[AsyncAwait]

> The ACA ("Obamacare") did a lot to make the US system look more like Germany and Switzerland.

It did not, because it still kept private insurance companies in control and still made it impossible to negotiate drug prices. It seems better than what came before it, but I'd argue it may have even done some damage, (in terms of the debate towards universal health care), since its failures are now ascribed to 'socialised healthcare' by its opponents and equated to a single payer system, whereas in reality it is in may ways the polar opposite.

[maxerickson]

Germany has private insurance companies and all US insurance companies negotiate drug prices. Even the specific drug prices that the talking point says Medicare should be able to negotiate are negotiated (by the private companies that administer that part of Medicare...).

Most Germans are covered by "sickness funds" but those with higher incomes have the option of buying private insurance. And the sickness funds aren't really single payer, spending is negotiated regionally, not at the national level.

[AsyncAwait]

> Germany has private insurance companies

Yeah, practically every country does, if you want it. The problem in the US is that it is practically the only option for many, not a choice.

> and all US insurance companies negotiate drug prices

But that's the problem, it should not be done by private companies, but by a state/national body with more power.

> Even the specific drug prices that the talking point says Medicare should be able to negotiate are negotiated (by the private companies that administer that part of Medicare...).

Yeah, private companies...

> Most Germans are covered by "sickness funds" but those with higher incomes have the option of buying private insurance.

I am not saying anything about the option of buying private insurance, I am saying it should not be a requirement for basic coverage.

> And the sickness funds aren't really single payer, spending is negotiated regionally, not at the national level.

That is semantics, the principle is the same.

[krrrh]

In Germany private insurance is the only option for self-employed. It is precisely a mandated requirement for basic coverage. The two "public options" are not available to freelancers, and anyway the public options are more akin to competing non-profit insurance companies than state-administered health care like in France, the U.K., or Canada.

Buying insurance is also a pain because unlike in the US under ACA, German insurance companies are able to charge higher premiums for pre-existing conditions up to a mandated Basispreis (approximately 3x a healthy person's rate - somewhere north of 600€ per month). Pre-existing conditions can include a hospital visit with a null diagnosis.

There's a lot more to it, but I get frustrated when people talk about European-style health care as if it means something concrete, when there are such a wide range of policies across Europe.

[maxerickson]

Abusive drug pricing would go away nearly instantly if the Medicaid formula considered the lowest effective price paid (by accounting for rebates when calculating Average Manufacturer Price).

It's really only patented drugs where it matters, most generics in the US are all but free (the exceptions to that pattern mostly have few users).

[refurb]

What? AMP accounts for rebates.

Add in the Medicaid rebate and Medicaid pays almost the lowest price in the US for drugs. I think the VA is the only org paying a little less than that.

[ahupp]

The Swiss system has mandatory private insurance. It's very ACA-like.

Drug costs are 10% of health expenditures in the US. Not sure this is a critical issue for controlling costs.