The traditional economic view is that private, profit seeking enterprises actually offer better prices to consumers because of competition, while monopoly firms charge higher prices bc they have more market power, and government run enterprises yield lower quality products because they don't have incentive to compete on quality. India has a very competitive healthcare system that is largely out of pocket and while they aren't perfect, they do pretty well considering the size of the country and their per capita gdp. On the other hand, though it is common to praise "single payer" European systems, these systems are not without fault. France is actually trying to learn about innovative American models of care because their system won't be able to afford caring for an aging population
The US system is more expensive due to weird interactions of profit seeking and regulations, and idiosyncratic local systems, all exacerbated by lobbying and political issues (like hospitals being major employers in most counties). Arguably another part of the US healthcare cost premium is that the US invests the most in innovation
It's simply not true either that healthcare is cheaper by orders of magnitude than other countries. Using health care expense as % of GDP as a metric of comparison, the US is at 17-18% while France / U.K. / Germany are around 10-12%
Attributing the high cost of healthcare in the US is a bit facile and simplistic
> the US is at 17-18% while France / U.K. / Germany are around 10-12%
One has to consider that many people in the US don't consume healthcare because they can't afford it (hence the lower life expectancy), whereas in other countries everybody who needs it can access it, with almost no limit.
So the part of GDP represented by healthcare in the US is much lower than it "should" be; or, to put it another way, there's a huge growth opportunity if one can lower prices.
Incumbent actors may prefer profits over volume, but they're vulnerable.
One of the big reasons why healthcare is more expensive in the US is Americans get a lot more of it, particularly out-patient care (~150% of OECD average).
And other single payer countries certainly don't offer limitless levels of care. The gov't determines what it will pay for and nothing else. For Americans with generous insurance coverage, the care is much more limitless when you look at things like experimental treatments and the latest drugs.
Comparing it to the population then suffers from not accounting for the wealth of a nation. It may appear expensive due to a high cost of living and therefore high staffing costs, but it doesn't matter if everything else is also scaled accordingly. You also have to consider outcomes, spending much more to get slightly better outcomes might be deemed worth it.
That said, it doesn't matter which metric you choose, US healthcare does poorly in almost all of them.
It's relatively easy to keep the costs low in Europe: you pay in queues and cheap health care instead of money. That doesn't mean good-or-bad automatically. E.g. giving birth by C-section is a rare event in Europe but it's very common in the US, making the "born" event very expensive on average in the US. You usually get over-testing in the US and under-testing in Europe.
If you have a suspicious mole, or a woman reports pain in the uterus, in Europe you might wait one or two years before a doctor sees you. And then you might get just an "everything looks fine" or a mild painkiller, and start again to look for another specialists or just go to the private health. It's known, but somewhat silenced, that a significant number of heart/liver/kidney patients just die before they get to see the specialist because the system is overloaded. This payment-by-queue drives costs down, but is obviously a bad thing.
It's also known that the public health in Europe just don't cover some treatments, depending on the country. Or they are so overloaded that they just don't work. Think about that: you pay for a supposedly full health insurance, but if you're so unlucky to catch a Hepatitis C that it's not covered because the treatment is expensive, you just wait for your death. Costs are lowered, for sure.
Another side effect is that the top notch specialists in Europe earns about the same money as an average or a bad doctor working for the public health. This causes some of the said top notch to go to greener pastures: the US. It's very typical that the (rich) Europeans go to the US to receive cancer treatments. Thus the US costs are driven up and the Europe costs down.
This is complete bullshit. In many European countries you get screenings for most common tumors (bowel, for women uterus and breast) for free depending on your age. Cancer treatment and chronic disease treatment is top notch and you get it for free (you pay it with taxes), like everything else. There is no such thing as "not being covered because treatment is expensive"---I had to reread that sentence twice because I thought you were talking about the US.
Life expectancy is higher in most of Europe than in the US, which would be pretty hard to achieve if people died because of "death panels" and waiting lists to see a specialist. Plus prevention is actually a thing.
Elective surgery has a waiting list that can be weeks or months, but this doesn't translate to everything else. If it takes months to get an NMR, probably it was the patient that insisted to get a useless one. If your GP marks an exam as urgent you can get it within a few days.
There is no such thing as "not being covered because treatment is expensive"
There most certainly is. Look at what the UK's cancer fund is going through. It's not unusual for NICE to say "we're not paying for that". For people with generous insurance in the US it's much more typical for the insurance company to roll over and pay for the latest and greatest due to public pressure.
You are confusing treatment that is expensive with treatment that is not cost-effective. Also, the parent message was not talking about cancer but hepatitis C.
> If you have a suspicious mole, or a woman reports pain in the uterus, in Europe you might wait one or two years before a doctor sees you. And then you might get just an "everything looks fine" or a mild painkiller, and start again to look for another specialists or just go to the private health. It's known, but somewhat silenced, that a significant number of heart/liver/kidney patients just die before they get to see the specialist because the system is overloaded. This payment-by-queue drives costs down, but is obviously a bad thing.
