[fsg7sdfg789]

If my understanding is correct, other nations with single payer systems have lower health care costs and frequently better outcomes than in the US.

Econ101 is good for teaching concepts about how to think about economic interactions, but when the data doesn't match the theory, you can't stick with the theory.

[fredkbloggs]

Well, as the article pointed out, some part of what the US is spending money on is subsidizing those other countries. How much? That would be interesting to know. There's also the small problem that "health care" doesn't have a UPC code; what people in those countries get and what people in the US get are not the same thing (which doesn't mean that the US standard of care is better, only that they're different). So it's pretty hard to look at what people are spending in two different places for two different things, with a probably large subsidy involved, and conclude that a theory about supply and demand for identical goods in a free market is wrong.

Let's put it another way: it seems that you must disagree with at least one of the following statements:

(a) Higher demand, ceteris paribus, means higher prices.

(b) A single-payer system implemented in the US would likely cover more treatments than the system that exists in the US today.

(c) Covering more treatments means more demand for treatments.

(d) A single-payer system would not shift the supply curve for treatments.

With which do you disagree? It seems like most of the interesting arguments here are around (d), but there doesn't seem to be any evidence against it. Of course, again, there is some seriously massive distortion going on here, so it's hard to be sure.

[beagle3]

I disagree with arguing (provably wrong) theory in the face of hard data (which disproves said theory) - drugs and care are significantly cheaper in every single payer market, and provide better outcomes as measured by life expectancy and many other measures.

> So it's pretty hard to look at what people are spending in two different places for two different things, with a probably large subsidy involved, and conclude that a theory about supply and demand for identical goods in a free market is wrong.

It's actually quite easy, just like you do with e.g. a McDonald's meal or a bottle of coke (e.g. the US subsidies these indirectly through corn subsidies, no other country does). It's not the same everywhere, not by a long shot, but it's functionally quite close.

Same drugs and similar are cost much more in the US.

The market is not free - it is illegal for you to have your medicine shipped from Canada or India or anywhere else.

[specialist]

With which do you disagree?

Well, everything. Including but limited to your random assumptions, weird logic, and counterfactual conclusions.

Single payer enables the capitation model for healthcare. Lowering costs by incentivizing prevention.

[vidarh]

Every other country on the planet have lower health care costs than the US by a large margin.

US public healthcare spending alone, excluding private payments and insurance, places the US in the top 20, possibly top 10, in government spending on healthcare.

In other words, Americans pay more than citizens of most developed countries over their taxes, and then pay about the same again to private insurers...

[hugh4]

This is true, but on the other hand the US does have a much higher standard of care.

In my experiences with the US hospital system I've been shocked by the way every single town seems to have all the fanciest, newest equipment. A scan that you'd wait days for in Australia you can get on the spot in the US.

That money is going somewhere.

[vidarh]

The reason for this gap is that these are unnecessary conveniences. There's a reason the US care actually never rank very well on WHO rankings, despite the availability of extremely advanced care.

You can get most stuff done immediately in the UK too, by paying for private insurance (incidentally you'd still pay less in taxes + private insurance than Americans pay in taxes towards healthcare alone) or just going to a private clinic. Most people don't, though, because as much as people might complain about waiting, they also tend to accept that the NHS prioritises by clinical need and will provide treatment when necessary. Including through buying capacity from private providers or sending patients abroad if serious enough.

The result is that when you need it, you generally get treatment rapidly, regardless of your financials. When you don't need it instantly, then yes, you get to wait (or pay).

If anything, this situation in the US reflects how distorted the market is by having a system where healthcare providers are have an incentive to find every means of charging sky high rates as most of them are not paid directly by patients, and insurers have little reason to push back (because the occasional experience of high medical expenses provides a massive reason for people to well covered by insurance, and they're competing with other insurers that will use unwillingness to cover certain types of expenses against them).

But ultimately this is also part of why so many Americans have been poorly covered by insurance: The system has been geared towards people who can pay higher premiums. Had the US system focused on affordability, and left luxuries to top-up insurance like in the UK, the US could have paid for universal care out of current taxes and still have (lots) money left over.

[DanBC]

> That money is going somewhere.

A lot of it is going on over diagnosing and over treating, both of which cause harm.

https://en.m.wikipedia.org/wiki/Unnecessary_health_care

[fredkbloggs]

So you're agreeing at least in part with my original assertion, then. Namely, that we probably need to be less willing to pay high prices for drugs (and by extension other treatments) because in many cases they are of much less value than other things we could buy instead. Right? I mean, overtreatment has negative value, so it's hard not to imagine that what was paid for it couldn't have been better spent on something else. Anything else. Throwing the money into a fire would have provided more value.

[specialist]

No. Over testing and over treatment is unrelated to the (initial) high price of drugs and other treatments.

[beagle3]

Just this week I got a 2-month wait from a US hospital for a scan I got a 1-month delay outside the US. And that's a major, top ten US hospital, not some dinky place no one has heard of (but it's a non-standard scan setting, I'll grant you that). And the out-of-pocket (despite having insurance) is almost as high as the entire scan if I did it privately in the other place (which I pay zero for - it's all covered)

> That money is going somewhere.

Mostly to the pockets of the health insurance companies, which rake in ridiculous profits for providing services which are essentially non-existent and not needed almost anywhere else in the world.

[dragonwriter]

> Every other country on the planet have lower health care costs than the US by a large margin.

To put it in concrete terms, of OECD countries (comparable non-OECD data is harder to get), the #2 country in per capita healthcare spending (Switzerland) spends about 72% of what the US does per capita.

> US public healthcare spending alone, excluding private payments and insurance, places the US in the top 20, possibly top 10, in government spending on healthcare.

Again, to provide some concrete numbers, in the OECD, the US is #3 (behind Norway and Netherlands) in per capita public healthcare spending.

It also has the second highest proportion (52%, just barely behind Chile) of total healthcare expenses that are private, rather than public.

[rational-future]

That's an interesting argument, but it misses the fact that the US is effectively subsidizing the healthcare in the rest of the world.

[dragonwriter]

Even if that's true -- and people asserting that never support it -- I don't see what the point of that is in defense of the status quo US policy. If that is the reason that Americans are paying so much more for healthcare and not getting any more benefits, it would be better for Americans if the US stopped doing that.

[lmm]

If the US stopped doing that there's no reason to assume that another country would magically step up to the plate. What if, as is the point of the article, the US stopped doing that and the world simply stopped getting as many new drugs?

[dragonwriter]

> If the US stopped doing that there's no reason to assume that another country would magically step up to the plate.

Another country, no, because that would be irrational and stupid (just as it would be for the US, if the argument atht the US is actually doing that is correct.)

On the other hand, if the US is subsidizing the rest of the world, that means the US is substantially reducing the marginal benefit of expenditures in the subsidized domain by other countries, disincentivizing their own expenditures (direct or through policy which promotes drug development.) It would be irrational to expect the removal of that subsidy and the associate disincetives not to result in increased expenditures.