Third-party payers are entities like the government and insurance companies that pay for healthcare but are not themselves patients or providers.
Per a 2017 research paper from the Mercatus Center at George Mason University, “[M]any countries that outperform the United States on performance measurements have less third-party control of payment than the United States does. The United States ranks in the bottom half of 13 high-income countries on the share of healthcare spending that patients pay directly out of pocket. The Swiss control one-quarter of healthcare spending directly, more than double the share Americans do. Even Canadians, subjects of the most tightly controlled single-payer system in the free world, control a slightly greater share of their healthcare spending than Americans do.”
“This separation of payer from consumer is associated with a significant increase in real healthcare spending per capita, with poor quality, and with waste that amounts to about one-third of healthcare spending," the paper says.
Excluding interest on the federal debt, 40% of government spending goes toward Social Security and Medicare.
According to the U.S. government, Medicare will become insolvent in 2026 and Social Security in 2034.
According to the CDC, "In 2017, 43.0% of all births had Medicaid as the source of payment for the delivery, up from 42.6% in 2016."
A paper published in the New England Journal of Medicine in 2016 found that "Medicaid coverage increased the mean number of ED visits per person by 0.17 (standard error, 0.04) over the first 6 months or about 65%" compared to individuals who did not receive Medicaid.
"For policymakers deliberating about Medicaid expansions, our results, which draw on the strength of a randomized, controlled design, suggest that newly insured people will most likely use more health care across settings — including the ED and the hospital — for at least 2 years and that expanded coverage is unlikely to drive substantial substitution of office visits for ED use," the paper says.
One in five U.S. adults uses the emergency room a minimum of one time each year.
According to a 2019 Premier white paper, proper practices could slash up to $8.3 billion worth of preventable emergency room visits per year.
The paper also revealed that "approximately 30 percent of ED visits occurred for issues that could have been treated in primary or other ambulatory care settings."
A 2019 report from the Department of Health and Human Services and the Department of Justice identified approximately "$2.0 billion in false and fraudulent billings to Medicare, Medicaid, TRICARE, and other federal and private insurance programs" in FY 2018.
The Centers for Medicare and Medicaid Services (CMS) reported $143 billion in Medicaid overpayments for fiscal years 2019 and 2020.
In an interview with the Daily Caller, Americans for Prosperity senior health fellow Dean Clancy put this figure in perspective: “$143 billion is enough to cover another 24 million low-income adults, or another 7.2 million disabled people, for a full year.”
According to a fact sheet from the American Hospital Association:
According to a fact sheet from the American Hospital Association, "In 2019, approximately 63 percent of hospitals lost money providing care to Medicare and 58 percent lost money providing care to Medicaid patients and about 30 percent of hospitals were operating on negative operating margins."