The US's healthcare system is so bleak because we quite literally fund healthcare for the rest of the planet. Taxpayers in the US get access to the best treatment decades earlier if they're rich enough. Prices are increased on US citizens to account for the strong arming other governments do to get prices lower for their citizens. If the pharma companies couldn't do this, for example, they'd refuse to negotiate with other countries. A microcosm of this behavior is medicare here is the US. Yes, the US taxpayers even have to be charitable to them.

IMO, if the US decided to actually help its citizens every country the average progressive considers "great at healthcare" would likely implode under the sudden increase in cost. The cost of medication alone would likely nearly bankrupt several governments. Imagine if the price of insulin, almost completely funded by US citizens paying absurd prices, went up to its US price.

Much like with defense, the US taxpayer is the hero of the rest of the world's healthcare. Without US tax cattle the rest of the world would not be as nice as it is. It's just like when prices go up at your favorite store due to theft. The US is punished by insurance companies because other countries refuse to pay more.

This could only be true if the majority of the healthcare spending diff came from payments to pharma/health dev cos, right? Do you know whether that's the case?

If we're paying more for nurse salaries, hospital administration, insurance company bureaucracy, and ineffective procedures near end-of-life with low probability of success, it's unlikely the cost diff is mainly due to "subsidizing innovation."

Almost everything you have said here is untrue. Pharma companies still make profits in other countries, they just make much more profit in the US. Much of medical research is in fact funded by the government to begin with.

By removing the for-profit system, you would actually be removing rampant rent-seeking on something that should be a human right.

> Imagine if the price of insulin, almost completely funded by US citizens paying absurd prices, went up to its US price.

A very strange example to select, considering it was first discovered by Canadians and the patent was later sold for $1. US citizens are certainly not "subsidizing" insulin elsewhere.

Sure bud. What is it about HN'ers talking with such confidence they legitimately have no idea what they're even talking about? I googled it for you, and gave you two sources are probably amicable towards - there are THOUSANDS more[0][1]. It's exhausting that everyone here talks like they are an expert at everything. I thought I left that when I came here from reddit.

[0] https://www.pbs.org/newshour/economy/do-other-countries-pigg...

[1] https://www.washingtonpost.com/opinions/2022/11/29/us-health...

The example you selected with insulin does not support your argument.

Of course, anyone can do a google search and find some opinion pieces confirming their world view, that doesn't make it true.

The post article in particular just looks at the total revenue and essentially says "look how big it is compared to other countries, we must be subsidizing them". But this just justifies the extreme profit-seeking already in the sector, it's not an argument that it's necessary for innovation.

This doesn't come close to supporting your claim that (most of?) the entire healthcare cost gap is due to subsidizing innovation, for the reasons I described in my other comment. (ie: Drugs are only ~10% of our healthcare costs.)

Even your own source [1] contradicts the idea that high costs are inevitably caused by this subsidization:

> Why doesn’t competition bring U.S. health-care prices down? The answer: America’s stagnant third-party payment system allows hospitals and doctors to avoid competing on price.

People making this argument tend to want 'better health outcomes for millionaires/healthy white collar people', either because they are one, or they think they will be one.

What I always point out is that markets are a form of rationing too. They are just form where people with money are allocated more goods than people without it, sometimes to the total exclusion of large parts of the population. Given that we set up polities for the common good, I'd argue that any necessity which markets fail to deliver to everyone should use some other kind of rationing strategy.

> If "better health outcomes per dollar" is not "what you want" -- how come?

Because I don't confuse "individual" with "group".

The fallacy here is to tally up every dollar spent on medical treatment in a given year, then saying "here we spent X on medical treatment, but it could only be 0.7X if the government were in charge".

But you never asked me how much I spent on medical treatment. What if I spent 0?

Well then, your plan has me spending more than I used to, to get me something I didn't want/need. It's not a good deal for me. And if it's a good deal for someone else, it's only because you shackled me up and made me work the fields for their benefit. No thanks.

Even if I was the sort to engage in that non-sense, the problem itself is insurance. And that holds true whether some private company (or many) is in charge of the insurance, or the government is in charge of it. You think BCBS rejects claims, but that the feds don't reject them? Wow, do I have a bridge to sell you.

When someone wants a good or a service, and they pay for it themselves, they are price-conscious. When they don't pay for it themselves (because the insurance company does, or the government), they aren't price conscious. But this encourages the goods-provider to raise their prices... even discourages them from keeping them low. Low prices signal low quality. This encourages the payers to reject claims, then once more the goods-providers to raise prices again to cover for all the rejected claims (bonus if they can go after the goods-buyers for the price too!).

And it all spirals out of control. There is nothing in this mechanism that makes it less ridiculous if the federal government owns the insurance company, and it is the only insurance company permitted by law.

I take that back, there is one thing different. Now you can introduce price caps, woohoo! That will certainly fix the problem. Some committee 2000 miles away and months-distance from the facts can magically determine a fair price for all physicians and surgeons nationwide for some procedure's medical code (not the procedure itself, these are always unique... but the little alphanumeric codes, nice and uniform so they fit in the database).

That definitely won't cause further meltdowns. Will it be blamed on nefarious capitalists hiding in the woodpile? Will it just be chalked up to disappointing reality "there can be no other way"? Probably will depend on just where we're at in the election cycle.

If you want to see prices drop (plummet really), outlaw all insurance. Make people pay cash, out of pocket, for everything. You starve if you can't sell your stuff to people who want it, and if those people only have 1/100th of what you used to ask, then you either learn to live with the 1/100th, or you starve. No one gives out bank loans for heart transplants.

> And [health care prices] all spirals out of control.

But... they don't. Peer countries with gvt subsidized/socialized care spend less than the US (per procedure and in aggregate).