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Things like medical supplies that, in the U.S. are significantly more expensive than elsewhere Yes, because a single buyer has enormous purchasing power. The i

Things like medical supplies that, in the U.S. are significantly more expensive than elsewhere Yes, because a single buyer has enormous purchasing power. The insurance-based system is the reason these costs are so high in the US and lower elsewhere. Would a universal healthcare system only further subsidize that kind of exploitative pricing? It has not in any other country which offers universal healthcare. I have no idea why people in the US are so averse to this idea - you can still have great private healthcare if you wish and can afford it, but public healthcare provides far better healthcare to the poor, lifts people out of poverty, and it's cheaper for everyone too (public expenditure per capita is dramatically lower). Everybody wins.

dragonwriter 8y ago
> The insurance-based system is the reason these costs are so high in the US and lower elsewhere. No, that can't explain it, because it's also lower in other places that use a mixed public/private system with mandatory insurance purchase and public fallback for the medically indigent, instead of a single buyer.
- dasil003 8y ago
  It’s because most people get insurance through their employer so the costs are less visible up and down the line.
  - thfuran 8y ago
    A pretty large portion of the population doesn't get it through employment or does but sees the price because they're paying part of it.
- beat 8y ago
  Food for thought... Japan also has private insurance/providers, mostly through employers, just like the US. But they have half our cost, universal coverage, and better outcomes. Why? The big difference is that Japan has strict price controls. Insurers and providers don't negotiate with each other (in network vs out of network in the US). Prices are set to make sure providers and insurers are both profitable but not profiteering. Of course, such an idea here would be seen as straight-up Marxism.
  - rootusrootus 8y ago
    Capitalism is such a core part of the ethos of the United States that we believe it is the best answer for all problems. Problem is, healthcare is about as inelastic a market as you can have. I really think we might be close to the tipping point now. Plenty of people on both sides of the great political divide are starting to appreciate that no matter what we try, health costs continue to spiral out of control. That and the hard core folks are starting to die off.
    - beat 8y ago
      This is why I think a lot of people on the left are misguided in their commitment to single payer solutions. They're putting means ahead of ends. It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model - thus minimizing political resistance from both the industry and the socialism-phobic public. There's something uniquely pathological about the US system to lead to costing about twice as much as any other industrialized nation per capita, while leaving millions uninsured, causing hundreds of thousands of bankruptcies per year (even if insured), and frankly having pretty crap outcomes. It's not just that we need a system that would be better... it's that it's hard to imagine a system actually being worse, if one is being realistic and not merely partisan. Another thing toxifying the discourse is American Exceptionalism, that underlying believe that America is better than everyone else at everything. It's hard for a lot of people to even admit that our system isn't the best. There's a lot of "Yeah, it's expensive, but look at our technology!" I don't really know how to argue against the Exceptionalism argument.
      - dragonwriter 8y ago
        > It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model - thus minimizing political resistance from both the industry and the socialism-phobic public. Single-payer has had more public support (usually majority public support) than other routes to universal healthcare all the way back to and before when Bill Clinton campaigned heavily on health care reform in 1992; Democrats keep putting up complex, unpopular insurance industry kickback schemes instead, which end up easing Republicans effort to kill them either in advance of implementation (as with Clinton's effort) or afterwards (as with the ACA's progressive dismantlement since Obama left office.)
bluecalm 8y ago
You have a mandatory insurance provided by private companies in Switzerland and the prices of services outside of your insurance as well as the one billed and covered by insurance are still reasonable. There is something else which makes American system not working. I suspect high barrier to entry, huge lawsuit risk and heavy regulation for entering the market. If there is no real competition to provide cheaper services it's no wonder existing players charge ridiculous amounts.
- avgDev 8y ago
  The huge lawsuit risk is mostly bs. I investigated suing a doctor due to a medical error. Unless it cripples you for life or kills you no regular person would be able to win a malpractice lawsuit. It is insanely expensive. Another medical professional would need to speak against the other doctor or pharma company. Speaking against pharmaceutical companies is pretty risky for doctors. I think the cost of healthcare is expensive due to high education debt, lack of price regulation, and very little consumer protection as far as pricing goes.
refurb 8y ago
Yes, because a single buyer has enormous purchasing power. That can't be the reason as United Healthcare (largest US insurer with 40M lives) pays much more than Canada (total population 35M).
- grey-area 8y ago
  I like that you count their power in souls, a little like landowners in feudal Russia trading in dead souls. Back to the point, I think the purchasing power of a state entity combined with its control over the market is a powerful combination, but also the dysfunctional US market seems to reward healthcare insurers for paying more - they don't care after all if they get ever more money from the poor suckers who have to pay for insurance, they can take a larger cut of a larger pie. I'm not saying insurance markets can't work (someone cited Switzerland above), just that the current US insurance market is out of control and needs solutions (like Obama's solution which has now been wrecked, or single payer which works well elsewhere). What the US has currently doesn't work, fails to serve much of the population, and even then is much more expensive than equivalent services elsewhere.
  - refurb 8y ago
    "Lives" is the term used in the industry. The real answer as to why Canada gets lower prices is gov't fiat - they just say "this is what we will pay you, take it or leave it".
    - grey-area 8y ago
      So the purchasing power of a state entity - exactly the solution I proposed for the US. The state has subtle levers of control over all the participants in this industry, which other players (no matter how large) simply don't have. This is not an objection to using single-payer in the US, quite the contrary.
      - refurb 8y ago
        No, it’s the ability of the govt to go beyond purchasing power to “I just changed a law that defines how much we pay you for your other drugs, tough”.

