[donw]

... are you joking?

Healthcare is one of the most regulated industries in the United States.

Want to be a doctor? You've got the aptitude, the knowledge, the mindset, and the will, but a government-guaranteed cartel of medical schools won't let you in, so too damn bad. Learn to code.

Want to open a clinic? You really only need about a half-million in hardware to operate at the level of a 1980s hospital, but regulatory compliance will push your annual opex into the millions as a baseline, not to mention having to deal with the nightmare that is health insurance.

Those "massive entities" you mentioned are entirely protected from competition by force of law.

You know why healthcare used to be cheap? Nobody had insurance.

Anyone that had the aptitude and wanted to be a doctor basically could.

You went to the hospital, paid your bill, and that was that.

I'm not saying "zero regulation, caveat emptor!", but over the past hundred years, the precise opposite of "deregulation" has happened across every aspect of American life.

[vasco]

How come it's cheaper in places where everyone has insurance?

[speakfreely]

Because there's a single payor that tells providers how much things are going to cost. The short answer for why US healthcare is so expensive is that Americans are economically disconnected from the price of the healthcare they are consuming. There is absolutely no free market system happening there because almost all the costs are hidden behind insurance schemes.

[robertlagrant]

> How come it's cheaper in places where everyone has insurance?

Those places don't have a hellish Frankenstein's monster combination of public and private and a load of regulations at the federal and state levels all adding up to high costs that have to be passed on to the consumer, but also weird niches of market inefficiencies that can be exploited by anyone who's managed to luck or judge their way into an advantageous position.

They also don't fund most of the world's healthcare advancements, which the US does.

They also cut off care at a certain point, whereas in the US you not only have access to most of the cutting edge treatments in the world that just aren't available on single payer systems, as they don't provide enough value, you also can find someone to pay to do it. You can bankrupt yourself on cutting edge treatments if you like.

I don't know what the answer is, other than "try again" and have a nice multi-insurer model, which I think one of the Scandies has, that just competes on efficiency and has its payouts and insurables defined by government, or maybe a single payer model. Or make healthcare a state-level problem and have each state solve it differently without federal overhead.

[sgerenser]

Providers also make a lot more money in the U.S. than in other countries. This encompasses much more than just doctors, but try running on a platform that’s seen as “cutting doctor salaries” and see how far it gets you.

[estebarb]

The problem is private insurance companies + private hospitals. They shouldn't exist.

Healthcare is an inelastic service: people will pay everything to get it. So private hospitals in a free market are pushed to bill their services as higher as possible. Actually, their prices would go to infinity, if not limited by people total savings and earnings.

So, here the insurance companies make the problem worse: they give people access to "infinite" credit. So you can pay for those exorbitant prices. But with insurance you just increased the pool of money people can use for health, so private hospitals can and will increase their pricing. Add more free market competition and you get the disaster of the USA healthcare system.

Because of that reason, basic economics, is that for profit Healthcare cannot work long term. The only way to make it work is making it a public service. But in USA politicians will cry that is comunism, so they won't do it.

And the USA Healthcare problem doesn't limit itself to USA. As americans are unable to pay for healthcare there, they started doing medical tourism, which is making health prices in other countries more expensive too.

[donw]

Japan has private insurance companies and private hospitals, many of them, and does just fine.

[rqtwteye]

Because everybody besides the US regulates prices.

[dennis_jeeves2]

>Want to be a doctor? You've got the aptitude, the knowledge, the mindset, and the will, but a government-guaranteed cartel of medical schools won't let you in, so too damn bad. Learn to code.

Will be consider mostly stupid/irrational, but I'll mention it:

Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons.

As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.

[skissane]

> Healthcare is one of the most regulated industries in the United States.

And yet other countries have even more regulation, and manage to deliver cheaper and more equitable healthcare overall, with better public health outcomes when measured at the national level

For example: in Australia, the federal government is a near-monopsony purchaser of prescription drugs, so it has enormous negotiating power with the pharmaceutical companies. By contrast, in the US, the federal government’s role in purchasing drugs is much smaller: the end result is higher drug prices, although the downside of Australia’s model is it can delay availability of new drugs. (Those with unlimited ability to pay can still purchase drugs privately at whatever cost the manufacturer will sell them-you can even get bureaucrat approval to import unapproved drugs for personal use if you can find a senior clinician willing to assist you in it.)

[ipaddr]

Most Americans don't want equitable healthcare they want the best they can afford and they want the newest treatments available.

The waiting for the patent to expire and buying in bulk keep down the costs down works. The US couldn't use the generic strategy because the drug companies get funded and create the new drugs this way. Cutting off the funding would mean no new drugs to copy so no new generics. Australia would have to start funding research.

