A commercialized health care system has lots of perverse incentives leading to price increases and profiteering. This sets the weakest fraction of the population up for losing all they've built up in the last 3 months of their life while barely impacting the strong. It also means that those hospitals don't care about overpaying for their supplies and medication (but not their workforce) because they get to pass those costs on to those already weakened people.

FWIW: Gall bladder operation in NL all in: 1500 euros, non-subsidized and paid for out of pocket because I wasn't paying into the local healthcare system when it happened. Same procedure in the USA: $24000!

https://www.lendingpoint.com/blog/gallbladder-surgery-costs-...

The US has had a private healthcare system for its entire history. Economics and incentives were the same throughout that history. Meanwhile prices only became stupid very recently.

A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. It seems to be very good at finding the optimal efficiency point, which essentially is very close to "no unused resources in the nimal situation". But societal resiliency requires that health care, utilities, food supply, etc, has some excess capacity just because at some point something will happen. A public system can at least be responsive to the value society puts on resiliency.

Medicare and state licensing agencies more or less control the hospital bed capacity in the US, not commercial incentives.

Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place.

Open the March update pdf here and look at the "excess" column on page 4:

https://www2.illinois.gov/sites/hfsrb/InventoriesData/Monthl...

The state has big impact on the capacity of the medical system.

> A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies.

I disagree, I'd say it's the opposite.

A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.

Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity.

Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.

this assumes that health care scales in the same way that an online retailer does, no?

the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in.

scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes

>A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.

Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense.

>ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.

You're right. A private company would just fire the nurses instead.

Private providers are not immune to oversights and waste.

Atleast they get punished for it, unlike public systems which might get punished once every 20 election cycles.

How does that square with a system that has the most critical care beds per capita:

https://sccm.org/Blog/March-2020/United-States-Resource-Avai...

As user lima-lima pointed out above, this most probably is an artifact resulting from different definitions of what constitutes an ICU bed - for example pediatric and neoanatal beds are included for the US, but excluded in the European numbers.

It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?

It only has less total beds if you exclude outpatient facility beds.

Are these included in the count of the other countries? This is exactly what I mean: Without the same definitions for all countries, the numbers per se are not really comparable.

Second most at best. Turkey has 46 / 100k.

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

Interesting, the last number I saw was 10x less. That is comforting

Yes, definitely, American healthcare system needs a reboot - this might be a good time to do that. The only difference is that I would be paying about the same but the insurance would cover the rest. The problem being - if you're well off, you pay $1500, if you're not, you pay $24000 and potentially go broke. That is the problem with the American healthcare system.

it may have been mentioned already but in the US healthcare prices are negotiable. It's strange because you can't go to a US grocery store and haggle over the price of cucumbers like you can in many other nations but you can do that with healthcare.

So $24000 is like the asking price, you can come back and say "yeah well, i'll write you a check right now for $2500 otherwise you're sol.". Once a provider realizes what the max they're going to get is then, magically, that becomes the price.

To anyone who doesn't know this, don't you dare pay out of pocket what the bill says. Never. What's on the bill is not based in reality at all.