What is the root cause w.r.t. the current situation? Are there any obvious ways out? Do any US politicians have any plans for a change? Are there any discussed proposals how to reform?
The current US is built to accomodate the top 0.1%. Their profiteering is more important than the good health of the population.
> Are there any obvious ways out?
Not really. Get money out of politics? Aggressively tax the wealthy and nationalize the entire health apparatus? Easier said than done.
> Do any US politicians have any plans for a change?
The only ones serious about it are on the progressive left, fought harshly by both Republicans and Establishment Democrats, under the guise of their respective patrons.
With paracetamol :)
(Dutch people know what I am talking about)
it is worth considering whether could a rational person could possibly disagree with the idea that the government is best placed to decide whether extending your life is a good investment (there are European systems that are not well run which resolve this unusual ways i.e. being unable to provide basic healthcare whilst giving hundreds of millions to PR agencies, sometimes run by people who happened to work for the government...total coincidence, to run media campaigns to "prevent" ill health).
it is not simple. there are largely private systems that run very well, funnily enough most of these are in Europe. there are public systems that run very badly, again many of these are in Europe. the discussion of public vs private is largely not relevant or particularly interesting (do people think that doctors just work for free in Europe? they do not, the incentives when you try to create a cheaper healthcare system by underpaying doctors, which exists in parts of Europe, creates some very bad situations i.e. an overreliance on doctors from Africa who have unknown training, Americans tend not to have imagined the scenario where healthcare is "free"/paid with taxes but they are being operated on by someone who can't speak English).
In which metric(s)? Afaik, life expectancy is lower in the US than in most of western Europe. And Americans are known to pay much more than Europeans on healthcare, on average.
Could be more tied to poor diet and lifestyle, and not the healthcare system itself.
Like if you sit on the chair all day on your remote job, then move to the couch for after-work Netflix and PS5, while you drink soda and eat processed food, then the only time you leave your house is you drive your Tesla/F-150 to Walmart and McDonald's, there's no magic healthcare system in the world that can undo decades of self inflicted damage.
Meanwhile people in some impoverished balkan town could end up living longer because they spend their entire lives moving outdoor all day in fresh air and only eat organic what they grow on their plot of land, even if their hospitals and healthcare systems are significantly worse than what americans have.
There's way more variables to life expectancy than just the healthcare system.
I find this explanation very unsatisfying. You have to look at systems to understand what is actually happening.
I never said anything like that but you could be right on that. A lot of those lifestyle issues are creeping in other highly urbanized rich western countries. Especially mental illnesses due to loneliness, lack of family unit, poor economic outlook, etc
>I find this explanation very unsatisfying.
Then come up with a better one and share it.
If you want to compare the success of health systems you need to compare just the health systems between them alone, not the life expectancy with is a cumulus of several other factors beyond the public + privately managed health systems, such as lifestyles, agriculture, diet, weather, genetics, income, exercise, pollution, etc.
For example, compare waiting times for MRIs, treatments, operations, procedures, post-op infection rates, etc then compare the life expectancy of those who undergo those procedures/treatments, etc.
>You have to look at systems to understand what is actually happening.
I just did.
Healthcare is an inelastic market, people are willing to pay anything to get it. Private insurance companies have grown into a kind of cartel and are able to jack up prices at will, going as high as customers are able to pay. They are disincentivized to pay for expensive treatments, to increase their margins. These companies are so powerful, and officials are so easily corrupted, that they are able to get their way with legislation every time.
All of this combines into a huge vicious cycle that is able to extract more and more wealth for worse and worse results.
Americans used to live longer than Europeans, you know? Now it's the opposite. Certainly, food in America is worse and people drive more instead of walking. But then again, the State isn't incentivized to keep its citizenry healthy, since it doesn't pay for healthcare. To me, this is part of a package deal, there's no sense in trying to decorrelate public health from healthcare systems.
When, in WW2?
>They are disincentivized to pay for expensive treatments, to increase their margins.
I've experience both systems. It's worse (for me) with European state-run healthcare I am right now, where they are even more disincentivized to pay for expensive treatments, except not to increase margins but because the system is constantly broke, so the treatments are always long-wait and last-gen compared to the cutting edge fast-track you get in the US, if you're insured, or you pay through the nose for it, or your insurance does if you work for a decent company.
So that doesn't explain why Americans live less despite being able to get cutting edge care faster. You know, maybe a diet of processed food and sedentary lifestyle can't be undone by a faster MRI/surgery appointment with cutting edge equipment.
