Why Is Health Insurance So Expensive

There are various factors which affect Health Care costs and eventually it affects every individual. It is a dire need to stretch medical resources to deal with the pressure on the overall health system. Over the past few years Health care costs have increased dramatically in Health care. Moreover, we all know it needs reforms and address the reason that Why is Health Insurance So expensive as most of the earning goes to Health Insurance premiums.

Health Insurance is an essential lifeline many as it avoids heavy debt to deal with medical expenses but on the other hand it is quite expensive as well. If we specifically talk about the US, it spends most on health care as compared to their peers but still the citizens are struggling to pay for health Insurance. We will talk in detail about the numerous factors which are affecting high healthcare costs.

To get the answer that Why is Health Insurance so expensive, primarily, the US never sets limits on payments for new treatments. Such treatments are MRIs, Organ Transplants and innovation of new drugs. Whereas many insurance companies want patients, doctors and hospitals need to prove that certain availed treatments are really necessary. It definitely increases cost as it makes the health care system more complicated and it needs a huge amount of people to check on payment services. Insurance companies need to check each and every particular insurance and their services.

Another driver for seeking the answer of So expensive Health Insurance is that hospitals and insurance companies have become more powerful with mutual settlement. Such things made them get more market power and can evaluate and command higher prices.

When did Healthcare become so expensive?

With every passing day, the demand for healthcare services Rosen from the past several decades and the need for health insurance for medical expenses. From 1966 to 1973, Medicare and Medicaid covered more people, and demand rose by 11.9% a year. After the increase in demand, health care providers invested in research to get more innovative technologies which were expensive indeed.

By 2012, there were 131 million emergency room visits as medicare helped create reliance on hospitals. From 1974 to 1982, health care prices rose by an average of 14.1% a year due to some particular reasons. Then from 1993 to 2003, healthcare spending increased by an average of 6% a year, and could not take particular measures against it.

Meanwhile, the US government approved expensive drugs without doing much research over cost control. Along with this, various Medicare Advantage programs increased to 22 million by 2019, and the costs rose abruptly.

What factors caused an increase in Healthcare

Two main factors caused massive increases in the cost of healthcare services.

First of all, the US relies on Company-sponsored private health insurance, and Government created programs help them without insurance. Medicare and Medicaid gave the ability to providers to raise prices. As a comparison, check that US hospital prices are 60% higher than Europe. Government policies are not working that effectively to cut the cost of drugs; they raised them instead.

Secondly, chronic illnesses have increased and are responsible for 85% of health care spending. Due to an unclean living style, almost half of Americans have diabetes or have heart disease. Such chronic diseases are expensive or difficult to treat and come at a cost. This Government created a program of medicare spending is much higher in recent years and life-saving costs one-fourth of its budget.

Overall costs of healthcare

According to recent studies, healthcare spending rose by around a trillion dollars from 2009 to 2019, which is quite an inflation outcome. US healthcare spending during the 2019 war was around $3.8 trillion. In other words, for each person, it costs $11,582. It is expected by 2028, and the healthcare cost will roughly climb to $6.2 trillion, meaning $18,000 per person. Such calculations help us get an idea of when healthcare became so expensive?

Why Is American Healthcare so bad?

The American healthcare system is quite expensive, indifferent, and worst. Commonwealth Fund regularly ranks health systems of the developed countries and considers the United Kingdom, Australia, and the Netherlands best countries for healthcare. The United States is the lowest performer although it spends the most. There are the following factors one needs to know why the United States lags behind its peers.

A lack of insurance coverage

One must understand that healthcare and health insurance are not similar, so they must focus on improved health outcomes rather than getting more people insured. Back in 2016, nearly a tenth of the population could not afford insurance coverage. However, now the health care reform law is there to obtain health insurance for millions of Americans. Everyone can obtain insurance regardless of age or health status, and recently insured individuals can need medical attention.

Fragmented Administration

America wastes a lot of money on administration as doctors and patients waste much time billing and insurance claims. Other peer countries provide private health insurers with standard basic benefit packages, and such private health insurance will reduce administrative burden and come with different insurance coverage plans.

Inefficient Primary care system. There are different insurance plans for different treatments, and doctors spend ample time coordinating with insurance companies for care assurance.

Inefficient Primary care system

A very disorganized, under-resourced, and inefficient primary care system, lacking so many benefits. Moreover, many primary-care physicians struggle to receive information or coordinated care from any hospital or specialist. Lack of investment in social services is damaging as these are important determinants of health. Focusing on better housing, subsidized healthy food, and home visiting for awareness could extend work for doctors.

