[lenerdenator]

A problem is that health insurance has no bare minimum to compete against. There is no saying "alright, fine, your rates are insane so I'm gonna just go with the state-operated option". That's more-or-less what happens in most Western countries; you can still get private insurance which gets you faster/better treatment, but if you're a fairly healthy person who just wants to cover their bases for a catastrophic occurrence, the state will do that for you. If the private guy wants any of your money, he has to justify it with more than "what happens if you get in a bad car accident or get a cancer diagnosis?".

In the US private insurance is the only way to go, and many of them are operated by people who have profit motives, even if they themselves work for an entity that is non-profit.

[bluGill]

In the US private insurance from your employer is the only way to go. My company puts in a lot of money towards my health insurance that I lose if try to find someone else. I can in theory find a different private insurance but there is no competition as no private can afford to compete with deal my company has - either they have to provide substantially worse service or they have to charge substantially more than my employer.

Since I don't have a real choice nobody tries to serve me. Complex billing and codes I don't understand - the people paying the bills like that.

[Symmetry]

Most Americans are only familiar with the US system and the completely socialized systems in Canada and Britain. Something like the French system isn't really politically on the table here.

[tracker1]

I'm of a similar mindset... even though I'm very libertarian in mindset... I think that all the current spending between Medicare/aid, VA Medical, Federal Employees and other programs would be better served by a govt backed non-profit insurance corporation, maybe a little more self-goverened than say the USPS. If federal employees and politicians had to deal with the same "plan" as everyone else as a baseline option, that would provide for better competition. Full negotiating power would also be necessary.

This should be combined with a 50% domestic production and at least dual sourcing requirements for all FDA regulated medications and devices. Both for strategic security, as demonstrated during the pandemic and necessary given political shifts. It would also have the side effects of requiring licensure of medical patents as well as at least some more open knowledge.

Blocking pharma ads would help a lot as well. Unfortunately, pharma is the single biggest advertiser as well as one of the biggest political donation blocks by a wide margin.

[bdzr]

> Blocking pharma ads would help a lot as well.

I don't really see how blocking ads for things help, I also think they serve a really valuable purpose. IME Doctors are so stuck in their first decade of work (CE programs are mostly a joke) that there actually needs to be a forcing function to get them to learn about new drugs. If they start irresponsibly prescribing drugs then that's not the fault of a company advertising drugs that have gone through the most rigorous approval process that exists in the world.

[tracker1]

There are pharma reps all over doctors offices. They're definitely aware.

People are generally over medicated and the drug pricing has nothing to do with actual costs for either research or production. Similarly for advertising highly processed "food".

[JTbane]

IMO there should be a medicare-for-all option that would provide the bare minimum of care, funded by increasing the FICA tax rate.

No doubt this would be politically unpopular with the right-wing and libertarians.