EDITOR\u2019S NOTE: Here\u2019s an installment from Tillamook County\u2019s State Representative Cyrus Javadi\u2019s Substack blog, \u201cA Point of Personal Privilege.\u201d Oregon legislator and local dentist. Representing District 32, a focus on practical policies and community well-being. This space offers insights on state issues, reflections on leadership, and stories from the Oregon coast, fostering thoughtful dialogue. Posted on Substack, 12\/26\/25<\/p>\n
By State Representative Cyrus Javadi<\/p>\n
At some point in any failing enterprise, someone finally asks the most dangerous question in the room:<\/p>\n
\u201cAre we actually making enough money to run this thing?\u201d<\/p>\n
After four essays walking through the slow unraveling of American healthcare\u2014the math that doesn\u2019t work, the history that boxed us in, the carnival financing tricks we pretend are normal, and the tourniquet known as Obamacare\u2014it seems only reasonable to finally ask the question everyone keeps circling.<\/p>\n
\u201cOkay. So what\u2019s the answer?\u201d<\/p>\n
In the Capitol, this is the moment when the conversation stops being a conversation and turns heated debate. Quickly.<\/p>\n
Someone says\u00a0single payer\u00a0with the confidence of a man who believes he has just discovered fire. Someone else says\u00a0free markets\u00a0with equal conviction, as if healthcare were simply a poorly run cable company in need of better branding and a customer-loyalty program.<\/p>\n
Everyone nods vigorously at their own opinion. No one listens very carefully. And, the problem is kicked down the road. Again.<\/p>\n
Which makes sense. Americans like fixes. We like clean answers. We like the idea that somewhere in Oregon (or Washington, D.C.) there exists a\u00a0Big Lever\u00a0that, once pulled, causes costs to fall, access to rise, wait times to shrink, and hospital billing departments to disappear in a cloud of morally satisfying smoke.<\/p>\n
The problem is that healthcare is not\u00a0that\u00a0kind of problem.<\/p>\n
Because healthcare is not a broken appliance. It\u2019s not even a complicated machine. It\u2019s more like an old house remodeled by six different owners, each of whom fixed the thing bothering them most without ever touching the foundation. The windows don\u2019t line up. The floors slope slightly toward the kitchen. And everyone keeps arguing about paint colors while pretending the creaking noise is just the wind.<\/p>\n
(Because People Keep Forgetting This Part)<\/p>\n
The\u00a0Affordable Care Act\u00a0was never designed to fix American healthcare. It wasn\u2019t a master plan. It wasn\u2019t a cure. And it certainly wasn\u2019t elegant.<\/p>\n
It was a tourniquet.<\/p>\n
It stopped the bleeding in a system already quietly failing. It forced participation. It ended the practice of treating sick people as actuarial mistakes. It cut uncompensated care roughly in half from\u00a0$40\u201350 billion a year pre-ACA to about $28\u201330 billion\u00a0today. It slowed medical bankruptcies. It kept hospitals open long enough for us to keep arguing about what comes next.<\/p>\n
Premiums went up (a lot)\u00a0not because insurers suddenly discovered greed in 2010, but because the system finally had to acknowledge something we had spent decades avoiding:\u00a0modern healthcare is expensive to deliver.<\/p>\n
Since 2019 alone, hospital labor costs are up\u00a021\u201325%, supplies\u00a018\u201320%, pharmaceuticals\u00a013\u201315%, and construction costs\u00a025\u201330%. Contract labor spiked even higher. You don\u2019t need ideology to understand what that does to prices, but a calculator helps.<\/p>\n
See, the mistake wasn\u2019t applying the tourniquet. The mistake was pretending we could leave it there forever without curing the gaping wound underneath.<\/p>\n
Because while we argued about Obamacare, everything underneath it kept changing. Labor got scarcer. Medicine got better and more expensive. Technology advanced like it had somewhere urgent to be. People lived longer (and with more chronic disease) requiring more care over more years.<\/p>\n
