsidizing people to get health insurance is not a cost without economic benefits. For example, it reduces the cost of providing care to the under and uninsured through ERs and through hospitals in general. Thus the ACA gradually reduces Medicaid and Medicare DSH government payments from 2014 to 2020.
Subsidizing (with debt) people to get health insurance is not a cost without economic negatives - too many to list here.
If you want the ACA to work you must be willing to pay more for it so those that can not afford it can have it.
If you want universal health care, you must be willing to pay more for it, whether it is delivered via ACA or any other mechanism. However, that universal health care reaps a measure of offsetting economic benefits as well as social benefits.
Regardless of whether coverage is universal or not, regardless of whether one looks at ancient times or the current regimen, provider costs were and are soaring. That was my original point. (If anything, costs have been rising more slowly the past few years, though due to a variety of factors.)
If you don't we will be working towards a two separate systems that is currently beginning i.e. doctors not accepting ACA plans. All people wi ll be required to pay for ACA plans. But those that can afford it will buy private plans that will be accepted by the doctors. Then we go back to ancient times - some will have good health care (pay for private plans) and those who have a lesser form of it (ACA only). You see that now where Canadians on waiting lists or denied care come to the USA for care.
Guy walks into a store, looks at prices, tells the shopkeeper the same item is on sale for 20% less down the street. Shopkeeper tells the guy to go buy it there. Guy responds: I can't, they're sold out.
So Canadians are coming but not enough of them? I don't get your point.
That's not to say that the more one (or society) is willing to pay, the more/faster/better the service one receives. Virtually no system is going to change that. (Even banning going outside the system wouldn't matter, as it would just give rise to a black market.) Yes, getting good care under ACA can sometimes be a challenge, and that needs to be addressed.
We had a two tier system before ACA (e.g. concierge medicine), and we have one now. But how many cancer patients really need Sloan Kettering? The objective is to make what's available to all good enough and fast enough that spending extra for more/better/faster is viewed as a luxury, not a necessity.
Yes we had it before, are you saying that is OK? That the rich can get health care and live while the poor do not get care and die? Health care delayed is health care denied.
Morn'in All, A quick check with real human beings in the neighborhood regarding pricing changes for a few health plans going into 2017. ---teen healthcare private plan (they don't qualify for the ACA state exchange) BCBS, Premier Value monthly from $103 to $117 (+13.6% increase) and annual deductible going up from $6,750 to $7,150 (+4.4% increase) Hey, if a teen needs to bump the deductible they better get good damn and ill, or don't get ill at all. ---On the Medicare scene Plan "F", supplemental insurance for coverage above Medicare limits going to $343/month (+4% increase) for a married couple. Medicare Part B cost, deducted from SS, remains at $243.60/month for a married couple
Other than these.....folks; "go about your business, there is nothing to see here, please move along".
Lastly, the GDP may find flag wavers in the business world and such; but household money flows will continue to be greatly impacted by cost structures in healthcare, eh? Hey, have a good one.....
A good overview today: http://www.nytimes.com/2016/10/28/opinion/obamacare-hits-a-pothole.html Health reform had two big goals: to cover the uninsured and to rein in the overall growth of health care costs — to “bend the curve,” in the jargon of health policy wonks. Sure enough, the fraction of Americans without health insurance has declined to its lowest level in history, while health cost growth has plunged: Since Obamacare passed Congress, private insurance costs have risen less than half as fast as they did in the previous decade, and Medicare costs have risen less than a fifth as fast.
~$65k is the subsidy line for family of 2, if I am doing the math right.
I may get around to going through point by point, datum by datum. But just as I don't get involved in discussions of funds when they go along the lines of "should I dump my fund, it took a nosedive last month", I'm disinclined to engage in health care discussions with people focused on short term figures.
The "largest increase in 32 years" reported by CNN/Money seems to be a 1% monthly increase in medical care costs, as clarified by Marketwatch. That cites the BLS August Consumer Price Index Summary. It looks like the 1% figure is an average of the 0.9% rise in medical care services and the 1.1% rise in the cost of medical care commodities.
But monthly figures are not worth discussing. That same August summary gives the Y/Y figures at 5.1% and 4.5% respectively.