Yes it does. Average lifespan in an average. Americans have worse access to healthcare on average than Europeans, hence why they die sooner on average. European systems may be worse for you specifically, because you are wealthy enough to get "fast-tracked" in the US. But America's just a worse system overall.
And you're wrong about incentives for state-provided healthcare. A competent government would recognize that healthy citizens are more productive and bring in more tax revenue. Too bad we're currently run by reactionary morons, but that can always change in the future.
> maybe a diet of processed food and sedentary lifestyle can't be undone by a faster MRI/surgery appointment with cutting edge equipment.
I seriously doubt that people are that much healthier in the EU, enough to explain away all the difference in life expectancy, when Americans have provably worse access to healthcare. Around 7.3% of American adults couldn't get access to necessary healthcare for cost reasons in 2024 [0].
[0] https://www.cdc.gov/nchs/fastats/access-to-health-care.htm
I am not sure what your point is about covering fewer people either. The point of public healthcare systems is that there are redistributive, correct? The reason the US public healthcare system does not cover everyone is because there are people who can pay for their own healthcare...which is the same in Europe. I live in Europe, in a system with "free healthcare", I pay $100/month for private healthcare because queues for most things are multiple years long AND I pay $1-1.5k/month for other people to use the public healthcare system I can't use.
The irony is in the US rather than paying a low amount on private healthcare so that you could potentially beat the queue on relatively low cost state healthcare, you would be paying a much higher rate for private healthcare with more copays and coverage exemptions and also contributing a higher portion of your taxes to a publicly funded insurance program you wouldn't be able to access at all when you lost your job or your insurer denied treatment.
Are you one of those people that believes most American schools are shooting ranges too?
All of the problems in the US are concentrated in subsections of the population (just as in Europe). America is a wealthy country that has a mix of south American and African problems attached to it. There is no healthcare system that is going to be able to fix this. Europe has the same problem, the difference is that share of the population was typically much smaller than the US.
I didn't say anything about the cost of healthcare on average. The US already has a public healthcare system, it doesn't work well expecting that to magically improve is not smart (again, particularly when you have evidence from other countries, even in magic Europe-land, that private healthcare can work effectively).
Always the same weird "You don't understand, America is really big" argument. GDP per capita is higher there than in anywhere in western Europe. Why is your healthcare system delivering worse results for much higher price? It's a simple question, and the answer is equally simple: private insurance acts as an useless and bloated middleman whose incentives are opposite to providing quality healthcare to its customers. They want to be paid the most in exchange for the least service. Couple that to a bought political class and you've got the least efficient healthcare system in the developed world.
> Are you one of those people that believes most American schools are shooting ranges too?
Strawman. I don't.
> America is a wealthy country that has a mix of south American and African problems attached to it.
???
If you mean to say that America is providing for the world, that's an insane position to hold. The USA are extracting much more wealth from these places than they are injecting.
Medicare works pretty well and the VA works pretty well despite all the negative propaganda. Both are different systems but both have government regulations on pricing.
People are pretending that in the private US health care system everybody gets stellar treatment without waiting times. That is simply not true. When I compare the waiting times my family in Germany has vs how much friends in the US are waiting, I don't see much difference. US quality doesn't seem better either. The main difference seems to be that in the US people are constantly strategizing whether they want to risk paying a month's salary for taking an ambulance or going bankrupt when they have a serious illness. Whereas in Germany they go to the doctor when they need to.
Yes, you can have super shiny new treatments in the US if you can pay but I prefer a system that first covers the most common problems in an affordable way.
The US pays more because it provides significantly greater coverage outside of aggregate statistics. All of the innovation in rare diseases is because of the US, in public healthcare systems some diseases are simply not treated because it isn't regarded as economic to do so. How do you even quantify that difference? It is like making a GDP comparison between 1800 and today, what price would someone in 1800 not to die of TB? Life expectancy of 20 years old in many countries? Anyone who compares the two things in terms of cost is a lunatic.
In short though, it is not obvious that a high-cost healthcare system is worse. The US system is inefficient, almost all of this relates to their decision not to use universal healthcare which leads to problems pricing insurance. However, this is not related to the system, there are many countries in Europe and worldwide which have effective private healthcare systems.
As to drug discovery etc.: I think, not easy to say how the world would look like if the US weren't offering the opportunities. What would be new equilibrium RoIs needed if the world were quite different (and, yes, I am aware of studies there).
Probably because Europeans commenting don't know how big Medicare and Medicaid are.