Most Expensive Healthcare in the World

Americans are facing rapidly growing insurance premiums with unaffordable costs in recent times. It is even worse than rising daily costs, and we need to know why health insurance is so expensive. However, the government is distributed around a trillion dollars to subsidize Medicare, Medicaid, and various federal healthcare programs. So the US is spending more on health care than national defense or social security. To see why the US has the most expensive Healthcare in the World, check out the following factors.

Tax Policy affects and increases health care costs.

Healthcare economists blamed being the most expensive Healthcare in the world on healthcare policies. The United States is the only developed country with the Internal Revenue Code of 1954 that relies on employer-based health insurance. The government has codified a law that companies have to provide health insurance benefits to their workers tax-free. They took such decisions in the context of a wartime tax code as there were overwhelming taxes to stop wartime profiteering. Moreover, if anyone buys insurance through their employer, they pay an insurance premium with pretax dollars. And there are numerous tax incentives to choose ESI plans with high premiums with low cost-sharing payments.

Drawbacks of not taxing health insurance

Employer-based healthcare insurance is valuable to workers, and companies keep it tax-free even after the war. Consequently, the dollar in health benefits is way more worthy to a worker than dollars in wages as health benefits are untaxed while in wages they have to pay tax. According to economists, there is a massive discount on the price of health insurance, and there are several harmful effects of this policy. Generally, it makes employers less sensitive to increases in their ESI premiums, and it weakens the ability of the competition among providers to keep prices low. Therefore, the doctors and hospitals do not compete or perform strenuously as they know that insurers will pass their high prices without any inconvenience.

A tax-free dollar buys a lot more medical care, and most non-elderly employees get their health insurance at work. If we talk about the health insurance tax in the Federal Budget, the Government of America loses nearly $260 billion annually by not taxing health insurance.

In addition, it’s pretty regressive as people with jobs have more paid healthcare benefits than those who do not have jobs. Why is American healthcare so bad? They have such a tax system that Americans with good jobs are getting their health subsidized by the masses with no jobs or worse jobs.

Lack of competition

There is a sheer lack of competition among hospitals, medical providers, and insurance companies if we talk about health care. Although competition is vital for functioning well, competition among businesses leads to quality services and reduces prices. According to economists, Government policies and regulations are the primary cause of the lack of competition. For instance, there is a law of State Certificate-of-need (CON), as if someone wants to build a hospital or wants to expand existing operations, they require the Government’s permission. The Government introduced CON rules to stop unnecessary hospital construction, but the existing hospitals used it in their favor by stopping the competitors from entering the market. Such policies with opposite results drive up prices and make it the most expensive healthcare in the world.

Moreover, strict medical rules are also there to prevent much-needed competition and keep qualified competitors out. Economists do not emphasize getting rid of licensing, but they want the proper use, like restrictions that encourage doctors’ overuse.

Although government rules come out with good intentions, they suffocate competition in the health care market. The Affordable Care Act has strict rules for insurance companies to plan their health care. It also regulates how much insurers can charge patients with different health plans and conditions, but the plan reduces competition.

Contribution of Medicare and Medicaid to high costs

The Government reimburses doctors and hospitals at a lower rate than private insurers pay, in the case of Medicare and Medicaid. It is a good deal for the Government, but hospitals and providers charge private insurers and patients by other means to make up the difference. Here John Cochrane delineated how the Government wants to subsidize health care for poor people suffering from chronic diseases or those who have money and want to spend less on health care. In a completely free market system, the Government can achieve goals to help people by raising taxes and subsidizing health care or insurance at market prices. But on the contrary, the lawmakers do not want taxing and spending. They want filled emergency rooms, and hospitals must overcharge everybody else. As Medicare and Medicaid do not pay for the complete services, hospitals eventually overcharge private insurers and cash customers.

Insurance Companies with small profit margins

Health insurance companies deny claims for care that people want towards the American HealthCare System and charge rising premiums for their coverage. But one must not overlook that the health care sector runs a 15.4 percent profit margin while health plans have an average profit margin of 3.2 percent. Check below to determine health sector profit margins:

Drug Manufacturers 20.8%
Industry Average 15.4%
Medical Instruments and Supplies 12.5%
Medical Appliances and Equipment 9.5%
Hospitals 3.7%
Health Plans 3.2%

It is a misconception that insurance companies keep about 50 percent share of the money, but they keep about 10 to 15 percent of it. And even from this, profit mostly goes toward claim processing and administration. We can see vividly that drug companies and device manufacturers make most of the money. Why is Health Insurance so expensive? Because insurers are so weak and have no negotiating power to deal with high price drug and device makers. According to Uwe Reinhardt, a health economist, “ Only a Nickel of your premium dollar stays with the insurance company” as they are spending premiums on quite expensive medical products.