More apropos, if one insists on looking at "what have you cost me lately", i.e. monthly, are the current(September) figures. Medical services didn't rise at all, and commodities went up 0.6%, for a 0.3% M/M average.
If you want to invest based on what the market did today, or you want to go to your doctor based on how much that tongue depressor is costing today, go ahead. I prefer to take a broader view.
I find it insensitive to say to our veterans who are waiting for care and some dying while waiting "You need to think about the long term and the broader view." But that is just me I don't judge others with that position.
@davidrmoran Well, to be a bit more specific, it appears you might be suggesting that Dan is using the "Chewbacca defense" here. Now that's over-the-top funny!
Capitalist markets work best when supply and demand for a particular good are at an equilibrium. If one exceeds the other by a significant amount, problems of exploitation will occur. If for instance demand significantly exceeds supply as is the case with healthcare-- people will pay whatever price is necessary to get well in a life or death situation so demand is inelastic--then suppliers of healthcare--hospitals, big pharma--will feel free to gouge consumers. (Supply is tightly controlled in healthcare thanks to patents and the difficulty in getting a medical degree ) There needs to be a suitable entity powerful enough on the demand side to prevent such gouging. That entity in this case should be the government in the form of single payer and/or regulations against gouging. Private insurers do not have the power nor inclination to negotiate lower medical supply rates successfully as it is far easier for them to either deny consumers medical claims or in its current iteration pass on the rising cost of supply via higher premiums.
From a purely ethical perspective there is a fundamental problem with the existence of private health insurance. Private health insurers derive the most profit by collecting premiums from healthy people while denying sick people coverage. Their role in society should actually be the opposite. To rectify this situation the government via Obamacare is now forcing them to cover sick people with for instance pre-existing conditions. This is a good thing but it does not address the problem of price gouging from suppliers of healthcare--pharma/hospitals-- for that sick population. This is why premiums continue to go up.
From a purely ethical perspective there is a fundamental problem with the existence of private health insurance. Private health insurers derive the most profit by collecting premiums from healthy people while denying sick people coverage. Their role in society should actually be the opposite. To rectify this situation the government via Obamacare is now forcing them to cover sick people with for instance pre-existing conditions. This is a good thing but it does not address the problem of price gouging from suppliers of healthcare--pharma/hospitals-- for that sick population. This is why premiums continue to go up.
The basic principle of insurance is that the insured that do have an insurable event pay the costs for the insured that do.
There is few if any reliable sources pointing to price gouging as a driving factor in medical costs.
In no special order some of the reasons are: Use of costly new technologies and drugs Administration - including all the reporting requirements Malpractice costs - including insurance Aging of the US population and associated health issues Increases in degenerative diseases - obesity, diabetes, heart disease etc.
@dan Are you saying that Merck, Pfizer, Gilead, Mylan, HCA and United Healthcare are not capitalist companies? "Use of costly new drugs and technologies." And why are they so costly? Have not the aforementioned companies and the healthcare sector in general been some of the most profitable on the stock market over the long term? Has not there been an outcry over Mylan's price gouging on Epipen? Does not the U.S. pay the highest prices for the same drugs in the world? Gouging exists.
One aspect of this that hasn't been mentioned are the people who run to the ER or MD for every sniffle or ache. That is a big factor in the cost of healthcare. People should be educated on when to go and where to go.
The free market response is that people should have skin in the game.
That's why, for example, the "Doc Fix" Medicare bill passed last year (92-8 in Senate, 392-37 in House) requires Medicare recipients to share in their doctor costs. Starting in 2020, they will not be able to buy (new) Medigap plans that cover "first dollar". That is, they will no longer be able to buy insurance that pays for 100% of their doctor costs without a deductible.
Of course, ACA plans tend to have high deductibles (that's one of their problems). So people under those plans also have a disincentive to go to ERs. Expanding coverage, getting more people insured, is a way that the ACA addresses the problem you raised.
Years ago, I went to a talk by Alan Simpson, who objected to the statement that the US did not have universal health care. He pointed to the Reagan administration law that required ERs to accept everyone regardless of ability to pay. At the same time, he said that this was an incredibly expensive way to provide that care, and that we needed to do better. So even if people do continue seeking treatment for sniffles, it's better (read cheaper) if they have insurance that has them seeing their doctors rather than going to ERs.
