Agreed, it’s crazy. Making healthcare contingent on employment is barbaric but aligned with other practices (like W2 tax withholding) where the government effectively deputizes your employer to enforce the civic contract.
I’d bet the $800/mo eyedrops this poor lady is relying on don’t cost that much in any other country (and I don’t mean poor countries - I mean in other rich countries like Japan, Singapore or Australia). So when she switches to Medicare as soon as she turns 65, how much are the US taxpayers paying for these eyedrops? It’s just wealth transfer from US taxpayers to the US medical industry complex.
So I fear “Medicare for All” would simply mean we pay even more taxes than we already do now and the US government will keep spending insane amounts of money on healthcare as compared to every other developed nation in the world with no better outcomes.
For example, if the generic option reduces the burden of disease by 10 DALYs and costs essentially ~0$ it will be fully covered, any other patented option with a 15 DALY average benefit will be covered up to a financial ceiling given by the total funding available and the extra 5DALY benefit it brings. A patented option that does not fit that ceiling will require patients to pay from their pocket, therefore cratering sales, therefore strongly incentivizing the pharmaceutical company to lower the price to fit the ceiling.
This is how other advanced countries lower spending on drugs without infringing on intellectual property - by forcing all manufacturers of all drugs for all diseases to compete on price, or risk selling basically nothing in that country until their patents expire. Since the marginal production cost of drugs is close to zero, it' always better to have some sales at some lower prices instead of no sales at a very profitable price.
I think in a way Americans are actually subsidizing pharmaceuticals for consumers in other countries because pharmaceutical companies are willing to sell the same product for less to them because as you said their marginal production costs are minimal and they have already recuperated a great return on their R&D investment from American consumers.
Another perspective is that this extra spending is more closely correlated with global pharmaceutical profits and the spending by these companies for their US sales and lobby apparatus (which influences Medicare prescribing physicians just as well), and much less with actual fundamental research and clinical study spending required to bring these drugs to market. So it's relatively speaking "wastage" compared to direct medical research spending - perhaps through a global research institution funded by major economies. Hey, we can dream.
As to why would Medicare leave these untold billions on the table, I don't know the details of how they decide what to treat, but it's a very tricky political problem. Once you start to deal with things like DALYs, QALYs and micromorts, you are plowing straight into the "death panels" controversy. So all pharma has to do is refuse to play ball, continue to sell most of their products into the open market, and watch their Madicare centralized buyers quickly fold. You can only force Pharma to play if you institute a national monopsony; a single program, even a big one, can't possibly work since by acquiescing they would threaten profits in the rest of the market. For the same reason, a single US state could not go at it alone, pharma would just refuse to sell to that state at the imposed ceilings; it needs to be a nation wide program.
Because drug lobbyists got the law changed to make drug price negotiation illegal. It's called the "noninterference clause". The inflation reduction act allowed some exceptions to this, but I don't expect this to last.
The way I see it, you will never wrestle away the trillion dollar bone from the mouth of the US healthcare industry, but you can make it wither away indirectly by creating a better universal system and dismantling the status quo. It's not like Europeans are forbidden the option of private insurance, it's just that it can't take hold and grow to control a significant part of the spending because everyone can see it's not the solution that will save you when you will get really really sick.
Seems ridiculous the US doesn't have it
https://www.commonwealthfund.org/international-health-policy...
Let's look at another country that has "great universal health care". Let's look to Europe, that's always "up there", right?
For statutory or public health insurance, you pay for your insurance through social contributions, the rate of which is 14.6% of the income as determined by the Federal Ministry of Health for 2024.
Pretty sure that's up but let's assume 15% of income.
And to not mis-represent Germany too badly - that 14.6% is split between the employer and employee
Let's take France. Looks like it's 8% you pay:
You’ll pay 8% of your income (that the French government is allowed to tax, after an additional standard deduction of around $11,000 per person). As a ballpark figure, an individual who has income to declare to the French government of $30,000 will pay around $1,520 a year in healthcare.
In order to make up the remaining amount in excess of the 70% reimbursement (80% for hospital stays), many French residents opt for private, or “top-up,” insurance. Several options exist, and rates vary from $36 to $72, on average, per month
> There is an income threshold—EUR 5,175 per month or EUR 62,100 (as of 2024), at which the percentage contribution is capped. What this means is that if your income increases, then this percentage remains fixed and doesn’t change with your salary increase.
Germany has a quite progressive tax scheme and the brackets are designed to be complementary, so that as income raises the pension and health benefits are capped while the general income tax grows more aggressively up to a total taxation rate around 45% for high incomes.
This is more than you would pay in the US but it includes both free healthcare for the rest of your life and a livable state pension after 67, and you get those benefits even if worse comes to worst and you suffer an accident, major disability etc. This is powerful social safety net that can't really be compared with what the American federal + state + private insurance offer you in return as benefits for your total tax+healthcare contribution.
Those incomes are by definition restricted to the top 5% of the general population - of course those top earners prefer not to be enrolled in a socialized medicine plan and prefer market insurance with a nominal price tag that is not proportional to income.
That's the entire point, to establish a social contract where the healthy and successful pay for the healthcare of the less fortunate, can benefit themselves from that social net if their fortune reverse, and deal with the risk they might never be net beneficiaries if they remain healthy and wealthy.
Given the option, high earners would argue that all public spending should be financed by flat nominal taxes, it's not like they personally require more work from the army or the police, or they drive longer distances on public infrastructure.
In fact some European countries have entirely privatized systems. Wasn’t the ACA based on those?
They are just mandatory and strictly regulated.
Getting to 60% for for such a deal shouldn't be too hard!
It is the most expensive and inefficient system but at least it's something.
Politicians love such unfunded mandates because they magically assert the problem is solved while not increasing the budget at all. But they create a humongous drain on the economy (those resources come from somewhere), and are ultimately a form of regulatory capture.
I certainly don't want it and nobody I know that actually understands the real cost does either. Every single nation that provides socialized healthcare is hopelessly strained by its cost, and the service has suffered as a result. The system relies on eithe dramatic reductions in the cost of healthcare or a positive birthrate to sustain it.
Nobody I know in socialized healthcare systems has good things to say about it when they actually need it.
You might think that this is merely because so many people in the US are not covered at all. But even when you account for people who are covered, the results are mixed at best. With the US performing slightly better in some areas, but much worse across the board.
I also know a few people who have moved back from the US, even though they had health insurance, just to receive better socialised medical care in their own countries. I also know of a who went to the US to get cancer treatment. None of that means anything really. The number of people you know and their uninformed attitudes are statistically insignificant.
Our system in Australia is absolutely fantastic, and far cheaper in taxes than you'd think.
I pay 30% in taxes for federal and state. House is paid off but taxes is about 3% my salary. My insurance is more than I need (I don't use it at all) and cost me less than 2% of my salary.
You can keep your socialized system, we are doing more than alright here mate. I got plenty of friends in Europe, England, Canada, and Australia all complaining about the same thing, wait times for care. I can see my doctor for basically anything inside of a couple weeks.
https://www.ilr.cornell.edu/scheinman-institute/blog/john-au...
You are OK with peoples lives (500,000 a year) being destroyed in order to 'keep the service good'. And you are OK with the price of good service being over 50% of American bankruptcies being due to medical dept. But who cares if peoples lives are ruined, you have a shorter wait.
When did this country become a country of sociopaths? This isn't working.
You are weak and your life is the outcome of your own actions. You should have prepare for such a situation if you feared it was possible.
As for all the others, same thing, literally not my problem. You failed your family, why are you blaming the healthcare system.