Please don't be sorry! I have done a lot of research into this, as I've been overly exposed to exorbitant healthcare costs, insurance appeals processes, and medical debt negotiation and settlement. This caused me to dig deep to find out why. My email is in my profile, I am happy to discuss at length and even hop on a phone call.

https://www.forbes.com/sites/robertpearl/2017/11/07/hospital...

> Three factors contributed to the need for layoffs: (1) reduced reimbursements from payers, including the Massachusetts government, which limits annual growth in healthcare spending to 3.6%, a number that will drop to 3.1% next year, (2) high capital costs, both for new buildings and for the hospital’s electronic health record (EHR) system, and (3) high labor expenses among its largely unionized workforce.

> That, along with higher labor and drug costs, explained the Cleveland Clinic’s economic headwinds, according to outgoing CEO Dr. Toby Cosgrove. And though he did not specifically reference Medicare, years of flat reimbursement levels have resulted in the program paying only 90% of hospital costs for the “older,” “sicker” and “more expensive” patients.

> The challenges confronting these hospital giants mirror the difficulties nearly all community hospitals face. Relatively flat Medicare payments are constraining revenues. The payer mix is shifting to lower-priced patients, including those on Medicaid. Many once-profitable services are moving to outpatient venues, including physician-owned “surgicenters” and diagnostic facilities. And as one of the most unionized industries, hospitals continue to increase wages while drug companies continue raising prices – at three times the rate of healthcare inflation.

> With pressure mounting, hospital administrators find themselves wedged deeper between a rock and a hard place. They know doctors, nurses, and staff will fight the changes required to boost efficiency, especially those that involve increasing productivity or lowering headcount. But at the same time, their bargaining power is diminishing as health-plan consolidation continues. The four largest insurance companies now own 83% of the national market.

Possible solutions:

* Government sponsorship through HHS of electronic medical records management. Have USDS and 18F to spearhead the project (cc matt_cutts), leveraging their experience revamping technology service delivery within the VA. This removes Epic's profit out of the equation.

* Government management of insurance. Medicare participants are fairly satisfied with it, and it can be just as efficient as Social Security. Cover everyone with Medicare, increase Medicare payroll deductions accordingly, and leave private insurance for additional fanciness some may desire (private rooms instead of shared rooms in hospitals, for example). This removes most of the profit from private medical insurance.

* Make it illegal to advertise drugs to consumers (this is only legal in the US and New Zealand). You immediately eliminate billions (estimates are ~$20 billion/annually) of marketing spend by pharma, and therefore costs they will desire to recoup.

* Let Medicare negotiate drug prices. This reduces profit realized from pharma concerns.

* Remove limits on medical students and residencies to increase GP and specialist supply. Streamline the process of nurses leveling up to nurse practitioners. This reduces the profit motive for practitioners; you'll make a decent wage, but not Lambo money.

* Subsidize medical school to prevent the need to go hundreds of thousands of dollars into debt to become an MD.