
If Europe is more expensive, why do Americans pay more for healthcare? - iamjeff
http://www.straightdope.com/columns/read/3336/if-everything-else-is-more-expensive-in-europe-why-do-we-pay-more-for-healthcare
======
Pigo
Just this weekend my wife told me about a co-worker who was bragging about
taking the ambulance to the ER the last time her son had a slight cough.
Normally she goes through all the trouble of driving him there herself, but
she didn't want to waste any gas. Apparently, any and all health matters end
with a trip to the ER in her family. She said several other co-workers claimed
to do this as well. Part of the reason is that they can ask for prescriptions
for Pediasure and other baby-related goods while they are there, so that it'll
be covered and they don't have to pay for it. I'd never heard of this.

For most of these families, the fathers of their children stay home all day
and don't work. I admire how these women pull long shifts and work everyday of
the week. But when it comes to healthcare, I've heard some ponderous stories
that shed some light on how some systems come to get over-worked and require
so much money to operate. Maybe our community is the only one in America that
this common, but it's a reality where I live.

Yeah I get a little ticked off when my premiums continue to rise when I hardly
ever seek any healthcare and my family is rarely sick, and insurance companies
count on my never going to help shoulder the burden of the people who do go. I
don't mind contributing some to help people who need it, but honestly it's
reaching a breaking point with me. The company I work for can't afford to
offer a plan better than Obamacare, so even the PPO plan is terrible.

~~~
curiousgeorgio
My wife was a teacher for middle school youth who were in state custody (or
had other behavioral issues), and _all_ of her students were raised with the
exact same approach to healthcare as your co-worker. "Why pay for anything
when you don't have to?"

When my wife was about to deliver our first child, she mentioned to her
students how the hospital bills can be expensive. Her students were absolutely
dumbfounded that anyone would actually pay out-of-pocket (with or without
insurance) for a baby delivery. They almost couldn't comprehend the idea that
anyone other than the government actually _pays_ for this stuff. Many of those
same students came from large families where a single mother literally chose
to have many children (with random fathers) in order to qualify for more
state-funded entitlements, and unfortunately, that whole mindset evidently
perpetuates itself through the generations as kids grow up and expect to
repeat the process.

And of course, their votes count the same as my vote.

~~~
mgbmtl
I'm a bit confused by the context. There's nothing wrong with the mindset of
expecting free healthcare, but I think it's how you get there that is
problematic.

In western countries, those things are "free" because we collectively pay for
them. I can't imagine having to pay for child birth. It's just something we
are collectively responsible for, because we try to provide basic human rights
to everyone.

Same for daycare. As a parent, finding a daycare centre that met basic health
standards was one of the most stressful parts of becoming a parent. When the
government started subsidizing non-profit daycare, it solved so many problems
and made me much more productive at work.

~~~
curiousgeorgio
> In western countries, those things are "free" because we collectively pay
> for them.

Are you implying that somewhere else, these things are free _without_ someone
paying for them?

> I can't imagine having to pay for child birth.

Really? Should raising a child be free then too? Should everything be "free"?
How does that work?

Except for rare circumstances, when someone gets pregnant, they _choose_ to
get pregnant. It may not be the desired outcome, but if you choose to play
with fire, you're just ignorant if you think you can't get burned. It's a
proactive choice. So if you don't have the means to deliver the baby (and
subsequently raise the child in a positive environment), why did you choose to
get pregnant and have the child? Why should everyone else be on the hook for
your mistake? Regardless of who pays, children _are expensive_. Should we
really reward people (and yes, that's what the system currently does) who want
to make irresponsible decisions and have children they can't afford (in both
time and money)?

Perhaps you're really pushing for full socialism? Sounds great! How's that
working out in Venezuela?

> If I have to fight all the time for basic things, then yes, I'll start
> cheating the system

Are you "fighting" to pay your taxes? Are you "fighting" to pay your insurance
premiums? We're not talking about a struggle to find the best daycare for your
kid; we're talking about paying into a system (whether through the government
or an insurance provider) that redistributes wealth from those that can pay to
those who "can't", but it only works when people don't abuse the system. And
if you have the ability to work, you should be contributing rather than
"cheating the system". Otherwise, you're just trying to justify getting
something for nothing.

~~~
ceejayoz
> Are you implying that somewhere else, these things are free without someone
> paying for them?

Free, no, but the rest of the developed world has universal coverage and
healthcare that costs half what it does in the US per capita, with similar
outcomes.

