These are all good points. But what's interesting is that very similar things could also be said about the US healthcare system. And yet unlike American universities, it's not clear that American hospitals or healthcare is worldclass.
To give you an idea, I can pay $60 for a FaceTime call with an urgent care clinic. That exact same call is billed to my insurance for $200 or 333.3334% more than what I would pay. An inhaler is priced at $70 at my local pharmacy, but can be had for $15 with a co-pay (God knows what they’re billing insurance for the “rest”) or $12 without insurance and just a coupon I picked up from a doctor rendering one of the “benefits” of my insurance moot. I’m pretty sure the inhaler itself can’t be more than a dollar to manufacture, but whatever, the pharmacist has to get paid, right?
This, once again, owing to the exorbitant amount of money spent on healthcare both by the public and the government. A lot of people seem surprised that our government spends way more money on healthcare than a lot of other countries and yet the system disenfranchises the vast majority of its consumers.
In fact, US citizens subsidize the healthcare of other countries as well. The money we are forced to spend on absurd medicine costs goes directly into making it cheaper in other parts of the globe. The standard for treatment and care is decided in the US at the expense of her citizens, and then it is offloaded to the rest of the world where it becomes cheap. Doctors from other parts of the world go to medical school in the US, once again subsidized by citizens, and then go home and take that knowledge with them. If other countries paid their “fair share” it would likely result in total medical costs going down in the US.
If you need a pill, go to another country. If you need treatment for an extremely rare disease there is no better place than the US (supposing you can afford it). This isn’t so much a complaint despite myself being a victim of the system, but rather the reality of it. America subsidizes the cheap healthcare of the rest of the world. This is why, on a practical level, a system on par with Europe in the US is fiscally intractable. To both subsidize the world and continue to lead the standard of treatment and care, the taxpayer would be on the hook for an absurd amount of money. I’ve yet to see an accurate tax burden calculation but I’d imagine it would be several dozen trillion a year, or around a flat 800-1000% increase in current taxes along with trimming the budgetary fat.
The problem with US healthcare is distribution (a similar but less acute problem exists in education) and efficiency (same).
In fact you could argue that US healthcare priorities being so similar to our education priorities (i.e. spend a bunch of resources on the absolute best, particularly infinitely scalable research like pharmaceuticals, but then hope and pray for the underfunded rest) is what causes a lot of the criticism people levy against US healthcare.
But the US seems to have worldclass outliers in just about any field you can think of.