dragonwriter 8y ago

> The insurance-based system is the reason these costs are so high in the US and lower elsewhere. No, that can't explain it, because it's also lower in other places that use a mixed public/private system with mandatory insurance purchase and public fallback for the medically indigent, instead of a single buyer.

dasil003 8y ago
It’s because most people get insurance through their employer so the costs are less visible up and down the line.
- thfuran 8y ago
  A pretty large portion of the population doesn't get it through employment or does but sees the price because they're paying part of it.
beat 8y ago
Food for thought... Japan also has private insurance/providers, mostly through employers, just like the US. But they have half our cost, universal coverage, and better outcomes. Why? The big difference is that Japan has strict price controls. Insurers and providers don't negotiate with each other (in network vs out of network in the US). Prices are set to make sure providers and insurers are both profitable but not profiteering. Of course, such an idea here would be seen as straight-up Marxism.
- rootusrootus 8y ago
  Capitalism is such a core part of the ethos of the United States that we believe it is the best answer for all problems. Problem is, healthcare is about as inelastic a market as you can have. I really think we might be close to the tipping point now. Plenty of people on both sides of the great political divide are starting to appreciate that no matter what we try, health costs continue to spiral out of control. That and the hard core folks are starting to die off.
  - beat 8y ago
    This is why I think a lot of people on the left are misguided in their commitment to single payer solutions. They're putting means ahead of ends. It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model - thus minimizing political resistance from both the industry and the socialism-phobic public. There's something uniquely pathological about the US system to lead to costing about twice as much as any other industrialized nation per capita, while leaving millions uninsured, causing hundreds of thousands of bankruptcies per year (even if insured), and frankly having pretty crap outcomes. It's not just that we need a system that would be better... it's that it's hard to imagine a system actually being worse, if one is being realistic and not merely partisan. Another thing toxifying the discourse is American Exceptionalism, that underlying believe that America is better than everyone else at everything. It's hard for a lot of people to even admit that our system isn't the best. There's a lot of "Yeah, it's expensive, but look at our technology!" I don't really know how to argue against the Exceptionalism argument.
    - dragonwriter 8y ago
      > It's perfectly feasible to get universal coverage and sane costs, while preserving the existing insurance/provider model - thus minimizing political resistance from both the industry and the socialism-phobic public. Single-payer has had more public support (usually majority public support) than other routes to universal healthcare all the way back to and before when Bill Clinton campaigned heavily on health care reform in 1992; Democrats keep putting up complex, unpopular insurance industry kickback schemes instead, which end up easing Republicans effort to kill them either in advance of implementation (as with Clinton's effort) or afterwards (as with the ACA's progressive dismantlement since Obama left office.)

bluecalm 8y ago

You have a mandatory insurance provided by private companies in Switzerland and the prices of services outside of your insurance as well as the one billed and covered by insurance are still reasonable. There is something else which makes American system not working. I suspect high barrier to entry, huge lawsuit risk and heavy regulation for entering the market. If there is no real competition to provide cheaper services it's no wonder existing players charge ridiculous amounts.

avgDev 8y ago
The huge lawsuit risk is mostly bs. I investigated suing a doctor due to a medical error. Unless it cripples you for life or kills you no regular person would be able to win a malpractice lawsuit. It is insanely expensive. Another medical professional would need to speak against the other doctor or pharma company. Speaking against pharmaceutical companies is pretty risky for doctors. I think the cost of healthcare is expensive due to high education debt, lack of price regulation, and very little consumer protection as far as pricing goes.

refurb 8y ago

Yes, because a single buyer has enormous purchasing power. That can't be the reason as United Healthcare (largest US insurer with 40M lives) pays much more than Canada (total population 35M).

grey-area 8y ago
I like that you count their power in souls, a little like landowners in feudal Russia trading in dead souls. Back to the point, I think the purchasing power of a state entity combined with its control over the market is a powerful combination, but also the dysfunctional US market seems to reward healthcare insurers for paying more - they don't care after all if they get ever more money from the poor suckers who have to pay for insurance, they can take a larger cut of a larger pie. I'm not saying insurance markets can't work (someone cited Switzerland above), just that the current US insurance market is out of control and needs solutions (like Obama's solution which has now been wrecked, or single payer which works well elsewhere). What the US has currently doesn't work, fails to serve much of the population, and even then is much more expensive than equivalent services elsewhere.
- refurb 8y ago
  "Lives" is the term used in the industry. The real answer as to why Canada gets lower prices is gov't fiat - they just say "this is what we will pay you, take it or leave it".
  - grey-area 8y ago
    So the purchasing power of a state entity - exactly the solution I proposed for the US. The state has subtle levers of control over all the participants in this industry, which other players (no matter how large) simply don't have. This is not an objection to using single-payer in the US, quite the contrary.
    - refurb 8y ago
      No, it’s the ability of the govt to go beyond purchasing power to “I just changed a law that defines how much we pay you for your other drugs, tough”.