There is a large number of people who are actively opposed to the "wrong" people receiving anything, even if it means cutting off their own nose.
There are some people who feel very strongly that it’s unfair to give out benefits such that the people who worked hard and took care of themselves are no better off than people who did not work hard.
For example, regarding student loan forgiveness, I have heard people say: “I struggled for years to pay off my student loans, but now the government is going to just cancel everyone else’s debt? That’s like punishing me for being responsible and rewarding people who didn’t sacrifice for putting the problem off.” And I can see how someone would feel that way. It would be more fair to track down everyone who had student loans and refund the full amount for all of them, including people who had already paid them off.
I’ve also heard friends who are legal immigrants oppose amnesty for illegal immigrants because they feel it’s like punishing everyone who went through all the trouble of the legal process.
I don’t think you can actually prove they are right or wrong in their argument. This is exactly like the parable of the prodigal son, so it’s an ancient human dilemma that giving grace and generosity to people who are in need tends to make people who are one notch up the ladder feel bitter that when they needed help they didn’t get it, and that their hard work is somehow invalidated by the fact that others got something for free when they had to work for it.
Finally, there’s always a question of who pays for things, and some people just feel that - while they’d prefer some government benefit in theory - they aren’t willing to pay any more in taxes in order to get it.
Considering the US has a track record of relatively high total taxation (when you add up all the local, state, and federal entities), while receiving generally poor public services, there are plenty of people who feel the answer is to stop “wasting money” on the problem and expect the government to become more efficient or better at providing services before they’d support any more taxes.
Yet most of those countries have cheaper/better/cheaper and better health outcomes.
'The supply of doctors is constrained' is largely a red herring.
This doesn't explain the disproportionate costs of decades-old medications and procedures still using decades-old methods.
You can maybe justify high drug costs based on that, but drug costs are a small fraction of overall medical costs.
Note in not saying this is ethically fair or optimal, just that it’s a consequence of the particular system
Your theory does not explain why the other 86% is so bloated.
Beyond that, you may be conflating prescription costs with drug research, which is not the same. The fact that prescription costs take up roughly the same percentage of total healthcare costs seems to support my point. An equal percentage of a bigger pie would indicate they are inflated.
My personal stance is that the US optimized for access and quality at the expense of cost. As the saying goes, you can only have two. R&D spending is a large part of this. The US contributes over 40% of the worlds medical R&D, effectively subsidizing other nations. It’s not a bad thing and it doesn’t explain away all healthcare costs but it does create systemic ramifications. It’s been awhile since I’ve viewed the numbers, but the US had the highest health access and quality scores for a country of comparable size. Off the top of my head, I think the next closest was Russia. Again, the point being simple comparisons are harder than one may think when dealing with complex systems.
I keep harping on drug prices, because you keep mentioning R&D. R&D is not the reason for why non-drug healthcare is so expensive. There is no mechanism by which high R&D costs lead to high specialist/GP/nursing/administration costs. There's no way for, say, Pfizer to siphon money from any of that into R&D. R&D is not the reason for why these costs are so high.
Related to your comment about the difficulties in comparison, you underscored my other point. People flippantly say “but look at country X’s costs” without understanding the nuances that make such comparisons worthless.