[donavanm]

As sibling mentioned thats not the model. From what Ive seen australia lags US access on the order of 6months to a few years for most things. Effectively theres an additional review period where TGA reviews foreign research and approval before (generally) allowing and entering it to the ARTG and PBS with the relevant prescribing advice. Once its on the MBS/PBS the patient gets access through their prescriber and/or chemist.

The PBS listed medications are essentially price capped copays at the point of sale, with the bulk of the cost covered directly by the government (who negotiates prices with the manufacturer, and fronts the pharmacist distribution costs). Its the same pfizer etc patent protected medication, unless theres a generic version which chemist & prescriber can vend with patient consent.

[skissane]

> The waiting for the patent to expire

That's not what the Australian government does.

Even for prescription drugs still under patent, the federal government negotiating on behalf of the whole country as a monopsony purchaser can demand (and get) much bigger discounts. (A monopoly is when a market effectively has only one seller, a monopsony is when a market effectively has only one buyer.)

Whereas, in the US, each insurer negotiates separately, so all but the very largest have weaker bargaining power than the Australian government has, simply because they don't represent as many insureds. The US has over 1000 health insurers, only the top two or three (such as UnitedHealth Group) have more insureds than the Australian government has (26 million).

Plus, even though a handful of very large US insurers such as UnitedHealth have more insureds than the Australian government does, the fact that the Australian government is a sovereign state and not just the purchaser but also the regulator and legislator gives it additional negotiating clout that such private insurers lack. Also, if UnitedHealth refuses to reach a deal with the drug manufacturer, they risk losing insurance customers to other insurers who are willing to do so; Australians can't realistically switch public health insurers (moving overseas is the only real way; private health insurance usually has very modest prescription drug benefits)

> Australia would have to start funding research.

Australia actually does have significant medical research funding. Unfortunately it seems to be a struggle to find good data on exactly how much (in easily comparable terms, such as %GDP) – the WHO's statistics [0] on this topic are missing both the US and Australia for whatever reason. But even in the absence of hard figures, I'd totally believe the US spends at least double (on a % GDP basis). But I think that's part of a broader economic problem with Australian underspending on R&D (both public and private) which goes beyond just health.

The other problem I know, is Australia has largely lost its ability to productise pharmaceutical innovations (outside of certain niche areas), which means even when some novel drug is discovered in Australia, they need to turn to to a US or European company to turn it into a product. But that's more a consequence of poor industrial policy (most of Australia's pharmaceutical manufacturing sector moved overseas, and what's left is mostly lower-end stuff like vitamins and herbal supplements, with rare exceptions such as CSL) than anything to do with drug pricing.

[0] https://www.who.int/observatories/global-observatory-on-heal...

[robertlagrant]

> But I think that's part of a broader economic problem with Australian underspending on R&D (both public and private) which goes beyond just health.

That doesn't matter to this point. What matters is the US pays for the R&D that Australia gets to benefit from. You can stop R&D and drive down prices, as long as you're comfortable making world drug discovery grind to a halt.

[tomrod]

100%. Deregulation hasn't happened. Regulatory capture and loss of effective regulation have both happened.

[nradov]

You're confusing cause and effect. Health care used to be cheap because it couldn't really do much beyond treating some minor injuries and infections. Until about a century ago, what we had was barely a step above witch doctors. Health insurance or lack thereof only started to become a major issue when care delivery started to become more effective and expensive.

[skissane]

> Until about a century ago, what we had was barely a step above witch doctors.

By the late 19th century, we already had general anaesthesia (developed starting in the 1840s), antiseptics (we’ve had them for centuries but their use became much more common in the late 19th century as the germ theory received broad acceptance), smallpox vaccine (very late 18th century development), a number of drugs (some known since antiquity others newly discovered), etc. Yes doctors were a lot more limited in what they could do back then, but even within those limits they saved people’s lives all the time. If your arm had gangrene, they could amputate it under general anaesthesia, antiseptics to try to prevent infection, and provide post-operative pain relief - which could literally save your life. Women with breast cancer received mastectomies (known about since antiquity but became much more common in 19th century, especially as general anaesthesia made the surgery more tolerable)-due to the lack of chemotherapy or immunotherapy, that wouldn’t do much for those with more advanced cancer, but if the cancer was sufficiently localised could be curative and lifesaving

[FireBeyond]

You also forgot that you'll have to apply for a Certificate of Need, which (while simplifying) allows other clinics and hospitals in the area to say they think you should be allowed to, and it won't cause them to have too few patients to see...