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> But, profits cannot be damned, at least not if you plan on being a going concern. At some point, the companies need to make a profit otherwise they go out of business and cannot provide any healthcare at all.

More than a handful of the BCBS health insurance companies run as non-profits. Other countries find a way to make it work without shoveling money into the gaping maw of retirement and pension funds. Hell, even profits are fine. No one expects the people at these companies to work for free. They just expect to receive coverage when they have it deemed medically necessary by a doctor. If that means that c-suiters make a max of $500k a year and that the institutional investors have to kick rocks, that's what that means.

> My point is not that UNH is a sterling example of healthcare service but to point out that the narrative justifying the public outrage is not really logically coherent or supported by evidence.

We have type one diabetics rationing their insulin to the point that they die, while the people who run the companies that are supposed to help cover the price of said insulin make millions of dollars in compensation per year. The American male has a median lifetime earnings of $1.8 million. This isn't logically incoherent or not supported by evidence; if you have a pulse and have looked at American news over the last 15 years, you'll have seen stories about people being screwed by their insurers, sometimes to the point of literal death.

> If you have private insurers, they will need to make profit.

See above.

> Also, public healthcare is not the panacea that it seems to be promoted as. Healthcare is expensive and at some point, limits will be placed to avoid bankrupting the system.

No one's suggesting it's perfect, just that it's better than having profligate executives and major shareholders insult your intelligence by telling you they just don't have the money to cover your claim for prescriptions and necessary procedures after you paid the cost of a decent used car in premiums over the last year. Even wait times seen in socialized systems could be tolerable to those who otherwise would not get to see a doctor.

I don't think a government-run health system would solve all problems either but it would address a lot of problems re: access, affordability and having a health baseline. Obviously doctors, nurses, supplies, etc are a finite resource and so they can't see everyone all at once so you have to prioritize based on need and severity. I think that's fair compared to... prioritizing based on who can pay.

Why can't US pretty much just directly copy-paste the entirely private (more so than in the the US since there are no Medicare/Medicaid equivalents) Dutch or Swiss systems, though?

If a government-run health system is such a contentious issue... turns out privatized healthcare can work just fine if there is sufficient regulation.

The US did essentially copy and paste the Swiss system. That's what the ACA was modeled after.

It left out a few key bits though - like requiring those who sign up for healthcare backpay premiums for the entire period they were uninsured to whoever they sign up with.

Also AFAIK drug prices are fixed nationally and negotiated by the government?

Then the basic plan is around 300-400 CHF (regulated by the government) and the deductibles are capped at CHF 2,500. This seems to be covering the overwhelming majority of costs (if we exclude government + cash) since the volume the market for premium/supplementary coverage seems to be pretty small (<20%):

https://www.deloitte.com/ch/en/Industries/financial-services...

> there is minimal waste in the system (jury is out on that one).

How could that be? Unless that's sarcasm..

I mean the US government alone (so excluding all private spending and insurance companies) spends more on healthcare per capita than many European countries which have universal healthcare.

Switzerland has a pretty much entirely privatized healthcare system (in theory too a much higher degree than the US) which is (relatively) well regulated. Also considerably higher median salaries and GDP per capita (albeit disposable PPP income is quite a bit lower) yet they spend 35% less on healthcare than the US.

My understanding is a lot of difference in healthcare spending in Europe v USA can be explained by the cost of pharmaceuticals and the fact that we have fancier (read more expensive) stuff.

The pharmaceuticals pricing is due to the factor that pharma companies believe they can charge higher prices in the US than anywhere else so the US consumer effectively subsidizes the rest of the world. I'm not sure how to solve this problem in a way that lowers prices AND maintains availability of the drugs. The obvious solution is to demand that pharma companies lower prices in the US, but (assuming they are unable to increase prices in Europe) this will just lead to some (many?) drugs not being profitable and reducing availability of drugs for all.

As for the fancier stuff, we do want to have fancier stuff. That means you get better healthcare outcomes for some pretty sick people. We should not want to cut that out. We're in trolley experiment territory when you start discussing whether it is better to have a life-saving, but expensive, procedure available but not everyone can get it because of cost or to not have the procedure available at all for anyone.

There is absolutely 100% of the same stuff used in the US, just fancier names.

Other countries reduce cost by having the state negotiate instead of many small insurance companies all negotiate separately. This is why other countries get a better deal because they offer a larger base of future sales.

Don't the Swiss also have very fancy stuff, though?

But yeah, drug pricing might be a significant part. I'm not sure about the reduced incentives for pharmaceutical companies, though? From what I understand the system is very inefficient, there are a lot of middlemen (i.e. waste) involved and price discrimination going on so a lot of that money might not necessarily be going to the drug companies doing the research.

Our stuff isn't fancier than their stuff. They administer the same drugs, they buy MRIs from the same manufacturers, their scapels are just as sharp.

My $25k single milliliter of fluid (https://imgur.com/a/HzqgLa2) costs the NHS about $4k in the UK.

It doesn't close much of the gap. Prescription drugs represent ~9% of healthcare expenditures in the US.