And we kept pretending the payment system would somehow absorb all of that.<\/p>\n
It didn\u2019t.<\/p>\n
Once you strip away the slogans, there are really only two ideas serious countries return to. They are not opposites. They are siblings who refuse to sit next to each other at dinner.<\/p>\n
The first is\u00a0universal, government-run insurance. Everyone pays in. Everyone is covered. Prices are set. Budgets exist. Canada is the usual reference point. No choice. No options. No out-of-pocket expenses. If you need it, you go to the doctor. No bill afterwards.<\/p>\n
The second is\u00a0mandatory universal coverage with private insurers operating under strict rules. This is Switzerland. Participation is required. Benefits are standardized. Prices are controlled. Subsidies make it affordable. A few choices (more cosmetic than functional), payroll taxes, out-of-pocket expenses. You go to the doctor when you need it.<\/p>\n
Both systems work. Both ration care. They just ration it differently.<\/p>\n
Yes\u2014rationing happens either way.<\/p>\n
And, news flash, we already ration care in the United States. We just do it through deductibles, networks, prior authorizations, and geography instead of wait lists. If you live near a major academic center, you enjoy the illusion of abundance. If you don\u2019t, you learn quickly that\u00a0choice\u00a0often just means\u00a0drive farther.<\/p>\n
Here\u2019s where things get uncomfortable.<\/p>\n
The United States spends\u00a0about $13,500 per person per year on healthcare. That\u2019s roughly\u00a017.3% of GDP. The average among wealthy nations is closer to\u00a0$6,500 per person\u00a0and\u00a09\u201310% of GDP.<\/p>\n
Canada spends about\u00a0$6,300 per capita\u2014roughly\u00a011% of GDP. Germany spends\u00a0$8,100 per capita, also around\u00a012% of GDP. Switzerland, often cited as the \u201cexpensive\u201d European system, spends about\u00a0$9,800 per person, still far below us.<\/p>\n
Japan spends\u00a0about $4,800 per capita, just under\u00a011% of GDP, while maintaining the\u00a0highest life expectancy in the world.<\/p>\n
So yes, we pay dramatically more.<\/p>\n
But here\u2019s the part most comparisons conveniently skip:
those countries also have\u00a0lower labor costs,\u00a0healthier populations,\u00a0fewer specialists,\u00a0fewer high-tech interventions,\u00a0smaller geographic footprints, and\u00a0cultural acceptance of limits\u00a0that Americans openly reject.<\/p>\n
Japan has\u00a012 hospital beds per 1,000 people. The U.S. has\u00a02.8. Germany has\u00a07.9. You don\u2019t need to guess how that affects surge capacity.<\/p>\n
Physicians in the U.S. (especially specialists) are paid\u00a0two to three times\u00a0what their counterparts earn elsewhere. That isn\u2019t greed. It\u2019s supply, training cost, malpractice exposure, and opportunity cost rolled together.<\/p>\n
And our population is sicker.\u00a0Six in ten American adults have at least one chronic disease.\u00a0Four in ten have two or more. Obesity sits around\u00a042%, roughly double the OECD average. Diabetes prevalence is about\u00a011%, compared to\u00a04\u20137%\u00a0elsewhere.<\/p>\n
No financing model escapes those realities.<\/p>\n
Here\u2019s the sentence that ruins everyone\u2019s favorite talking point:<\/p>\n
Universal coverage solves how we pay for healthcare. It does not, by itself, solve how much healthcare costs.<\/p>\n
You can nationalize insurers\u00a0tomorrow. You can regulate them into polite submission. You can replace every executive with a golden retriever wearing a lab coat. If labor remains scarce, drugs remain expensive, and medicine keeps advancing faster than the system that pays for it, prices will keep chasing costs.<\/p>\n
Every country that \u201csolved\u201d healthcare did so by\u00a0explicitly controlling prices, volumes, workforce supply, and technology adoption. Not vibes. Not slogans. Actual constraints.<\/p>\n
They decide how many specialists to train.
They decide which drugs they will pay for\u2014and which they won\u2019t.
