It's not just features of the "health care" system, there are many features of American life and culture that put us in a uniquely bad position:
- Higher rates of overweight and obesity than almost any other country. Obesity is a top correlate of most of the most expensive chronic conditions.
- Healthy food is less available and more expensive than unhealthy, ultra processed food engineered to be hyper palatable and not very filling. Govt policy that reinforces and subsidizes this.
- Infrastructure design that discourages walking. Culture that encourages sedentary activities and lifestyle in general.
- Being overweight and out of shape has been culturally normalized. Propaganda telling us that weight is genetic, out of our control, and we can be "healthy at any size" anyway.
- Work culture that leads to chronic stress and time deprivation worsening all the other problems and leaving people unable to expend the time and energy to avoid chronic problems proactively by losing weight and being active.
I’ll fight you on your second point, though I feel the rest are valid.
Healthy food is not more expensive than ultra processed food. Easy healthy food is. You can go get quite a bit of basic meat and veggies for very little money compared to some Hot Pockets or McDonalds or whatever. I can make a stew for $15 that’s at least two meals for my family. Chuck roast, carrots, potatoes, onion, etc. Chicken is even cheaper.
Availability is only poor in areas where people won’t willingly buy raw ingredients. Food deserts are (largely) lazy oases.
Pick two. So you can have fast, cheap, but low quality food ('fast food'), or slow, cheap, good quality food (cooking at home), or fast, expensive, high quality food (decent restaurant).
By time I would also include mental overhead required, i.e. thinking about cooking. Unfortunately poor people often have neither the money or the time to choose quality.
The daft thing is that cooking individually, or indeed to order in a restaurant, is very inefficient. In fact it is possible to win on all 3, but this requires a communal style cafeteria as would be found in offices, schools, the military etc.
Wouldn't it be great if such cafeterias were available to the general public, with a limited but rotating good quality menu, using actual plates instead of single use plastic, bench seating such that singles would feel comfortable dining there, tap water on tap, self serve with trays.
You can find something like this in shopping malls, but often a wide menu instead of a rotating menu, so failing to scale and thus falling behind with quality
Poor people also often don't have cooking training. We used to teach basic cooking skills in public school but that's fallen to the wayside. If you grew up in a home where you weren't taught to cook (common in working poor households) you didn't learn there either.
One more thing, which might even be the most important, third party payments, which means the patient has almost no incentive to find cheaper options. This is exacerbated by the inability to compare prices built into the system.
I don't think a market for health is appropriate or could function correctly at the consumer level. If I'm ill, I want to get fixed with the currently understood medical best practice and in a timely manner - not look for 'cheaper options'. That is what universal/non-marketplace healthcare is intended to deliver - and to a first approximation does just that in many places, and any rationing necessary is done according to need, not ability to pay.
Even in those systems if you have more money you can get better and faster care. Something like 60% of Canadians have private insurance. I live near the border and several of my friends have visited the US for to bypass lines.
And they do this because they're only allowed to take a certain percentage of their revenue as profit. The more healthcare costs, the more they can charge and the more they can make.
The obvious answer here is that health insurance should not be privatized. Health insurance should be negotiating to keep costs low so that they can cover more, not letting costs skyrocket to make more profit.
Have you tried not being poor? We all know the poors don't deserve healthcare.
The answer unfortunately lies in Health Insurance companies existing and we don't really want to do anything else. Eventually they'll have to stop somewhere but with everything else going up what will give if not guillotines?
Even for the top 10% some hospital bills are "honey, we need to sell the car" money. They'll wipe 1-2 years worth of disposable income. A 10 day hospital stay + airlift back home can be 120k.[1]
No it’s not just health insurance to blame
Doctors and nurses (who are very expensive) cost money as well as the drugs and the research costs behind them.
I know Bernie and socialists love to blame health insurance, but doctors, nurses, hospital staff and drug companies would still cost money. See how much NHS costs are in Britain..yes they maybe lower per capita than in the US, but still HUGE
Unless the wages of doctors, nurses, hospital staff and the employees of drug companies have gone up 200% the last 20 years I seriously doubt they are the root cause.
An interesting comparison might be veterinary care, which has also been increasing for quite some time. The typical insurance model for veterinary care is quite different than human healthcare insurance.
However, one aspect in common is a consolidation of medical supply chain providers (decreased competition, rising costs for providers) and a proliferation of for-profit, private-equity backed, large healthcare providers who are able to negotiate prices and maximize profits by passing on price increases to those able to pay.
Private Equity has been getting in to veterinary care in a huge way, and many vet offices are cutting back on services and staffing significantly. It's very easy to see the change in motivation.
When you have for-profit healthcare, it’s not surprising that the system optimizes for short term profits over the well-being of healthcare workers or patients. People are willing to pay almost anything to stay alive and/or healthy.
Healthcare workers will be paid (and otherwise treated) just well enough that they don’t leave. Sadly, the incentives are awful for people who get into healthcare for altruistic reasons.
When you have state run healthcare there are a lot of wait lists. You can have an excess supply and ration by price or a modest supply and ration by waiting
Not all not-for-profit institutions are government run. Supposedly, there are more non-profit hospitals than for-profit hospitals. Although I am not in the industry, the cynical part of me suspects that some of these exist to shelter liability from profit centers.
When you have private for-profit healthcare you get a lot of wait lists. They come in the forms of "I can't afford that" and "I can still walk on that leg, I don't need to spend our retirement."
Much of the cost in the NHS is due to creeping privatisation and a mountain of PFI debt that could have been funded for a fraction fo the cost of what it bought.
NHS consultants working at their hospital privately. Hiring their own companies.
You're an NHS nurse, your pay has declined drastically in real terms and the job is increasingly stressful due to a staffing shortage. You spend part of each shift teaching a clueless agency nurse, who's costing the NHS 2-4x more than you, how things work.
The government has over the last two decades, gradually shifting more work to private services, despite paying more for less each time they do so.
> but doctors, nurses, hospital staff and drug companies would still cost money.
Doctors, Nurses, and staff are employees. They cost money, yes.
Drug companies cost money, yes. We, in the US, pay them a massive amount of money to socialize the risk and privatize the success. We should probably investigate that as well. The primary issue, however, is insurance companies. They're for profit. They need their numbers to grow. How do they do that? Cover less, raise prices for medication and procedures, and raise premiums.
Don’t get disabled either! Then you’ll have extreme medical bills you cannot afford that aren’t exempt from being reclaimed via garnishment! So you’ll be stuck with only social security and nothing else to survive on!
- ageing population, ironically because of the success of healthcare
- (US specific) avoidance of preventative/precautionary treatment for fear of outsized bills
- (US specific) wildly inefficient and predatory 'insurance' system