Health Care cost issue is not an individual issue; in fact, a global perspective.

According to the cross-national analysis to compare health care spending, supply, utilization, prices, and health outcomes across developed countries by the Organization for Economic Cooperation and Development (OECD). America usually spends more on health care than other countries, and this higher spending is due to greater use of medical technology and health care prices instead of doctor visits or hospital admissions. Despite spending a lot on healthcare, Americans have poor health conditions with a wide prevalence of chronic conditions. The healthcare prices are significantly higher in the United States, explaining a large part of higher health spending and depicting why is health insurance so expensive? The US spends a small share of the economy on social services, like housing assistance, disability benefits, food security, and employment programs. But the outcome is quite discouraging as poor results in life expectancy and prevalence of chronic diseases.

America spends more on Health Care.

Via extracted data by Organization for Economic Cooperation and Development OECD; the United States spends 17.1% of its GDP on healthcare. Whereas France spends 11.6 percent of its gross domestic product and the UK spends 8.8%, a survey held in 2013. Americans still outspend on health care despite poor health outcomes.

Private Spending on Health Care

Usually, an American resident spends $1,074 on healthcare from their pocket for doctor visits, prescription drugs, and health insurance deductibles. Including private health insurance premiums and other private health spending in the U.S. at $3,442 per capita is five times more than we spend in Canada at $654. However, Canada is the second-highest spending country on healthcare. But still, we seek answers to know Why is American healthcare so bad?

U.S. public spending on healthcare is so high.

The U.S. is the only country that does not have a universal health care system, but public spending on healthcare is as high as $4,981 per capita. In 2013, nearly 34 percent of American residents were covered by public programs, including Medicare and Medicaid. At the same time, the U.K. was covering every resident by the public system, and spending was $2,802 per capita. It is a fact that public spending on healthcare would be worth and more excellent if there is tax exclusion for the employed-sponsored health insurance.

Americans have fewer hospitals and physician visits.

Although America spends more on health care, they have fewer practicing physicians, and the ratio was 3.2 physicians per 1,000 population. Americans have fewer physician visits, nearly four per year, whereas OECD median 6.5 visits. On the other hand, the average Canadian had 7.7 physician visits, and the average Canadian resident had 12.9 visits. Compared to the median OECD country, the U.S. has fewer hospital beds and even fewer discharges per capita and here we get why is Health Insurance so expensive?

Great consumers of medical technology

The US is distinguished as a more significant consumer of sophisticated medical technology, including diagnostic imaging and pharmaceuticals. Along with this, the US had the highest per capita rates of Magnetic Resonance Imaging (MRI), Computed tomography (CT), and Positron emission tomography (PET). However, the US and Japan have the highest number of such imaging machines. Moreover, America was the top consumer of prescription drugs. According to the 2013 Commonwealth Fund International Surveys, in the United States and New Zealand, adults take more prescription drugs than other countries, at 2.2 per adult.

Americans pay way more for healthcare insanely.

HealthCare in the United States is expensive as Americans pay more than any other country for health insurance. According to an executive director of the non-profit Commonwealth Fund, If the healthcare system becomes an economy, it would be the fifth-largest. It would be more significant than the UK, France, China, Japan, and Germany. Although the American Government spends more on public healthcare than Canada, the UK, Japan, and Australia. The average American does not visit a doctor very often compared to people in peer countries.

Health Care prices are higher in the U.S. compared with other countries.

Data extraction by the International Federation of Health Plans in 2013 depicts that hospital and physician prices for procedures were highest in the U.S. However, the average price of bypass surgery was $75,345 in the U.S., which is more than $30,000 higher than in the second-highest country, Australia. Based on this published data, MRI and C.T. scans were also the most expensive in the U.S., which portrays the significantly higher prices in many areas of U.S. health care.

More prices for the same drugs

Usually, the peer countries of the United States have measures for drug price control as the Government does negotiation with drug companies and even has the power to win it. On the other hand, the U.S. government does not take any measures to deal with drug companies. For not doing any settlement for drug price control, they say that we do not want to stop innovation. Paying higher is a financial incentive, and companies try to develop innovative and outstanding new drugs.

‘Fee-for-service’ System

As we think about getting Health Insurance services, we are thinking about the most expensive healthcare in the world. Experts describe it as a ‘fee-for-service’ system as doctors make money by prescribing treatment. This mentioned way describes how this business works, as doctors provide lots of health care rather than good healthcare. Patients need to buy an improvement in their health, but American doctors go for their financial interests.

