| Exactly. German perspective here: I pay for my public health care quite a lot. Probably around $10.000 a year pre-tax which is half coming from my employer and half out of my pocket. My wife is having a private insurance and is paying a little less. That is ok, even if I don't think her option should exist and the overall system is only working due to the gating for the private option. I'm earning above average and am paying for some who earn less. Any public option that covers a large population section needs to include some redistribution aspects. Because health care is too expensive for people on lower incomes. But it does not need to be as expensive as in the US i.e. twice as expensive as anywhere else and no better outcomes. Insurance companies are not the party that is benefiting the most. They make money and probably more than they should but this does not explain the difference. Most doctors are also not swimming in money. So where does it go? One is Pharma companies who are then using that money to do marketing. So Pharma Marketing gets a share including doctors taking money from that source (another whole can of worms). Larger hospital organizations and their management as one of the stronger buyers of services being able to push for high rates and low salaries. Bill adjusters, debt collectors, partly working in insurance companies (where they contribute to insurance cost) to deal with the chaotic billing, payments and non-payments. There are many, many who earn a good living who would not be able to get similar jobs in other advanced countries as these jobs simply do not exist. The US system is inefficient but there are powerful incentives for many to keep it going. It is really important to separate access from payment. Otherwise small wounds will fester until it is too late or really expensive. A good compromise imho. is having some small access fee (in Germany we had a once per quarter 10 Euro fee on top of a 5€ per prescription fee. That was too much for low income and too much paperwork and the former was scrapped) as we know there is a huge difference between demand for free services and services that cost $0.01. |