Sorry but that's wrong. I've only used the health systems in the UK and Germany but in both countries, you can get an appointment either directly (if you're flexible with time) or within a few weeks. In urgent cases, all hospitals have specialised staff and will see you immediately.
Hell, even in my poor Southern European corner you might wait a couple of months for a scheduled appointment; I've never heard of waiting years for a GP consultation. An year is what my brother waited for surgery for a minor shoulder problem, not to see a doctor!
The average cost for vaginal delivery is not all that much lower than for C-sections, especially if someone needs/wants epidural etc.. Last US data I looked at showed average costs were something like 20% apart. The lower use of C-sections in most European countries is because it is only done if medically indicated - it has risks. People can, however, and do, do it privately in most European countries, and it is most places substantially cheaper than doing a C-section in the US..
> If you have a suspicious mole, or a woman reports pain in the uterus, in Europe you might wait one or two years before a doctor sees you.
If we ever came across a situation like that, we'd scream bloody murder to the nearest national newspaper. Maybe it happens some places, but my experience with healthcare in European countries does not in any way reflect what you describe. I'm in the UK now, and when I want to see a doctor, my experience is that I have never needed to wait more than a couple of days - most cases I've gotten an appointment same day. It's what I expect. If my GP can't see me fast enough, I have a number of walk-in centres I can go to (caveat is 2-3 hour waits). Out of hours or for something more serious but not an emergency, I can go to the nearby hospitals out of hours service. If I freak out, A&E will never turn you away (though they might scold you if you show up with something that you should know better about). If I'm unsure, there's a non-emergency number where an nurse will triage and either get a doctor lined up or tell you to get yourself to A&E.
Basically, if I have a concern that I think merits immediate attention, it will get immediate attention.
On the occasions I've needed to see specialists or have tests one, I've gotten it done within a week or two.
Yes, there are queues for some services, and especially surgeries, but after you've been triaged by primary care.
If it was like what you suggested most places, you'd expect takeup of private health insurance to be much higher, yet e.g. in the UK it hovers around 10%, most of which are employers offering it as a benefit whether or not you care about it (e.g. I have private insurance now; it made absolutely no difference to my evaluation of my employment offer, same for my ex). It's offered because it is dirt cheap (because most of them cover "add-ons" like seeing a specialist faster, and rely on the public system for most routine stuff) and perceived as worth more than it actually is.
> This payment-by-queue drives costs down, but is obviously a bad thing.
Queues are there because you are triaged by doctors, and clinical needs rather than ability to pay is what determines who gets treated first.
While mistakes happen, overall the high life expectancy in most European countries show that it's for the most part working very well. E.g. 2015 WHO data shows a life expectancy for the UK about 2 years higher than the US - in total 21 European countries in 2015 data had higher life expectancy than the US, including all of West / North Europe. The ones falling behind are the poorer Eastern European countries.
I'm sure there's room for improvement, and I'm sure occasionally people die because they wait too long, but the life expectancy shows the priorities largely work.
Another point is that the lack of queues in the US to a large extent is fiction: The queues are not there because a lot of people can't afford to use healthcare more. Even with insurance, if you have large co-pays etc., it doesn't take much before you use healthcare services less than you should. What a system that is free at the point of service does is give a full picture of the actual demand and ability to actually make decisions of funding and prioritisation based on clinical need. You don't have that in the US system.
> Another side effect is that the top notch specialists in Europe earns about the same money as an average or a bad doctor working for the public health.
I don't now of any place in Europe other than possibly Norway where this would be the case unless they themselves don't care to earn more, as most places top doctors can easily mix and match public and private services, and often do. E.g. in the UK a lot of consultants will do private surgeries, and will do so in NHS hospitals, as NHS hospitals can rent out spare capacity (and some run their own private clinics), and can earn a lot extra that way.
Esoteric or non-physical things, mostly. The NHS really sucks at trans issues, for example, where a two year waiting list is not unusual. It's one of the few areas that US healthcare sometimes does better in, where the state is one which permits informed consent care.
To be fair, if you're willing to pay US prices you'll also get immediate treatment. There are enough private clinics with no waiting list that will treat you immediately. But insurances that cover those are not much cheaper than US health care.
The US system is more expensive due to weird interactions of profit seeking and regulations, and idiosyncratic local systems, all exacerbated by lobbying and political issues (like hospitals being major employers in most counties). Arguably another part of the US healthcare cost premium is that the US invests the most in innovation
It's simply not true either that healthcare is cheaper by orders of magnitude than other countries. Using health care expense as % of GDP as a metric of comparison, the US is at 17-18% while France / U.K. / Germany are around 10-12%
Attributing the high cost of healthcare in the US is a bit facile and simplistic