[zanny]

There is tremendous waste in US healthcare. For every doctor there are a dozen accountants, marketers, insurance reps, sales reps, etc. Tons of bureaucracy trying to get a slice of that grotesque money pie.

The model you describe, a town subsidizing a few, is why the optimal state of healthcare affairs is the whole of a nation (through taxes) providing healthcare to everyone. It maximizes your healthy pool to offset the costs of the sick.

[dilap]

Another factor is we're just really unhealthy. Diabetes is exploding, obesity is exploding, Alzheimers is going up, cancer is going up...

[zanny]

Turns out another part of keeping healthcare costs down is curing the sick as early as possible. In the US, even if you have insurance, you still often have deductibles and copays that strongly disincentivize you going to the doctor. So you don't, until that cold turns into pneumonia or you tear your trachea from a bad cough.

Theres a completely different mindset in the first world compared to how people in the US behave - if there is anything unusual "its better safe than sorry" in any European country. You still go to the doctor even with a "routine" illness because there is often no expense to you to do so.

But that is the right behavior. You want that at the societal level. Because for every false alarm there is someone developing a crippling or lethal ailment that will dramatically reduce their productivity and cost you substantially more than 15 minutes of consultation and 30 pills would have had they seen a doctor right away.

The US is killing its own citizens to line the pockets of the money hungry just by having its healthcare system be insurance based at all, regardless of if people are insured or not.