> I'm not saying that American healthcare is a paragon of efficiency and low cost. Good. Because it isn't. American healthcare is a laughing stock in the devel

> I'm not saying that American healthcare is a paragon of efficiency and low cost. Good. Because it isn't. American healthcare is a laughing stock in the developed world. Per capita, Americans spend more of their income on healthcare than countries with universal health. Ironically, health outcomes for Americans are actually worse. http://www.stiglitz-sen-fitoussi.fr/documents/overview-eng.pdf http://www.stiglitz-sen-fitoussi.fr/documents/overview-eng.p... > You could spend a week shopping around. You can shop around for elective procedures. If you are sick however, shopping around is a terrible and exploitative burden. You're sick. Your primary concern should be to get help and get better, not whether or not you can afford it. > If the government is the only buyer of medical care and they "negotiate" for discounts and don't do business with people who "charge too much" then that's EFFECTIVELY regulation. It might not be in the technical sense; there might be no law saying "an ACL surgery costs $4200" but if the sole purchaser of ACL surgeries says it's not willing to pay more than $4200 that kinda-sorta sets the price. This isn't what I'm saying at all. Firstly, I'm not saying the government is the sole buyer of healthcare services because experiences the world over (UK, Australia etc) have shown there's plenty of room for private insurers. Secondly, I'm not saying that prices are kinda-sorta fixed. What I am saying is that if the government decides apriori that ACL surgeries (whatever that is) are something that's important to universal health, and something everyone should have access to, they subsidise the cost. Period. Whatever it is. If multiple providers exist, they opt for the cheaper option. If they're getting stiffed by all the private providers then the government has two options: (i) they can decide to offer ACL surgeries in public hospitals for a lower price; (ii) (in the case ACL surgeries depend on some very expensive bit of licensed kit controlled by a single supplier) they can set limits on the amount of time that supplier can wield exclusive control over this technology. Break the monopoly, lower the price. Recall that they've decided beforehand ACL surgery is something everyone should access to.