Anyone who has ever been to an ER knows people don't generally run to it "for every sniffle." It is a miserable experience. And Like MSF observed ER treatment is actually often more expensive than preventive medicine. If anything, the opposite is true. Poor people often go to the ER when it's too late and their condition has become so exacerbated that it is very expensive and sometimes impossible to cure. The reason they wait to go is they historically haven't been able to afford to go to the doctor for every sniffle. So they sit on their illness and wait till it becomes too painful to ignore. That is what Obamacare is trying to prevent but until it addresses the problem of the suppliers of healthcare gouging consumers with exorbitant costs for procedures, tests and pharmaceuticals--costs that far exceed most other industrialized nations with single-payer healthcare--premiums on insurance to cover those costs will continue to rise.
Actually, anyone who knows ER docs or nurses know that there are a lot of, if not sniffles, low-urgency usage, and much worse, repeat business, also opiate seekers. Primary / preventive helps this considerably.
Pharma does gouge, sure, but there are larger problems. One thing, and I am not expressing an opinion, is that US docs make a lot more money than docs elsewhere.
@David Agreed that the price gouging goes way beyond just pharma and includes pretty much everything in the U.S. healthcare experience, including seeing a doctor. But griping about doctors' salaries seems politically verboten here. I don't know why that exactly is except to say that the AMA is a very powerful lobby. But it's more that that. Every year I glance at these stories about the top paying jobs by average salary, and every time jobs in the medical profession dominate the top ten: businessinsider.com/top-paying-jobs-in-america-2015-9/#11-pediatricians-general-20 In this 2015 story, nine of the top ten were medically related, and the tenth position was for CEOs--pretty funny when you think about it. Imagine going to a hospital where every MD working there makes more than your average CEO and you can figure out pretty quickly why healthcare here is so expensive.
I can't say my experiences with New York emergency rooms mirrors those of ER workers you know. What I saw were awful dungeon like places with people sometimes literally bleeding from open wounds right next to you as they waited for hours to be seen by an ER nurse or doctor. But I suppose those experiences vary by location, and a big city ER probably looks a lot different from, say, a suburban one.
@dan Are you saying that Merck, Pfizer, Gilead, Mylan, HCA and United Healthcare are not capitalist companies? "
If they operate in a communist country are they communist? If they operate in a socialist country are they socialist? If they operate in a fascist country are they fascists ?
Comments
http://nymag.com/daily/intelligencer/2016/10/obamacare-is-a-policy-triumph-and-a-political-failure.html
To put this in perspective, here are a few articles from ancient times (pre-ACA):
The Economist, 2010, "The Insurance Death Spiral Is Here" (The ACA has since put a lid on insurers' profits with medical loss ratio requirements, but not so much on provider costs.)
In the small business market:
NYTimes, Dec 11, 2013: It's also interesting to read a 2004 paper from The Heritage Foundation. Yes, that Heritage. The one that promulgated many of the ideas in the ACA. Among other things, it advocated using tax credits, noting: "Unlike a tax deduction or tax exclusion, which favors upper-income workers, a tax credit provides either the same level of assistance to each recipient or even more help for lower-paid individuals."
http://www.heritage.org/research/reports/2004/06/reducing-uninsurance-by-reforming-health-insurance-in-the-small-business-sector
http://www.vox.com/2016/10/25/13397930/obamacare-mandate-penalties
https://pbs.twimg.com/media/CvyFz_MXgAA_GzK.jpg:large
https://www.washingtonpost.com/opinions/higher-health-insurance-premiums-dont-mean-the-affordable-care-act-is-a-disaster/2016/10/26/1b7f7ce0-9b84-11e6-a0ed-ab0774c1eaa5_story.html
and the less-good news:
http://www.nytimes.com/2016/10/27/us/obamacare-affordable-care-act-tax-penalties.html
http://singularityhub.com/2016/06/23/elon-musk-says-were-probably-living-in-a-computer-simulation-heres-the-science/
Your robo-comment reminds me of a robo-call I received today from my healthcare provider.
