[bhelkey]

If your implication is that this is a private vs public spending problem, that's not it. Healthcare in the US (both private and public) costs dramatically more than in other developed countries.

Why that is is a bit complicated and doesn't have a single root cause. It's also a bit tricky because every major component blames the other components for the total cost.

Part of the problem (roughly 10% by one estimation I read) is drug prices. Drug prices in the US are >2x the price as compared to other developed countries [1].

[1] https://www.ncbi.nlm.nih.gov/books/NBK611301/

[rayiner]

> If your implication is that this is a private vs public spending problem, that's not it.

No, my point is that we couldn't achieve UK costs by doing "single payer." Our publicly funded systems, like schools and transit, are also cost-inefficient (public schools somewhat less so, public transmit somewhat more so).

[bhelkey]

Again, healthcare in the US is dramatically more expensive than in other countries. This is true for publicly funded healthcare (e.g. Medicare) and privately funded healthcare.

I already mentioned drug prices, another input in the cost of US healthcare is the cost of physician salaries. Physicians in the US are paid ~2x what physicians in the UK are paid [1].

One input to physician salaries is that we limited the number of new doctors by limiting the number of residency positions.

[1] https://www.physiciansweekly.com/post/how-do-us-physician-sa...

[rayiner]

I'm not denying it's more expensive. I'm disagreeing with your premise that we could reach the cost effectiveness of European countries. Europe and America aren't interchangeable. You can't achieve the same results in each just by turning the policy knobs to the same settings.

[bhelkey]

I reject your argument. It is easier to see when comparing the cost of goods. It is not a fact of life that goods in the US cost 2x the price of equivalent goods in the UK.

If I compare the prices of a PS5 in the US to a PS5 in the UK (excluding the 20% Tax), they are basically the same price [1].

If I buy a pair of 501 Levi's jeans in the UK [2] and a pair of 501 Levi's jeans from the US [3] I pay basically the same price (again excluding VAT).

If I buy a Ford compact crossover in the US and buy a Ford compact crossover in the UK, I pay basically the same price of ~$33k.

Please explain why it is a fact of life that a drug in the US costs considerably more than the same drug from the same manufacturer just purchased in Europe.

Why can we not compare the cost of drugs Canada, Japan, UK, Germany, ... to the price of drugs in the US?

And again, drugs cost considerably more in the US whether they were purchased publicly or privately.

[1] https://blog.playstation.com/2026/03/27/new-price-changes-fo...

[2] https://www.levi.com/GB/en_GB/clothing/men/jeans/straight/50...

[3] https://www.levi.com/US/en_US/clothing/men/jeans/straight/50...

[rayiner]

> I reject your argument. It is easier to see when comparing the cost of goods. It is not a fact of life that goods in the US cost 2x the price of equivalent goods in the UK.

Services aren't goods manufactured in a single place. Delivery of healthcare services in the U.S. versus U.K. reflect myriad factors that are rooted in differences between Americans and British people. Americans wouldn't tolerate the trade-offs in the British healthcare system--a system I think is very good, btw--for the same reason they wouldn't tolerate living in little British houses or driving little British cars.

> Please explain why it is a fact of life that a drug in the US costs considerably more than the same drug from the same manufacturer just purchased in Europe.

It's a policy determination to subsidize drug companies to make sure we get access to the latest drugs.

[bhelkey]

> Americans wouldn't tolerate the trade-offs in the British healthcare system

I do not believe this is true. Keep in mind that the UK has universal healthcare (NHS) but also has a private healthcare system.

The private healthcare system can be used to prioritize speed, comfort, elective procedures, ...

Around 12% of the UK population has private medical insurance [1].

> It's a policy determination to subsidize drug companies to make sure we get access to the latest drugs.

There are cases in which a drug is under extreme demand outstripping manufacturing capacity. In these cases, paying more can provide access to a limited resource.

However, to my eyes, this appears to be an unusual occurrence rather than the typical state of drug production worldwide. I don't see evidence that the amount the US pays for drugs results in dramatically higher access.

I believe the opposite is true. If a drug is available in a US pharmacy but it is unaffordable, does one have access to it? I would say no.

[1] https://www.theguardian.com/society/2025/jan/30/almost-one-i...