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https://archive.ph/rhvHx

Most of the bloat comes because profit-seeking insurers try to avoid paying for care by imposing complex rules and documentation requirements.

"Our profit-oriented system rewards providers for devoting more resources to gaming the payment system," said lead author Dr. Steffie Woolhandler.

Private-sector providers can increase profits by investing in administrative activities such as marketing and "upcoding"—padding bills with irrelevant diagnoses—that boost revenues but have no clinical value.

The VA is a far from perfect institution and has been subject to a lot of scandal. Some of that is simply due to coding.

Despite all this, it arguably proves the superiority of the funding model over a for profit system.