Because Americans don't want to let people who can't pay for emergency care die (which I'd argue is a good thing) but also can't have a serious conversation about how to pay for that.

It’s a false excuse. Plenty of countries that also don’t let poor people die because they cannot afford going to the hospital also spend much, much less per capita. Actually, all of them do, and by far. The US really are an anomaly.

The socialism / capitalism argument is a way entrenched interests rile-up the public and stop productive conversation.

Is it more about emergency care or the fact that we pay more for prescription drugs and expensive procedures?

I like to say that there's blame enough for everyone to share. There's truth to virtually every argument. The entire "system" is so "sloppy" and filled with points where money just leaks out.

The emergency care angle is what drives the socialism / capitalism bickering and that's what I see a the biggest impediment to actually making effective change.

As a paramedic (part-time) and someone who has worked in claims benefit management systems, EMTALA (the rules/laws around emergency stabilizing care) are not what make our healthcare astronomical. It's prescriptions, imaging, and labs. You can easily be charged several thousand dollars for diagnostic imaging. My insurance covers labs 100% but a recent stool sample test charged $780 to see if I had blood in a stool.

Speaking of DI, DI is a money-printing machine, with CT and MRI machines that range from a few hundred thousand to over a million have breakeven points well under two years. And the DI companies work to find and gather physicians who want to start a DI practice. Offer financing, consulting, and then, shockingly, we find that physicians who own a DI practice or a share in one tend to over-refer their patients to imaging.

EMTALA (and the ACA) drives the socialism / capitalism bickering that I think is a primary cause of conversations about reform to run aground.

Because Obamacare legislation ended up as a terrible version of socialism/pork-barrel spending/crony-capitalism in order to get the required support to pass.

The democrats wanted to get subsidized healthcare for low income people and people with existing health issues that would guarantee they would be uneconomical to insure. The healthcare providers, insurance companies and pharma companies wanted to remain viable, profitable businesses.

The compromise was to essentially guarantee profits to healthcare companies by crafting legislation that overcharges young people, healthy people, male people, middle class and affluent people to subsidize costs for other groups, while giving a consistent profit margin regardless of costs to insurance companies.

There is nothing about American healthcare that resembles functioning markets or capitalism. It's a very heavily regulated industry where the government exerts extreme control, while choosing to legislate in a way that maintains a consistent flow of money to influential lobbying groups and political donors.

I'm old enough to remember health care prior to Obamacare, and I can assure you it was broken before too.

Frankly the difference I noticed post Obamacare was a friend of mine was able to get insurance in time to not go bankrupt treating her colon cancer.

I can't get behind the idea that Obamacare is somehow what broke our medical system.

It was actually worse in that you could be denied health insurance. And I know a lot of people who are denied health insurance for very mundane reasons.

Insurance companies had teams of people who, if you made a substantial claim, would look over your application for anything that was amiss. And if they found it, they'd drop you so they wouldn't have to pay.

Your health record became a criminal record. You just hoped there was nothing on it that would prevent you from getting coverage in the future.

Obamacare has some very serious problems, but at least you can't be denied insurance just because you have back pain.

surgeon here. before Obamacare insurance companies denied payments if they deemed the issue pre-existing and were not told about it in the patient's application. I was in private practice for 10 years and now employed surgeon for 12 bc insurance companies notoriously deny payments for no legitimate reason. One time I saw a patient with an inguinal hernia and then fixed it. We were denied payment because my initial consultation said, 'presents with hernia he's had for 2 years, but now increasing in size and causing discomfort'. Their reason for denial was that he only had coverage for a year and had not told them about the hernia. From then on, my notes were very brief. 'Patient presents with symptomatic hernia'

Before Obamacare, some policies had lifetime limits, which could affect expensive treatments like cancer.

We celebrated the fact that now medicare can negotiate 10 drug prices. It should negotiate all drugs. The organization that gets the lowest prices is the VA. Congress could easily pass a law saying medicare will only pay that much and it would not cost much to implement.

System is very broken.

The ACA made broad and sweeping changes, but the "shadow" socialist component of the American healthcare "system" goes back to the EMTALA[0].

[0] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

> There is nothing about American healthcare that resembles functioning markets or capitalism.

This is cope, just like "(socialist catastrophe) wasn't caused by TRUE socialism" is cope.

The mechanism by which capitalism causes concentration of wealth and power, and by which said concentration then creates means, motive, and opportunity for self-dealing is crystal clear.

If it were fully free market, there would be more competition. If it were fully socialized, the government would control prices.

Instead, our system is the worst* of both worlds. The government limits the supply to prevent competition, but allows those they've licensed to charge as much as they want.

*(That is, worst for patients; it's the best for profits)

I don't believe there exists a possible free market for health insurance, just like with flood insurance or earthquake insurance. Adverse selection kills it.

Even if there were no insurance, I don't believe there exists a possible free market for expensive emergency medical procedures either.

Well, we don't have competition because the much-vaunted doctor's union blocked how many doctors we could have so that they could keep doctor pay up. And that's not me attributing purpose. That's them saying why they did it.

Because we don't have death panels like in countries with government-run plans. Your insurance carrier won't deny you a bone marrow transplant because you're 85 (it costs over $1m). Other countries will deny it, because you're 85 and have had a good life.

The UK's death panel is called NICE: https://en.wikipedia.org/wiki/National_Institute_for_Health_...

We should have something similar in the US. 80% of all healthcare spending is consumed by people in the last 3 years of their life.

> Your insurance carrier won't deny you a bone marrow transplant because you're 85 (it costs over $1m).

Your experience with insurance in the US is very different from mine.

My experience is insurance denying my 34 year old sister's MS meditation until she ended up in the ER.

True. I've never had a bad experience with them.

I think it could be cool to have an evidence-based death panel of experts instead of our ad-hoc death panel of one guy (or one LLM!) running through a spreadsheet and clicking "no."