It went something like this:
"Mr bee your are receiving this automated call so that we can provide you with the most up to date information regarding your most recent health screening test results. We have good news and we have bad news to report as a result of these tests."
Then there was a pause.
"Press 1 for good news and press 2 for bad news."
Obviously I was ready for the good news first so I pressed 1.
The robo-voice joyfully announced, "The good news is you have 24 hours to live!"
Wow! That was the good news! I quickly pressed 2 wondering what news could be worse than this.
The robo-voice lamented, "We regret we were unsuccessful in reaching you yesterday."
If you want the ACA to work you must be willing to pay more for it so those that can not afford it can have it. If you don't we will be working towards a two separate systems that is currently beginning i.e. doctors not accepting ACA plans. All people will be required to pay for ACA plans. But those that can afford it will buy private plans that will be accepted by the doctors. Then we go back to ancient times - some will have good health care (pay for private plans) and those who have a lesser form of it (ACA only). You see that now where Canadians on waiting lists or denied care come to the USA for care.
Subsidizing people to get health insurance is not a cost without economic benefits. For example, it reduces the cost of providing care to the under and uninsured through ERs and through hospitals in general. Thus the ACA gradually reduces Medicaid and Medicare DSH government payments from 2014 to 2020. If you want universal health care, you must be willing to pay more for it, whether it is delivered via ACA or any other mechanism. However, that universal health care reaps a measure of offsetting economic benefits as well as social benefits.
Regardless of whether coverage is universal or not, regardless of whether one looks at ancient times or the current regimen, provider costs were and are soaring. That was my original point. (If anything, costs have been rising more slowly the past few years, though due to a variety of factors.) Guy walks into a store, looks at prices, tells the shopkeeper the same item is on sale for 20% less down the street. Shopkeeper tells the guy to go buy it there. Guy responds: I can't, they're sold out.
Makes a good joke, but doesn't comport with facts. Not that there aren't any Canadians coming to the US for health care, just not in large numbers.
http://www.aarp.org/politics-society/government-elections/info-03-2012/myths-canada-health-care.html
That's not to say that the more one (or society) is willing to pay, the more/faster/better the service one receives. Virtually no system is going to change that. (Even banning going outside the system wouldn't matter, as it would just give rise to a black market.) Yes, getting good care under ACA can sometimes be a challenge, and that needs to be addressed.
We had a two tier system before ACA (e.g. concierge medicine), and we have one now. But how many cancer patients really need Sloan Kettering? The objective is to make what's available to all good enough and fast enough that spending extra for more/better/faster is viewed as a luxury, not a necessity.
A quick check with real human beings in the neighborhood regarding pricing changes for a few health plans going into 2017.
---teen healthcare private plan (they don't qualify for the ACA state exchange)
BCBS, Premier Value monthly from $103 to $117 (+13.6% increase) and annual deductible going up from $6,750 to $7,150 (+4.4% increase) Hey, if a teen needs to bump the deductible they better get good damn and ill, or don't get ill at all.
---On the Medicare scene
Plan "F", supplemental insurance for coverage above Medicare limits going to $343/month (+4% increase) for a married couple.
Medicare Part B cost, deducted from SS, remains at $243.60/month for a married couple
Other than these.....folks; "go about your business, there is nothing to see here, please move along".
Lastly, the GDP may find flag wavers in the business world and such; but household money flows will continue to be greatly impacted by cost structures in healthcare, eh?
Hey, have a good one.....
Regards,
Catch
A good overview today:
http://www.nytimes.com/2016/10/28/opinion/obamacare-hits-a-pothole.html
Health reform had two big goals: to cover the uninsured and to rein in the overall growth of health care costs — to “bend the curve,” in the jargon of health policy wonks. Sure enough, the fraction of Americans without health insurance has declined to its lowest level in history, while health cost growth has plunged: Since Obamacare passed Congress, private insurance costs have risen less than half as fast as they did in the previous decade, and Medicare costs have risen less than a fifth as fast.
~$65k is the subsidy line for family of 2, if I am doing the math right.
https://thefinancebuff.com/federal-poverty-levels-for-obamacare.html
I may get around to going through point by point, datum by datum. But just as I don't get involved in discussions of funds when they go along the lines of "should I dump my fund, it took a nosedive last month", I'm disinclined to engage in health care discussions with people focused on short term figures.
