Seriously what's wrong with the U.S. Here in Europe, heating bills can bankrupt people and they have to overpay for rent because gas is so expensive they can't rent further from their jobs - their commute radius is frequently limited with gas costs that are insane - resulting in needlessly dense cities. A separate house is a thing for upper class. All of it sucks, but... no one gets bankrupted by healthcare costs here. This is simply unheard of. And health insurance costs an invisibly small amount. I guess it removes a great deal of worry for health-concerned people.

where in the eu are you talking about? every time i visit/talk to friends there it seems to be the opposite because public transit is ubiquitous and you can get a train out to all sorts of small towns and villages.

There is a compounded med that isn’t covered by insurance and I wonder if I could find a pharmacy in my homeland(Poland) to compound and ship it directly to patients. I have found some places that apparently do it but the sites are bad and don’t seem legit.

>needlessly dense cities

Guess you've never been in Asia? European cities are far from too dense.

On the normative question of blaming groups, it’s like that imposter Spider-Man meme of each person pointing at the other. Hospitals charge 10x the actual market price and health insurance boasts on your explanation of benefits that they got you a 90% discount. Americans demand cutting edge maximum intervention perfectly safe treatment with no formal government rationing, or HMO rationing.

Health care is a for profit sector. Fees are paid by third parties (so patients are not directly exposed to routine costs). There is heavy quality regulation. Providers are incentivized to treat more through fee for service so the sicker you get and the more procedures they perform the more revenue they earn (perverse incentive). There is no counterweight to negotiate prices down. The end result is 7% medical inflation per year.

You'd think the medical schools might remain independent under their universities, but that often turns out to not be the case as well. Turns out asking for handouts from the endowment looks a lot like bankruptcy, and the rest of the university takes a dim view of it, especially considering how home addresses of their physician colleagues (hint: very large houses in the best neighborhoods). See Tulane, Georgetown, etc. The state school systems, like the UCs, tend to do better, or are at least shielded by the state budget.

If you point to Mayo, Stanford, and Partners as exceptions, I'd say they're the exceptions that prove the rule. Mayo has always been a self-sustaining business. Stanford and Partners have ready consultation with the strongest business schools in the US, if not the world, and the endowments to match.

> Over the past decade these firms have quietly increased their presence in America’s vast health-care industry (see chart ). They do not make drugs and have not, until recently, treated patients. They are the intermediaries—insurers, chemists, drug distributors and pharmacy-benefit managers (PBMs)—sitting between patients and their treatments. In 2022 the combined revenue of the nine biggest middlemen—call them big health—equated to nearly 45% of America’s health-care bill, up from 25% in 2013.

Their answer to the question "who profits most?" is this category of company. That's still compatible with the fact that the manufacturers of the pharmaceuticals have extremely high profit margins.

The article says Big Health, which is defines as the middle-men between providers and consumers (such as perscription benefit management system), takes the biggest slice of the cake.

A bit related but separate, one of the most compelling arguments that anti-vax has is that vax mandates translate to a built in mandatory market for manufacturers. You don’t have to agree with these but it’s an obvious factor in a follow the money type of way

The article barely mentions Big Pharma except in this blurb at the top. It's not an attempt to downplay Pharma profits, it's an attempt to draw attention to lesser-known players with even larger profits.

The commenter took issue with that which I think is correct.

It completely ignores survivorship bias. You can't just look at the profit margin of the biggest public companies. You're basically just selecting for the winners. And the entire business model of biotech is 90% are losers and of the 10% that win, they win big to make up for all the losers.

You'd need to do an analysis that looks at profitability of the entire industry. Look at all the VC backed biotechs that get $500M in funding then go belly up. Look up the multiple acquisitions in the past decade that were just written off.