[vineyardmike]

Revenue is an incomplete signal of the complexity and waste. It’s just a signal of the money flowing through. A “single payer” system would probably also show a huge revenue number even if the profit was <=0. There’s just a lot of money and a lot of people who are patients.

I don’t disagree that the system requires change and is extremely complex, however.

The real problem is that it’s nearly impossible to “scale” healthcare and keep it personalized, and people want personalized healthcare - because that’s shown to be more effective healthcare. Doctors can only see a limited number of patients a day, and they need to be paid some compensation commensurate with their skills and efforts. That alone makes it hard for everyone “healthy” to see a doctor often enough and for long enough to get deeply personal care. Most people realistically can pay out of pocket for preventative care. $100-200/yr for an American isn’t crazy. Even most drugs are super affordable out of pocket if the profit margins are kept low (which is started to be available, bits at a time).

The real complexity, of course, is the long-tail where a few people get cancer and car accidents and other serious conditions which swamp the costs of everything else.

[marbro]

I don't think $100-200 per year for preventative care is enough. I reckon $1000-$10,000 per year, depending on age, is more accurate. You should spend at least $500 per year on nutritional supplements like Vitamin D. Switzerland has a better medical system that's cheaper than our system, but it's still expensive.