We pay for a single payer system, we just don't get it.

[1] - https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Perhaps more important, the US spends a bit more as a share of GDP on public healthcare than most developed countries with a mainly-public universal system. (And on top spends even more on private healthcare, but the combination still isn't a universal system.)

Per capita costs are going to be higher just because incomes are higher. But that doesn't explain per GDP costs being so high.

We also subsidize the most expensive people, including the elderly and people with cancer and AIDS. Plus, we directly subsidize hospitals in rural areas etc. It’s a giant flood of money.

I am saying even if you ignore paperwork costs and crazy bills, it’s still a vast sums of money often sent with minimal overhead. The VA for example is quite expensive though somewhat less so than the rest of US healthcare.

Non-profit insurance corporation that anyone can buy policies from. Shift existing medical systems over to the new one. Limit extension patents. Require dual-sourcing for FDA approval. Restrict charging more than 20% price difference between clients for the same medication/procedure. Require fiduciary efforts from insurance carriers in terms of negotiation.

It's a matter of a few legal shifts and some better policies allowing for more competition.

And politics, do you mean US lobbying?

Which is why I view the situation as hopeless, but not serious.

When you're developing most of the world's medical innovations, it should not be a surprise that we are the top spenders. For example, treatments like Car T-Cell therapy aren't cheap to develop or administer. Over time, those innovations will diffuse and they will become more available to less well off Americans and will become available to those outside America once cheap enough.

Everyone wants affordable healthcare in America, the question is a matter of where Americans spend on line items, but the debates in America revolve mostly around ideological concepts and not budget concerns directly.

And it's not 40% towards healthcare. It's at most 27% of total tax (less because it's bracketed alongside education) - most of tax is other social spending, a lot of that being retired people.

So healthcare is 7-10% of Sweden's GDP, or so. And falling. This being one of the most expensive healthcare systems in the EU, if not the most expensive.

I guess you're trying to hide that your argument is invalid. Trying to justify US mismanagement or lack of health policies.

For your information, USA spend almost 18% of GDP on government funded healthcare. And still rising. And USA is 28% richer than Sweden per capita, PPP normalized. This ignores additional private costs, which are probably significant.

And getting very uneven access. Some in insurance and medical industry are striking it rich, who cares about social costs.

A) https://en.wikipedia.org/wiki/Taxation_in_Sweden

B) https://www.cms.gov/research-statistics-data-and-systems/sta...

C) https://www.nationmaster.com/country-info/compare/Sweden/Uni...

Who cares about reality when there's a narrative waiting to be pushed.

What narrative? These are hard numbers. There's no debate. If you took my income and compared it against American tax law and Swedish tax law, I'd be paying literally over double, nearly triple in taxes if I was Swedish versus if I was American. There's no "extra 10%," your math is just plain wrong.

What a perverse argument; I don't even try to justify anything in my original statements.

"US Pharmaceutical Innovation in an International Context," the American Journal of Public Health. "We explored whether the United States is responsible for the development of a disproportionate share of the New Molecular Entities (NMEs) produced worldwide. [...] The United States was responsible for the development of 43.7% of the NMEs. The United Kingdom, Switzerland, and a few other countries innovated proportionally more than their contribution to GDP or prescription drug spending, whereas Japan, South Korea, and a few other countries innovated less. Conclusion: Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

"Global Drug Discovery: Europe is Ahead," Health Affairs Vol. 28 Supplement 1. "It is widely believed that the United States has eclipsed Europe in pharmaceutical research productivity. Some leading analysts claim that although fewer drugs have been discovered worldwide over the past decade, most are therapeutically important. Yet a comprehensive data set of all new chemical entities approved between 1982 and 2003 shows that the United States never overtook Europe in research productivity, and that Europe in fact is pulling ahead of U.S. productivity. Other large studies show that most new drugs add few if any clinical benefits over previously discovered drugs."

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5....

The argument that the US "subsidizes" the rest of the world's health care is something that US pharmaceutical companies would very much like us to believe, but the evidence for it appears to be pretty shaky.

If it's by revenue to the much maligned Big Pharma, then I think not. R&D is a big cost, but not nearly as big in percentage as shown by the pharma companies, so were they all to contract due to sudden existence failure of the USA, they'd still make big profits if they kept the costs the same. The smaller companies would evaporate.

I'm basing this on comparing Teva USA vs Teva Global R&D spending data. That is 10% everywhere, 15% in the US (dropping faster) and falling regardless of the USA or not, which is pumping in more money into this company every day.

I picked Teva because they're representative and one of global market leaders.

https://www.statista.com/statistics/272544/expenditure-on-re...

Solid: https://articles2.marketrealist.com/2018/01/whats-teva-pharm...

(Yes, you can also read their quarterlies for USA branch and other ones. I checked a few.)

Decent write-up, if a bit old: https://www.healthaffairs.org/do/10.1377/hblog20170307.05903...

