People misunderstand non-profits. There is nothing stopping you or I from starting a non-profit and soliciting donors then paying yourself a $1M salary.
Non-profit simply means any surplus of revenue is spent. So, the more revenue generated by a non-profit's paying customers means they get to funnel that to their core mission (likely research, possibly those that can't pay, or cynically more salary for those running the show).
Definitely not paid for with reimbursement revenues.
> amenities for staff
Try cutting these, and see how quickly 1199 SEIU comes down on you.
> raising administrator salaries "to retain premium talent", etc.
Even if you assumed that there were no relationship between the wages paid and the quality of work performed (there is), these are nowhere near big enough to account for the difference. They're also not that far out of line with other countries, either: 25% in the US, compared to 20% in the Netherlands, for example.
But more so than that: they're SG&A expenses, which are further down the balance sheet than the reimbursement revenues. And yet, hospitals actually lose money on the top line for Medicare patients (who represent about 40% of the market). That's the real reason reimbursement rates are raised for private insurers - the private insurers are required (by law) to pay more, and they need to subsidize the sub-COGS reimbursements from the public insurers (Medicare, and to a lesser extent Medicaid).
So no, none of the things you listed actually explain the reason hospitals charge private insurers the rates they do.
> No. That’s the justification given so that people get angry at the wrong thing. Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit.
Hospitals make very low profit margins; hospitals have been hemorrhaging money and either being bought out by hospital systems or insurers, or even shutting their doors entirely.
In any case, it's not uninsured patients that cost the hospital money; there aren't enough of them to make a difference at most hospitals. The patients that cost hospitals money are Medicare patients, because Medicare reimburses rates that are below COGS, and private insurers are required by law to reimburse more.
In other words, yes, it's the politicians that enable a broken system, but no, it's not the uninsured patients who are at fault, and it's not "profit-maximizing businesses" that are at fault either. Hospitals don't want this convoluted billing system any more than patients do, but it's literally forced on them as a result of accepting Medicare patients.
No. That’s the justification given so that people get angry at the wrong thing.
Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit.
Don’t get angry at the uninsured get angry at the politicians for enabling a broken system.