| > They make their money on poor service and deceit -- charging wildly different prices for the same product where they can get away with it). You have that backward. Hospitals and doctors charge wildly different prices for the same product when they can get away with it. That's why you can... wink, wink, nudge, nudge... pay a lower price in cash. Because the hospital knows a cash price means that you are paying the bill directly, not a rich insurance company. In economic terms, hospitals have economic power to set prices. The elephant in the room is that medical doctors in the United States earn between about 2x and 4x (depending on specialty) more than medical doctors in France or England. Yes, two to four times as much. Where, exactly, do you suppose that extra income comes from? And that's when they're honest--medical claims fraud is a major issue. You know those "this is not a bill" explanations of benefits you receive when you go to the doctor? Well... it turns out that a fantastic lead for finding medical claims fraud is when a member phones their insurance company and asks "Hey, I don't remember this... why does it say ____?" Removing insurance companies from the equation will not radically change the landscape. The ACA set a lower bound on the medical loss ratio at 80%. That is, insurance companies must pay out in claims at least 80% of what they charge in premiums. Yes, some of that 20% is profit, but some is also intrinsic overhead for storing medical records, validating claims, etc. Do you think AWS lets France store medical records for free? So France pays 50% as much as the US. Let's say we take out insurance companies and pretend that you can administer claims with 0 overhead in fairy-tale land. Now USians pay 80% as much. Where did the other 30% go? At worst, insurance companies are a second-order effect. The first order effects are that we pay too much for doctors (because the AMA is a cartel that limits access to medical school) and too much for drugs. Just look at how forcefully doctors groups have pushed back at state attempts to expand the scope of work for PAs and NPs (whose licensing is not under the thumb of doctors, and thus can't be restricted in the same way). |
However, a lot of people in the US are morally opposed to "giving someone else a free ride", you can see the current hubbub around student debt cancellation. And doctors heavily fall towards the higher-income side of the scale, so they are precisely the kinds of people that everyone points to as being undeserving of student debt relief.
It is what it is, Americans are a selfish (ahem, libertarians would say self-interested) people, but you can't make this cost go away. People may not explicitly state it, but their preferences are obvious, they would rather pay 4x the amount to a private actor than have 1x the cost in taxes, same as the rest of the problems with our health care system. People are more worried about micromanaging what everyone "deserves" than overall cost efficiency, and they vote accordingly.
It's rather sad, in a way, that Americans can't grasp that having a more highly educated, more skilled society benefits everyone in the long run. Those people go on to pay taxes, and educated people will contribute a lot more in taxes over their lifespan than they cost in education, it's a long term financial benefit, but people abhor the idea of someone getting "a free ride", despite it being the most financially vulnerable and unstable portion of people's adult lives. It's just straight-up "I chose to be a plumber, why should I have to pay for some fancy doctor's education!?".