I'm curious why they chose that time period. It was published in 2010. This omits 6 years between publication date of the article and the end of the range they chose and omitted all data prior to 1992. How would the data differ if you didn't choose this 12 year period?

> although fewer drugs have been discovered worldwide over the past decade, most are therapeutically important.

> Other large studies show that most new drugs add few if any clinical benefits over previously discovered drugs.

These two statements contradict one another and the second one sounds awfully like moving the goal posts because the data doesn't support the conclusions.

The abstract I quoted reads: "Some leading analysts claim that although fewer drugs have been discovered worldwide over the past decade, most are therapeutically important. Yet a comprehensive data set of all new chemical entities approved between 1982 and 2003 shows that the United States never overtook Europe in research productivity, and that Europe in fact is pulling ahead of U.S. productivity. Other large studies show that most new drugs add few if any clinical benefits over previously discovered drugs."

The first snippet you pulled out is prefaced by Some leading analysts claim. This study's meta-analysis concludes that those analysts are incorrect.

> All major health care innovations were invented here

To quote Rage Against the Machine: whoever told you that is your enemy

Sorry, what?

My country doesn't have any "free access" to drug innovation, it pays mucho dinero to buy drugs, and American companies hold and enforce all kinds of patents on them.

It's also not some "one way" innovation street. Tons of medical/drug innovation, especially all the major "low hanging fruits" (which make up for most of modern health benefits) up to the mid-20th century came from outside the USA.

And that's not counting all the major European etc drug companies GlaxoSmithKline (British), La Roche (Swiss), Novartis (Swiss), Sanofi-Aventis (French), Bayer (German), Boehringer Ingelheim (German), etc.

Of the top 5 grossing drug companies, only 1 is American (#1 Pfizer). And the revenues of #1 are close to the revenues of #2 and #3, (45 vs 40 and 38 billion) so it's not like some great disparity where Pfizer takes all.

Not to mention that a lot of "USA innovations" were created by immigrants, whose country of origin paid for their raising, education, etc, even up to their undergraduate degree, and then they went to the USA and innovated as researchers...

Slow down with the chauvinism...

If you didn't develop a drug or pay for its development, but get access to it one day at only the cost of manufacture, then you're getting the R&D for free.

All of the drug companies you mentioned, while not founded in America, do most of their R&D in America.

You're right about many immigrants developing those drugs, but they came to America to do so. You should ask yourself "why?"

For the record, I'm an immigrant to the US.

Everybody gets the free access (including other American companies). Like you get free access to European drugs, once the patents expire. But all this is played into the cost of the drug while the patent holds. Nobody sells drugs at a cost, so there's that...

>All of the drug companies you mentioned, while not founded in America, do most of their R&D in America.

That's just wrong.

>You're right about many immigrants developing those drugs, but they came to America to do so. You should ask yourself "why?"

More cushioned life, compared to a place like China (at least of yore), and opportunities to make it big in business.

Also, by that thinking, all the suckers and losers in the market subsidize others.

Citation needed.

I never went through the whole list because it took a super long time, but when I tried sampling where most of these ~300 drugs were developed, it was like 80% developed in the US. I got through like 50-60 of them before I gave up. 50-60 should be good enough to be representative of the 300 or so. Feel free to go through them yourself if you don't believe me.

I didn't so I did.

I checked the first thirty listed in the Wikipedia article. Of those, only 8 have been developed in the USA including one developed by the American branch of a Swiss company.

That's merely 26%. Not insignificant but quite far from 80%. After a quick sampling of the rest I would be surprised if the exact proportion is above a third.

Halothane - England (1956)

Isoflurane - United States (1979)

Nitrous Oxide - England (1772)

Oxygen - N/A

Ketamine - United States (1966)

Propofol - United States (1989)

Bupivacaine - Sweden (1957)

Lidocaine - Sweden (1885)

Ephedrine - China (?, introduced to western medicine by an American traveling to China)

Atropine - Germany (1833)

Midazolam - United States (1976)

Morphine - Germany (1803)

Aspirin - France (1853)

Ibuprofen England (1953)

Paracetamol - United States (1877)

Codeine - France (1832)

Fentanyl - United States (1960)

Methadone - Germany (1937)

Amitriptyline - United States (1960)

Cyclizine - United States (1947)

Dexamethasone - United States (1957)

Diazepam - United States (1959)

Docusate - ???

Fluoxetine - United States (1972)

It's ridiculous how hard it is to figure out where most of these were developed.

When I first went through the WHO list, I did so in reverse by year of discovery:

https://en.wikipedia.org/wiki/List_of_drugs_by_year_of_disco...

I stopped checking again at this point. As a reminder your first claim was 80% of the list. I think your reliability has clearly been established at this point.

https://en.wikipedia.org/wiki/List_of_drugs_by_year_of_disco...

Except for Alectinib, which was developed in Japan, 13 of the 14 drugs developed in the 21st century for example have been developed in the United States:

That's 93%. Again what has the rest of the World been doing?

So 9 by the 24th in the list not 30, so your reliability has also been established.