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Comment by bhelkey | Hacker News Reader

Public perception is that the US is not willing to pay for universal healthcare. However, the US spends enough money, it just spends it inefficiently.

The US spends ~$900 Billion a year on Medicaid [1] and ~$1.1 Trillion a year on Medicare [2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Universal Healthcare without increasing its budget.

[1] https://www.kff.org/medicaid/medicaid-financing-the-basics/#...

[2] https://usafacts.org/answers/how-much-does-medicare-cost-the...

[3] https://www.bbc.com/news/articles/cwy7zvp5xrqo

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Incomes are dramatically higher in the US than in Japan. Their economy has imploded so badly due to debt + currency destruction that they're now just barely above Lithuania (which has come a long ways of course) on economic output per capita.

Japan is no longer a primary economic power and their (perpetually falling) purchasing power + incomes represent that.

US GDP per capita is estimated at $92,000 for 2026. Norway is $96,000 for comparison. 340 million people vs one of the world's richest nations at 5 million people. The UK is $60k, and Japan is a mere $36k.

Read that again. US GDP per capita will soon be 3x that of Japan.

Doing a direct comparison of healthcare costs is silly accordingly. At a minimum you need to 2x to account for the drastically higher US incomes vs Japan, and at least 50% higher vs the UK.

Japan is also way thingger than America, which the article points out: > The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD. That gap is roughly $3 trillion per year.

Need to have people go in for checkups and get shamed for unhealthy habits, not really a money question.

I don't agree with your framing but let's accept it for the sake of this conversation.

The UK and Japan are not the only countries with more efficient healthcare systems than the US. We can look at a variety of countries, some of which have a higher GDP per capita than the US.

If we look at a graph of 'healthcare spending per capita' by 'GDP per capita' [1], we can see that the US is a massive outlier spending ~2x countries with comparable GDP per capita.

In fact, the US has a higher healthcare spending per capita than every other OECD country. By a large margin.

[1] https://www.healthsystemtracker.org/chart-collection/health-...

Japan's economy imploded because it was doing better than the US and Japanese were buying big American names like Rockefeller Center, so the US forced Japan to destroy their currency, which popped the Asian miracle.

The direction is right. Total US healthcare spending is $4.87T for 335M people ($14,570/capita, CMS NHE 2023). Japan's per-capita is $5,790, with the highest life expectancy in the world and lowest infant mortality in the OECD. The annual national gap is approximately $3T.

The series is not arguing for a specific coverage structure. It is documenting where the excess goes, mechanism by mechanism. Four issues in, $128.6B is accounted for conservatively: drug pricing, hospital commercial markups, PBM extraction. Each mechanism has a defensible, operationally precedented fix that does not require redesigning the entire system. Montana Medicaid adopted commercial reference pricing at 200% of Medicare and measured no quality deterioration. The FTC documented PBM specialty drug markups and three states have already enacted clawback restrictions. None of that required universal healthcare.

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