Big agree with this. Also there's no all-encompassing definition of 'healthcare' that will cover all categories, the way there is for groceries or cars or servers. As people get more disposable income to spend, they'll gravitate towards what is not so much medicine as improving their bodies (speaking as an older athlete who's spent significant money to repair shoulder, hip injuries & stay relatively young- my grandparent's generation would've said 'your shoulder's done, you're not young anymore, it's over', etc.) And then also end of life care- some amazing % of our healthcare costs go into the last 6 months of life, which is all totally optional care and we don't 'have' to have- but we want to because we have the disposable cash for it. We want the $27,000 cancer drug or the $100k for an extra two weeks of life on the backend

Right, this difference of scale is enormous. Back when hospitals couldn't do that much, and were not far from being hotels with better hygiene & worse food, then how to pay for them wasn't such a hard problem. But now US healthcare is 17% of GDP (if I recall correctly) and this proportion rises with GPD, unsurprisingly, as more other needs are already met. It isn't going to go down.

Pensions are in a way similar. When steelworkers retiring at 65 could expect on average a few golden years, then deciding how to pay for that wasn't such a huge deal. When they can expect a third of their lifetime to be in retirement, then it's very different.

You say it won't come down, but that's because the US is in it's own ballgame. In most other advanced western country healthcare "only" accounts for 7~11% of GDP.

The chart on [0] is incredible. I also shows how much that percentage has grown over the last 45 years.

[0] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [1] Source data OECD: https://stats.oecd.org/Index.aspx?DataSetCode=SHA

I agree it's higher, and while some of this is waste, some of the higher proportion is explained by the US being richer.

Whether it will come down, I guess that's partly a forecasting guess. Will the healthcare sector be a smaller part of the economy in 10, 20 years? Employ fewer people? I would be extremely surprised if this happened in any advanced country.

Agreed, healthcare became a human right right around the time it changed from being mostly palliative care to curative care. I'll pinpoint it to somewhere between the invention of insulin and penicillin. It's at that point where healthcare outcomes really start to diverge between rich and poor.

Something I'll note, Jay Gould, one of the wealthiest men of his time died of tuberculosis - something we now think of as a poor persons disease.

I see what you are saying but prices are completely out of control precisely because an insurance company will pay a 6 or 7 digit bill.

If insurance was gone tomorrow and there was a cap on how much a single payer system would pay I am pretty sure million dollar surgeries would go down significantly in price.

I mean surgeons are paid well but a million dollars for a few hours of their labor?

Constraints on how many people are permitted to become doctor's also reinforce this issue.

also we've thankfully left behind the age of caste systems, where you just were poor, because well, peasants be peasants. Today I don't see any rich people engaging in that kind of (really screw up, if you think about it) "philantrophy" anymore... Especially in America (with Amazon and Walmart-slavery) the attitude is more like: you're poor, because you are not putting enough effort in.

What's screwed up about philantrophy? And it's still here, Bill & Melinda Gates Foundation is a most prominent example.

The inequality that creates philanthropy shouldn't exist. Bill Gates did not himself earn his fortune.

the one where people somehow think, the status quo is god-given and that it's their godly duty to give alms. And no, Bill Gates is not an example for that - I think it's basically limited to the 3rd world, people in the US are still supposed to get their life together ;).

Since 1980 or so, the caste system is on a return. Not in rhetoric, but in outcome. "Social mobility" is down, down, down in the US.

yeah, I reckon that. But compared to the old caste systems the people on top tend to show even less regard for the ones down (because they are so great and all selfmade!)

Behind the bastards has a good podcast about the lady who mainstreamed adoption. She convinced rich people that they could adopt poor children and they wouldn't be genetically inferior, to be blunt.

She also stole kids and let babies die from lack of care...