[lmm]

> Something about the US system causes outcomes to be better for people with insurance than they are in most other countries.

No it doesn't? Outcomes for lower-middle to lower-upper class people (people with insurance, but without enough money for custom treatment etc.) are normal for an industrialised high-GDP country, not particularly better than comparable countries.

> The question is how to fix it.

As with so many problems in the US, maybe you could try doing what works in other countries?

[AnthonyMouse]

> Outcomes for lower-middle to lower-upper class people (people with insurance, but without enough money for custom treatment etc.) are normal for an industrialised high-GDP country, not particularly better than comparable countries.

Basically nobody has money for "custom treatment" -- it takes years to do medical research, if not decades, with no guarantee that it will pan out before you die. If you're rich and you get diagnosed with something, you're getting the same drug as anyone else (because nothing better is known to exist), in a comfier room and possibly with marginally faster lab results. And if you did manage to spend a billion dollars to actually cure the thing, everybody else gets the cure too.

The rich people in other countries come to the US to get largely the same treatment as ordinary people in the US with insurance get, and it's not for no reason.

> As with so many problems in the US, maybe you could try doing what works in other countries?

This is a structural problem. The US constitution was drafted with the intent of having a weak federal government and doesn't include the right kinds of checks and balances to thwart corruption when there are large federal programs -- and some of the most important preexisting ones were removed, like requiring federal taxes to be apportioned and having US Senators elected by state legislatures so they would dampen federal overreach.

But it's not clear how to unscrew the pooch. Typically that sort of change happens following some turmoil, but those kinds of events can just as easily make it worse as better. You need to have someone in power who is willing to institute formal limits on their own ability to be corrupt, in a system where those currently in power are corrupt and interested in using their power to maintain that as the status quo.

Also, many other countries have equivalent problems, and some other countries have only solved them in ways that create different but at least equally undesirable problems.

[lmm]

> Basically nobody has money for "custom treatment" -- it takes years to do medical research, if not decades, with no guarantee that it will pan out before you die.

No-one has money for original research, sure, but there's a level that's above "going to the place you would normally be referred to for condition x" where you instead go to the best hospital in the world for condition x, get treated by the world leading expert on condition x, etc.. And that level is not generally covered by regular people's medical insurance in the US, nor by public healthcare systems in other industrialised countries.

> The rich people in other countries come to the US to get largely the same treatment as ordinary people in the US with insurance get, and it's not for no reason.

They do? Are there really more people coming to the US for medical treatment than other wealthy industrialized countries, once you control for size? (Like, I'm sure "the best hospital in the world for condition x" is in the US more often than it's in Switzerland, just as a function of there being more people and hospitals in the US, but I'd be surprised if that's still true once you control for that). And are the institutions they go to really accessible to regular people with in-network rules etc.?