The "largest increase in 32 years" reported by CNN/Money seems to be a 1% monthly increase in medical care costs, as clarified by Marketwatch. That cites the BLS August Consumer Price Index Summary. It looks like the 1% figure is an average of the 0.9% rise in medical care services and the 1.1% rise in the cost of medical care commodities.
But monthly figures are not worth discussing. That same August summary gives the Y/Y figures at 5.1% and 4.5% respectively.
More apropos, if one insists on looking at "what have you cost me lately", i.e. monthly, are the current (September) figures. Medical services didn't rise at all, and commodities went up 0.6%, for a 0.3% M/M average.
If you want to invest based on what the market did today, or you want to go to your doctor based on how much that tongue depressor is costing today, go ahead. I prefer to take a broader view.
I find it insensitive to say to our veterans who are waiting for care and some dying while waiting "You need to think about the long term and the broader view." But that is just me I don't judge others with that position.
Many if not most of us die while 'waiting for care.' A deeper and subtler analysis of the facts, for the nonjudgmental (indeed):
http://www.politifact.com/truth-o-meter/statements/2016/jun/01/donald-trump/donald-trump-thousands-veterans-die-waiting-treatm/
Well, to be a bit more specific, it appears you might be suggesting that Dan is using the "Chewbacca defense" here. Now that's over-the-top funny!
https://en.wikipedia.org/wiki/Chewbacca_defense
From a purely ethical perspective there is a fundamental problem with the existence of private health insurance. Private health insurers derive the most profit by collecting premiums from healthy people while denying sick people coverage. Their role in society should actually be the opposite. To rectify this situation the government via Obamacare is now forcing them to cover sick people with for instance pre-existing conditions. This is a good thing but it does not address the problem of price gouging from suppliers of healthcare--pharma/hospitals-- for that sick population. This is why premiums continue to go up.
There is few if any reliable sources pointing to price gouging as a driving factor in medical costs.
In no special order some of the reasons are:
Use of costly new technologies and drugs
Administration - including all the reporting requirements
Malpractice costs - including insurance
Aging of the US population and associated health issues
Increases in degenerative diseases - obesity, diabetes, heart disease etc.
That's why, for example, the "Doc Fix" Medicare bill passed last year (92-8 in Senate, 392-37 in House) requires Medicare recipients to share in their doctor costs. Starting in 2020, they will not be able to buy (new) Medigap plans that cover "first dollar". That is, they will no longer be able to buy insurance that pays for 100% of their doctor costs without a deductible.
Of course, ACA plans tend to have high deductibles (that's one of their problems). So people under those plans also have a disincentive to go to ERs. Expanding coverage, getting more people insured, is a way that the ACA addresses the problem you raised.
Years ago, I went to a talk by Alan Simpson, who objected to the statement that the US did not have universal health care. He pointed to the Reagan administration law that required ERs to accept everyone regardless of ability to pay. At the same time, he said that this was an incredibly expensive way to provide that care, and that we needed to do better. So even if people do continue seeking treatment for sniffles, it's better (read cheaper) if they have insurance that has them seeing their doctors rather than going to ERs.
Pharma does gouge, sure, but there are larger problems. One thing, and I am not expressing an opinion, is that US docs make a lot more money than docs elsewhere.
In this 2015 story, nine of the top ten were medically related, and the tenth position was for CEOs--pretty funny when you think about it. Imagine going to a hospital where every MD working there makes more than your average CEO and you can figure out pretty quickly why healthcare here is so expensive.
I can't say my experiences with New York emergency rooms mirrors those of ER workers you know. What I saw were awful dungeon like places with people sometimes literally bleeding from open wounds right next to you as they waited for hours to be seen by an ER nurse or doctor. But I suppose those experiences vary by location, and a big city ER probably looks a lot different from, say, a suburban one.
Doctors do price-gouging? Handsomely paid (except for PCPs), yes.
If they operate in a communist country are they communist?
If they operate in a socialist country are they socialist?
If they operate in a fascist country are they fascists ?