They accept wait times as a tradeoff instead of a scandal.<\/p>\n
Americans say they want European healthcare.
They recoil from European decisions.<\/p>\n
Here\u2019s the number that quietly explains why American healthcare feels so expensive even before you get sick.<\/p>\n
It costs\u00a0about $2,700 to $3,000 per person, per year\u00a0just to\u00a0run\u00a0the U.S. healthcare system. Not to deliver care. Not to pay doctors or nurses. Not to buy drugs or MRI machines. Just to move money around.<\/p>\n
That\u2019s the cost of administration: billing departments, coding teams, prior authorization, network negotiations, utilization management, claims appeals, employer benefits offices, compliance staff, and an insurance ecosystem so complex that entire careers are built on knowing which box to check on which form for which payer on which day of the week.<\/p>\n
By comparison, Canada spends roughly\u00a0$500 per person\u00a0on administration. Germany spends about\u00a0$400\u2013500. Switzerland, despite relying on private insurers, lands around\u00a0$600\u2013700. Japan runs one of the leanest systems in the world at roughly\u00a0$150\u2013200 per capita, thanks to a single national fee schedule and minimal billing variation.<\/p>\n
In percentage terms, the United States spends\u00a018\u201320% of all healthcare dollars\u00a0just on administration. Most wealthy countries spend\u00a03\u20137%.<\/p>\n
Put differently: even if America somehow matched European prices for doctors, hospitals, and drugs\u00a0tomorrow\u00a0(no miracles required, just pretend) we would still be spending\u00a0roughly $2,000 more per person every year\u00a0than our peers simply to operate the system.<\/p>\n
That gap alone is larger than what many countries spend to cover an entire citizen\u2019s healthcare.<\/p>\n
This isn\u2019t because Americans are uniquely inefficient people. It\u2019s because we built a financing system that treats complexity as a feature. Multiple payers. Nonstandard prices. Constant network churn. Prior authorization as cost control. Employer-based insurance as a middleman. Pharmacy benefit managers skimming value in ways even experts struggle to fully explain.<\/p>\n
Every layer added to manage cost creates another layer that has to be managed. And managed layers need staff. And staff cost money. And eventually, someone gets handed the bill.<\/p>\n
Usually the patient. Or the employer. Or the hospital trying to keep its doors open.<\/p>\n
Here\u2019s the answer that won\u2019t fit on a bumper sticker.<\/p>\n
We have to\u00a0choose a universal financing system\u00a0and\u00a0pair it with real cost control.<\/p>\n
That means admitting healthcare is not a normal market. It means standardizing prices where markets don\u2019t function. It means expanding the workforce instead of treating burnout like a personal failing. It means simplifying administration so clinicians spend less than\u00a025% of their time\u00a0feeding billing portals that collectively cost\u00a0$90 billion a year.<\/p>\n
It means confronting drug pricing where\u00a02\u20133% of prescriptions drive half of all spending. It means acknowledging that consolidation raises prices, but also that thin margins force survival mergers.<\/p>\n
And it means accepting out loud that better medicine costs money, whether we pay through premiums, taxes, or time.<\/p>\n
Obamacare bought us time. We spent that time arguing about whether the tourniquet caused the wound.<\/p>\n
It didn\u2019t.<\/p>\n
But time is running out. And choosing nothing is still a choice\u2014just one where the system keeps deciding for us, hospital by hospital, county by county, mile by mile.<\/p>\n
Which is fine.<\/p>\n
Unless you think healthcare matters.<\/p>\n","protected":false},"excerpt":{"rendered":"EDITOR\u2019S NOTE: Here\u2019s an installment from Tillamook County\u2019s State Representative Cyrus Javadi\u2019s Substack blog, \u201cA Point of Personal…\n","protected":false},"author":2,"featured_media":215636,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[103,397,396,61,60],"class_list":{"0":"post-215635","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-ie","12":"tag-ireland"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/215635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=215635"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/215635\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/215636"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=215635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=215635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=215635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}