> The United States in an extreme outlier in terms of cost. This is separate from rationing care. This is separate from even population health (ex. higher obesity rates)
Are you sure? People comparing US healthcare costs to European costs don't realize that these are two very different products. The US population is much more unhealthy, yet it has about the same life expectancy as an average European country. This would suggest that Americans actually have access to significantly more healthcare services than Europeans do.
I think a lot of people assume that some of this stuff is linear when it actually seems to be exponential (or super-exponential) in cost. The median American spends half of their lifetime medical bills in their last year of life. That's a lot of money for not a lot of time. Incidentally, American doctors also tend to spend a lot less in this period, indicating that they have a much more healthy relationship with at least one of health or death.
I haven't been particularly convinced, looking at the healthcare systems across the pond, that they are providing anywhere near the same level of service that you get from the ultra-expensive US healthcare system. They are somewhat more optimized for efficiency and the US healthcare system is much more optimized for outcomes - partly because Americans are so litigious and IMO partly because the patient is the customer. That doesn't lead to low costs.
If US healthcare is optimizing for outcomes, it’s doing a poor job and maybe we should optimize for something else. Our outcomes based on relative rating does not justify the additional cost.
What do you mean by that? The population of the US is incredibly unhealthy, but that has little to do with the healthcare system and a lot more to do with consumption habits.
It has a lot more to do with food safety regulation.
Noone can be an expert in everything so everybody needs to fall back to authorities to advise or act in unknown fields. Blaming it on habits is like saying "why did you choose the doctor that botched the surgery?"
Do you not consider weight management and physical exercise part of health care? EG my insurance covers Ozempic, physical therapies, psychology of dieting, addiction...
That's the point of looking at global healthcare plans, which are giving two prices for the same person depending on whether they will or won't be in the US.
And while they aren't giving the same service, there isn't much evidence the service is necessarily worse. More healthcare doesn't necessarily lead to better outcomes, it's not uncommon for more liberal treatment guidelines to only improve through statistical errors or to lead to compensatory idiopathic illness.
This is systematically incentivized in the US, where both the doctors (obviously) will be paid more for more/worse care, but also the insurers which have to follow the 80/20 or 85/15 rules and are therefore incentivized to increase costs to increase total profits, especially in places where they have little competition, or agreements with hospital systems to pay a similar amount to other insurers.
Additionally, the spurious nature of claims in the US system wastes massive amounts of resources where insurers (with their 15-20% of premiums) but also practitioners (sometimes even over 20%) spend their time just haggling over approvals instead of using a clear and deterministic system, which also causes knock-on consequences later.
I don't think your methodology of looking at global plans holds up, because on balance those are a self-selected crowd (a bias, likely toward healthier people) and if you note that the standard of care is different, the price is going to be different. These healthcare companies know what product they are selling well.
I think it's clear that there's significant waste in terms of advertising, haggling with each other, etc. that you don't get in a universal healthcare system. However, there is also waste in universal healthcare systems around the cost of the bureaucracy to manage the leviathan.
The life expectancy of the USA is a few years lower than the average in Europe. And of course Europe is poorer on average, plus has a war ongoing. Adjusted for those, I imagine the gap is larger still
> yet it has about the same life expectancy as an average European country
Not quite. Let's take, for the sake of quantification, the life expectancy of a developed western European country: France. Considered poor when compared to American wages, it has health care system of average quality when compared to its neighbours. (So this could be done with any other west European country)
2023 life expectancy: 83.5 years.
2023 life expectancy USA: 79.3 years. Which is the same life expectancy as France in 2000/2001.
> They are somewhat more optimized for efficiency and the US healthcare system is much more optimized for outcomes - partly because Americans are so litigious
So by having the "customer" die early the system ensures that they can't be sued..?
Are you sure? People comparing US healthcare costs to European costs don't realize that these are two very different products. The US population is much more unhealthy, yet it has about the same life expectancy as an average European country. This would suggest that Americans actually have access to significantly more healthcare services than Europeans do.
I think a lot of people assume that some of this stuff is linear when it actually seems to be exponential (or super-exponential) in cost. The median American spends half of their lifetime medical bills in their last year of life. That's a lot of money for not a lot of time. Incidentally, American doctors also tend to spend a lot less in this period, indicating that they have a much more healthy relationship with at least one of health or death.
I haven't been particularly convinced, looking at the healthcare systems across the pond, that they are providing anywhere near the same level of service that you get from the ultra-expensive US healthcare system. They are somewhat more optimized for efficiency and the US healthcare system is much more optimized for outcomes - partly because Americans are so litigious and IMO partly because the patient is the customer. That doesn't lead to low costs.