Cost of COVID-19 Testing, Treatment, and Care

According to a survey by Physician Advocacy Institute (PAI) in 2019, they find out that Americans usually avoid care due to an inability to afford needed medical care. A KFF poll suggested that 50% of the public avoided postponed medical care after the outbreak of the COVID-19 pandemic.

After the pandemic outbreak, many of the experts expected a rise in healthcare costs, and some expected them to fall. As there is an increase in testing, treatment and care would affect the healthcare cost. But healthcare spending failed as very few patients seek care, but it is expected to grow 5.4% annually and reach $6.2 trillion by 2028.

The cost of average health insurance premium

Roughly, the cost of health insurance for an individual in 2020 was $456 per month, and for a family, it was $1,152. Although this figure is not static and depends on healthcare needs and health insurance, you buy and see a yearly cost increase.

Health Insurance Premiums cost in 2021

However, there is a long-term trend of increasing costs, but the short-term factors can bring a big difference. There will be a significant increase in the cost of health insurance in 2021. Although various factors affect the cost, primarily it is due to the cost of COVID-19 testing and treatments.

Multiple Systems Create Waste

There is excess medical spending, making it the most expensive healthcare in the world. The U.S healthcare system is the most expensive and complex due to separate rules, funding enrollment dates, and costly employer-based insurance. Along with this, the U.S spends 8% of healthcare on administrative costs compared to other developed countries, which use 1% to 3% overall.

Then the private insurance from healthcare.gov, Medicaid, and Medicare come with higher prices as consumers choose among several tiers of coverage and high deductible plans and fees for the service system.

Sources of Waste in American Healthcare

Much of the waste depicts an inefficient healthcare system as various health plans come with different prices for the same surgeries and scans. The Institute of Medicine estimates that $765 billion is wasted each year and $210 billion on medicine we do not need. Apart from the waste of money, this extra medicine can be harmful.

Unnecessary Services $210 billion
Excessive Administrative Costs $190 billion
Inefficiently Delivered Services $130 billion
Prices that are too high $105 billion
Fraud $75 billion
Missed prevention opportunities $55 billion

Health Insurance for 2022 has gotten a lot less expensive.

After the pandemic outbreak, millions of Americans got cash infusions from the Government. The American rescue plan also helped break the cost of health insurance for many who buy their health coverage. However, this federal program will continue in 2022 to make health insurance much less expensive for deprived healthcare facilities. Even though the extra financial help for those who buy their insurance through the national Marketplace at Healthcare.gov.

Such health insurance will help you save thousands of dollars in case of any sickness. We have an idea that when did healthcare become so expensive? Previously, people with higher incomes with more than four times the poverty rate did not qualify for financial help but now anyone making six times the poverty level can get help.

The American Rescue Plan

The Government signed the American Rescue Plan (ARP) into law in March 2021, which increased coverage under ACA for more financial assistance for ACA premiums. More and more people will qualify through the end of 2022. Almost $46 billion to expand federal, state, and local testing for COVID-19 contact tracing capacity. Moreover, a 100% subsidy on COBRA health insurance premiums laid-off workers to cover.


Generally, Americans spend a significant amount on healthcare annually, rising with every passing day. The highly complex and expensive healthcare is under criticism, making it essential to lower the costs.

There are short-term factors like the 2020 financial crisis answering Why is American healthcare so bad and pushing up the cost of health insurance. Roughly, the average increase in health insurance is about 4.5% per year individually. At the same time, long-term factors involve administrative waste as billing requirements from multiple payers. There are higher costs of pharmaceutical drugs and medical equipment due to little regulation of drug prices and less negotiation with manufacturers. Hospitals are almost profit centers with the most expensive treatment, and doctors and nurses are highly paid.

High costs are not easy to fix as we must know first when healthcare became so expensive, but the new legislation came up with new protections for consumers. The government is trying to reduce ESI plans’ tax preferences and encourage competition among healthcare providers and insurers.

Tony Bennett

Tony Bennett

Tony Benett makes his living in the insurance industry by teaching and consulting. He is also recognized by the legal profession as an expert on insurance coverages. His insurance experience includes having worked at the company level, owned an independent general agency and having worked for an insurance association. He has received various certificates over the past few years and helps his clients and readers by giving them a realistic outlook on what they can expect to achieve within their set targets. At Insurance Noon, he is known for his in-depth analysis and attention to details with accuracy. He has been published as one of the most referred agents by his peers in the insurance community. Tony loves the outdoors and most sport events. His passion other than providing excellent advice is playing golf.

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