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Comment by simonsarris | Hacker News Reader

> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down.

Why do you think this would be true? Why do you think the bargaining power would work the way you think it would?

If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case?

What about other goods? Laptops? Cruise missiles? etc.

Actually is it true for any good which the US Gov is the sole buyer? Can you think of even a single good where your supposition is true?

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Perhaps this is a good reason:

>Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.

Really? So there are zero people from other industrial nations that come into the US for health care?

Zero people from other nations come to the US to save money on health care. The ones that do come are looking for specialists for some exotic condition, not because they love the level of care or the price tags.

And do you think those specialists would exist here if we had medicare for all? no, evidence: all those other countries that have that and no such specialists.

Yes they would. The Americans also go to other countries to seek treatment in special cases.

Also, if our healthcare works well to treat rich foreigners in special cases, but sucks otherwise — I say, we should scrap it.

But sure, we can cherrypick metrics all day long.

This is a great point more people should make. There’s nothing “America first” about preserving the inefficiencies of a system just so that very wealthy people from everywhere can get care and leave (and ultimately specialists would anyway still exist, even if their treatments aren’t covered by Medicare)

Actually, that's completely what "America first" means by those who say it, at the least the ones who are in on the deal.

if everyone had that specific knowledge, there would be no specialists. no, different countries develop different specialties. famously, Kobe Bryant went to Germany (a country with national healthcare) to get a knee procedure from a specialist.

It's not a one way street, though. Americans go to other countries like Canada or Cuba for health care, including, famously, GOP Congressman Paul Ryan.

But why those nations have lower costs isn't so simple. If you remove all profit and admin overhead from the US system, its still something like $5000/person more expensive than other countries (I think that that was vs Canada).

A large component of healthcare cost in the US is simply healthcare use. We are deeply, deeply unhealthy with 75% overweight rates and absurd levels of pre/diabetes, which are the largest comorbidities of all, and comorbidities of each other. Costs will never be comparable until overweight/obesity rates and usage are comparable too. They are not.

High prices in the US are very unfortunately largely explained by usage, and no amount of profit-reducing or cost cutting will work unless you are cutting usage itself:

https://randomcriticalanalysis.com/2016/09/25/high-us-health...

It's not just about cutting usage, it's about cutting the right kinds of usage as well.

Lots of Americans, anecdotally, skip out on regular checkups or checking on minor ailments because of anxiety about paying copays. And then eventually something that could've been easily treated when detected initially blows up into an expensive ER visit or requiring specialists.

A good chunk of this could be solved if we stopped using the ER as the catch-all emergency net for literally everything.

In the UK the NHS negotiates prices for drugs. NICE have to approve all drugs and if a drug is too expensive, the manufacturer either has to lower the price so that the benefit outweighs the cost, or they lose a large market.

This is why hand waving away "bargaining power" ignores one of the sources of high costs.

The other is that our doctors are mostly either employed by the NHS, or employed by a private provider who is paid by the NHS ... yes, there are doctors who do private only work, but they are fairly small in number.

Perhaps our student loans system also helps - fees are £9k a year, but you start paying them back at 9% of income over £25k ... so it's essentially a graduate tax and they are fully written off after a set number of years if you don't pay them off.

The difference in drug spending between countries amounts to a small fraction of overall healthcare spending. $1200 a year in the US versus $900 in Switzerland or $800 in Germany, Canada, and Japan.

It's incidental what the numbers are. Given how effed the US system is, I would fully expect that $1200 being spent on the entirely wrong things, like a few super expensive drugs, and a lot of antibiotics which should have been dirt cheap getting a ridiculous markup, or on Oxycontin.

Doctors should earn enough to pay the loan off

Cop cars aren't collectively bought. For one its on a state by state basis, and then in some states individual PDs are responsible for their own vehicles, they just get a budget to buy and fix them.

That means they usually end up in an imbalanced power relationship of small 20-30 person local PD force approaching Ford / GM asking for their police cruisers.

Some states, of course, do collectively bargain their service vehicles like that, the USPS is probably the most prominent example of collective bargaining on a national scale - the post office bought 140,000 of them over 7 years for below consumer grade vehicle pricing. Even nowadays when they are reevaluating replacing their fleets it only averages out to about 41k per truck for a new model and that includes having to refit garages and post offices to accommodate them.

I'm also pretty sure there are licensing deals between US auto makers and various state bureaucracies to price control service vehicle costs, but its still never like a private automaker is getting an order for 80k cop cars from one entity.

What other goods is the US Gov the sole buyer of, for which the sellers can't easily shift to other customers? Cop cars clearly doesn't apply, as carmakers have other customers. Doctors, hospitals, and pharmaceuticals will face true monopsony, which means sell at gov rates or quit entirely. Some suppliers will quit entirely, but most won't.

Wait, how much are you paying for cruise missiles? I always feel like my cruise missile guy is ripping me off.

This is how the NHS functions and it has far better rates.

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