About

The United States spends about $15,474 per person on healthcare. Japan spends about $5,790 and its citizens live six years longer. That gap is roughly $3.24 trillion a year.

The American Healthcare Conundrum is an investigative data journalism project that asks where the money goes. Each issue identifies one fixable problem in the U.S. healthcare system, quantifies the waste using publicly available federal data, and recommends a specific policy solution.

What we've found so far

Issue #1 identified $0.6 billion in Medicare Part D spending on brand-name drugs with over-the-counter equivalents. Issue #2 documented nine top-spend brand drugs costing 7 to 581 times more than international peers ($25 billion in addressable savings). Issue #3 analyzed cost-to-charge ratios for 3,193 U.S. hospitals using CMS federal cost reporting data and found commercial insurers pay 254% of Medicare rates ($73 billion). Issue #4 quantified six pharmacy benefit manager extraction mechanisms at $30 billion per year, corroborated by FTC enforcement data and state audits. Issue #5 analyzed administrative overhead at 4,518 hospitals and found the U.S. spends 5.6 times more on healthcare paperwork than peer nations ($200 billion). Issue #6 analyzed per-discharge supply costs at 5,480 hospitals and found hospitals in the same size and acuity class spend wildly different amounts on identical supplies ($28 billion). Issue #7 modeled Medicare's first coverage of GLP-1 weight-loss drugs and found U.S. prices run 3 to 5 times higher than international peers ($40 billion).

Issues #8 through #14 extended the analysis to insurer prior-authorization denials ($32 billion), the employer-premium wage tax ($6.6 billion), low-value procedure overuse ($7.6 billion), Medicare Advantage overpayment ($28 billion), hospital consolidation ($13 billion), nonprofit-hospital tax exemptions ($5.4 billion), and specialist-payment distortions ($27.6 billion).

Running total: $516.8 billion per year identified across 14 issues. The full archive and a running savings tracker are on the site.

How this works

Every analysis uses publicly available data from CMS, OECD, the FTC, SEC filings, and peer-reviewed research. Every script, dataset, and methodology note is published on GitHub. The caveats are named explicitly. Anyone can check the work.

This is not advocacy. It is accounting. The numbers are presented. The code is open. The reader decides what to do with it.

Where to find us

Code and methodology: github.com/rexrodeo/american-healthcare-conundrum

The fund that supports the data behind the analysis: ahcdata.fund

No paywall. No sponsors. No ads. Questions, corrections, or data tips: vonrexroad@gmail.com