I think the essential ingredients for controlled healthcare costs is a) the principle of universal healthcare b) government control of procedure and drug costs.

I think the essential ingredients for controlled healthcare costs is a) the principle of universal healthcare b) government control of procedure and drug costs. No one is as expensive as the US per capita for healthcare. All the other nations beating us have wildly mixed healthcare delivery systems from full public to hybrid public/private - the hybrids are all administered differently. The characteristic they all seem to share in common is those two features. Even the worst of the modern nations systems beats the US cost and universality of coverage, and quality, by a large margin. Japan seems to have a mixed private/public insurance system, but has government control of the fee schedule. https://en.wikipedia.org/wiki/Health_care_system_in_Japan https://en.wikipedia.org/wiki/Health_care_system_in_Japan "The government has well controlled cost over decades by using the nationally uniform fee schedule for reimbursement." "Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting" "Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply)." For Singapore: https://en.wikipedia.org/wiki/Healthcare_in_Singapore https://en.wikipedia.org/wiki/Healthcare_in_Singapore "Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls." Notice the "price controls"... It really doesn't seem to matter strongly exactly what mix of private/public does the actual administration. To capture first order cost savings better than what the US pays you need to control the fees.