Someone has to pay, yes. The US's way of paying is just horrendously complex,
expensive, and inefficient.

~~~
narrowrail
>the rest of the developed world has universal coverage and healthcare

Why should every country have the same solution to healthcare? The US was
formed as a democracy when 'the rest of the world' was run by monarchs.
Healthcare is still a rivalrous good, and if we don't limit it by who can
afford it, we will limit by some other ambiguous term like 'need.' My friend's
grandma (80 yrs old) just had to fly to the US from Paris to have a surgery
for which the French system deemed her ineligible (she was too old).

~~~
ceejayoz
> Why should every country have the same solution to healthcare?

Single-payer systems have a variety of implementations - Australia has a
vibrant private insurance industry alongside their public system, whereas
Canada forbids it.

It's quite clear that the US healthcare variant simply isn't working and isn't
sustainable. I pay more for my family's health insurance ($2,000/month) than I
pay for my mortgage, and it goes up 10-20% every year (both pre-ACA and post-
ACA).

We're well past the point of saying "well, that experiment didn't work, what's
everyone else doing that works?"

~~~
narrowrail
We were past that point when Clinton raised the issue in the 90's (or even Bob
Dole). I just don't think a federalized system with central control/power is
the prudent path to pursue until we get price transparency for healthcare
costs.

~~~
ceejayoz
We already have price transparency for our single-payer system. Medicare pays
a specific amount for specific procedures - you can get a full list
([https://www.cms.gov/medicare/medicare-fee-for-service-
paymen...](https://www.cms.gov/medicare/medicare-fee-for-service-
payment/feeschedulegeninfo/)).

Our current path is demonstrably not prudent, with a good dozen or more
examples of what appear to be prudent approaches to draw from.

------
petilon
The reason healthcare costs so much in the US is insurance. When insurance
pays for everything patients don't care how much the medical providers are
charging, and patients don't care if medical providers are providing
unnecessary services. When somebody else (i.e., insurance) is paying, the
individual consumer is encouraged to consume without any restraint. When all
consumers behave this way, providers are able to charge high prices, which in
turn causes insurance premiums to go up. (Look up "tragedy of the commmons").

The solution is to make the consumer participate in driving costs down. One
employer I know of has an excellent solution to the problem: Make employees
pay 100% of the bill up to a certain amount, such as $6000. That's a large
amount, but the employer then contributes a large amount to your Health
Savings Account (HSA), such as $4000. This amount is for you to keep
regardless of whether you have any health bills or not. (This money can be
used for medical expenses only, either in the current year or in the future).
This means the max you will spend out of pocket per year is $2000. How does
this encourage the consumer to scrutinize medical spending? Because the first
$6000 of medical spending in a year is "your money". This is money you'd be
able to keep in your HSA if you didn't have any medical expenses. This gives
the consumer a strong incentive to reduce costs, question charges, avoid
unnecessary services, and so on.

~~~
narrowrail
>The solution is to make the consumer participate in driving costs down.

The insurance companies and hospitals do not want this, and they seem to
prefer to have large administrative bureaucracies and collude on pricing. I'm
glad there are many comments making the point about price transparency and
competition.

Edit: Just found this somewhat recent article: "those indecipherable medical
bills theyre one reason health care costs so much"
[https://www.nytimes.com/2017/03/29/magazine/those-
indecipher...](https://www.nytimes.com/2017/03/29/magazine/those-
indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html)

------
anthonybsd
I think the basic premise of the question is utterly flawed. Europe is NOT
more expensive when it comes to just about anything except for certain
categories of items (like cars and for good reason!). Take Germany for
example. Childcare? Free or 200 EUR per month if you want extended hours.
College tuition? Free. Rent? Fairly cheap. Food? Again, fairly reasonable.
Almost any kind of -care or -service is cheaper in Germany as compared to the
US.

~~~
rubatuga
I heard Germany also has less working days in a year on average.

~~~
MagnumOpus
Well, a legal minimum of 20 vacation days (and 30 being the norm for full-time
work), plus 9-10 public holidays that fall on workdays, plus as many days of
paid sick leave as the doctor asks for.

So maybe 220 days at work per year? I guess that is 6-10% less than in the US.

~~~
germanier
An average German employee works about 1.3k hours a year, in the US about
1.8k. There are some European countries where people work even longer on
average. (Note that these numbers include all workers, so also part-time
employees. There are also differences between countries on how they are
exactly measured so comparisons should be taken with a grain of salt. But for
a rough idea that should be enough).

Source: [https://data.oecd.org/emp/hours-
worked.htm](https://data.oecd.org/emp/hours-worked.htm)

------
carsongross
Most people are aware that the US pays the most for healthcare per capita.

Most people are not aware that the US pays more per capita on socialized
medicine than any country except Norway:

[https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...](https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File%3AOECD_health_expenditure_per_capita_by_country.svg)

In fact, the US spends more in _socialized_ medicine per capita than many
countries spend in _total_ (public and private): France, the U.K. and Japan,
for example.

