Compare and contrast with a US doctor who has a number of support staff, one of whom is probably full time doing nothing but insurance paperwork.
IDK all the details, but when the US looks more bureaucratic than Italy of all places... something isn't right.
Of course it's definitely a complicated system and more expensive end of life care is probably part of it too.
- End of life care in the US is indeed a lot more extensive than in other countries.
- As davidw said, administrative overhead throughout healthcare is ridiculously inflated due to the nature of having to deal with insurance companies and billing. This is both people and software.
- Drugs generally cost a lot more than they do elsewhere in the world due to a lack of regulation on costs and the need of pharmaceutical companies to recoup their development costs by charging Americans more than they can make elsewhere.
- Without a single payer system, billing is completely ridiculous and leads to hospitals way overcharging for services, knowing that insurance companies will negotiate it back down.
- Hospitals are required by law to treat everyone, even uninsured and homeless people who will never be able to pay for their care, so they have to charge more to everyone else to compensate.
- The profession of doctor in the US is a weird semi-monopoly setup with artificial constraints on how many new doctors enter the market each year. As a result, you end up with people spending a good chunk of their lives studying to be a doctor, regardless of what kind, and taking on huge debt until they become a "real" doctor. The end result is that the profession makes a lot more money than it does in other countries.
- Because healthcare in the US is so expensive even with insurance (the amount you have to pay before your insurance kicks in can easily be thousands of dollars a year), many Americans don't use healthcare for preventive care and thus health issues that would be cheap to prevent become expensive to treat later.
- Hospitals in the US are mostly private and for-profit, with margins in the 6-8% range. That's money going to executives and shareholders rather than to actual healthcare.
I don't doubt that, but it's worth pointing out that they make good money - as they should - in other places too. My wife has a family friend in Italy, who has a ski house up in the mountains a motorboat on the Po river delta and regularly goes on fancy vacations. And that's as a general practitioner. I think most of us want doctors to be well compensated for the service they perform and would be wary of a system where that's not the case.
[1] https://journal.practicelink.com/vital-stats/physician-compe...
This blog series[1] by healthcare professionals goes through it all. The primary culprits are: more expensive inpatient care, more expensive outpatient care, more expensive drugs, higher administrative costs, higher insurance costs, higher health investment costs, higher disease prevalence costs, and higher defensive medicine costs.
https://theincidentaleconomist.com/wordpress/what-makes-the-...