[Mirioron]

They also tend to have tax burdens that are 50-100% greater than what the US has. The main problem with US healthcare is that prices have gone out of control because there aren't market forces to keep it in check nor does the government keep it in check. This means that prices can soar.

On the other hand, when somebody has a rare disease or wants the absolute best healthcare then they are likely going to the US.

[welterde]

Aren't the insurance companies private in the US? Why don't they keep the prices in check?

And the US isn't the only destination for such medical tourism (anymore)..

[AnthonyMouse]

> Aren't the insurance companies private in the US? Why don't they keep the prices in check?

The entire US system is a disaster. There are major tax incentives for employers to provide health insurance, so they do. But then it's corporate executives choosing the insurance policy, and the one they choose affects themselves and their families, and is tax-deductible compensation, but they're spending the shareholders' money instead of their own. Meanwhile the insurance company is happy to sell a policy that covers more stuff for higher premiums. And everybody hates it when the insurance doesn't cover something -- it's bad PR for the insurance company, bad employee relations for the company who chose that policy and bad for the employee who is sick and denied coverage.

So all the incentives line up for there to be very expensive insurance policies that cover everything no matter the cost. And once you have a policy like that, the patient has no reason to decline unnecessary tests or choose lower priced alternatives because the insurance is paying for everything.

The insurance company can try to negotiate prices, but that only works in a competitive market. Many things are patented and there is only one supplier, who knows the insurers are captive buyers. Even when there are multiple suppliers, they all have to pass on the same regulatory compliance costs. And the insurance company itself imposes a large amount of bureaucratic overhead on medical providers to try to prevent insurance fraud, but the cost of that overhead then gets built into the price. Plus the cost of the insurance fraud itself, which is hard to detect when the provider and the patient are both in on it.

The way to make health insurance work is for it to actually be insurance, i.e. it only covers major catastrophes with a multi-thousand dollar deductible and everything else is out of pocket. Then the insurance would cost less than half what it does now and the amount paid out of pocket for substantially everyone would be less than the difference in insurance premiums. People would then have the right incentives to compare prices and refuse unnecessary procedures, none of the routine medicine would have to involve insurance paperwork, and less insurance coverage would mean less insurance fraud.

But everything in the US regulatory environment is configured to prevent that from happening.

[pgeorgi]

> The way to make health insurance work is for it to actually be insurance, i.e. it only covers major catastrophes with a multi-thousand dollar deductible and everything else is out of pocket.

Health insurance is also cheaper if certain preventative measures are taken, so it's in their best self-interest to cover those, too (and also to make being up to date on them attractive).

For example, German insurance covers annual dental checks and reduces the copay on dental work if you have been up to date on those checks for a number of years because that's cheaper than dealing with the fall-out.