I think unfortunately only a collapse will offer opportunity for reform.

------
Theodores
There are some things that are expensive about the U.S. healthcare system that
are totally unnecessary - for instance the epidemic in prescription
painkillers of the opium variety - tens of millions of Americans are hooked on
those things. The expense here is not the main problem, it is the millions of
lives ruined by big pharma.

There are other curious upsells that go on in U.S. healthcare, e.g. off-label
prescriptions. That does not happen in Europe as the incentive is not there,
the hospital/doctor is not profit motivated to get their patient on the hard
drugs, as per the U.S. situation.

Expense begins at birth if you are male - when medical staff get paid for
circumcisions then they happen, in Europe there is not this financial
imperative so the only people getting themselves circumcised are doing so for
religious or actual medical reasons, not just because it is an upsell from the
hospital.

The more I find out about U.S. healthcare the leas I see it as that.

------
andreiursan
Europe was more expensive a couple of years ago. Now is much cheaper, just
pick equivalent cities and compare them on Numbeo.

e.g. Hamburg vs Seattle [https://www.numbeo.com/cost-of-
living/compare_cities.jsp?cou...](https://www.numbeo.com/cost-of-
living/compare_cities.jsp?country1=United+States&country2=Germany&city1=Seattle%2C+WA&city2=Hamburg&tracking=getDispatchComparison)

The past years I used to travel each year to US, in different parts (Dallas,
Chicago, Seattle etc...) and I always had the impression that USA is way more
expensive - from the perspective of someone who goes to a restaurant and
enjoys good food and a good bottle of wine.

Also health insurance is cheaper here, and my coverage is very good.

~~~
fivestar
US big cities are expensive, but there are plenty of places in the US that you
haven't visited that are quite affordable to live in. You can't judge the
whole US by NY, LA, and Chicago.

~~~
maxsilver
> there are plenty of places in the US that you haven't visited that are quite
> affordable to live in.

Sure, but almost none are nearly as affordable as the parent poster's example.

"Hamburg - Apartment, 1 Bedroom, City Centre - $823/month"

I'm in the so-called "affordable" Midwest, and there's not a single apartment
even _remotely_ close to that price, in any city anywhere within 400 miles
here. In Michigan, for example, that same apartment will cost at least
$1,200/month. This is true despite the fact that our average income is roughly
identical to what Numbeo lists for Hamburg.

~~~
ac29
>I'm in the so-called "affordable" Midwest, and there's not a single apartment
even remotely close to that price [$823], in any city anywhere within 400
miles here.

I am in the definitely unaffordable Bay Area, and you don't have to go 400
miles to rent a 1 bd apt for under $800. Its not going to be in a desirable
city and probably not a very nice apt, but they certainly exist. Literally the
first listing I found on craigslist was $775 (in Modesto, about an 80 mile
drive to San Jose).

~~~
maxsilver
> Its not going to be in a desirable city and probably not a very nice apt,

That's what the comparison is though, it's using "city center" apartments,
apartments inside urban areas. Of which, there aren't any anywhere near that
price, in almost _any_ city in the US. (Even somewhere like Detroit).

If you want to look at crappy apartments way outside of town, the comparison
still holds up:

> Dresden - Apartment (1 bedroom) Outside of Centre - $392/month USD

That "affordable" Modesto apartment is still about 2X the cost of a comparable
unit.

~~~
AstralStorm
And likely has proper public transport (very lacking in the US) so you might
be able to reduce your gas bill.

------
siderax
I read somewhere, don't remember where that your healthcare system is more
costly because of you're legal system.

There are more legal risk and cost for doctor, hospital, etc.. in the US, so
their insurance is (way) more costly, so their price is higher.

But I don't have any data, so that's just an hypothesis. But if this is true,
good luck to change that.

~~~
e40
_I read somewhere, don 't remember where that your healthcare system is more
costly because of you're legal system._

Cost controls are the reason. Providers can charge anything they want in the
US. Not true in the EU.

~~~
alkonaut
The reason is that somehow business has more political power than patients,
doctors etc. That all comes back to the eternal problem of politicians having
to have _funds_ to be elected. So everyone in office owes favours to various
people and organizations. If campaigning politicians weren't allowed to accept
any money from anyone at all (people or organizations) then a lot of the
political problems in the US would just vanish I think. It's somehow so
natural that americans tend to not even think that it's odd that personal
political campaigns are paid for by donors.

------
hectorr
There are a lot of bad reasons for this, and a lot of bad impacts, but there
is at least one benefit for humanity: American healthcare dollars create
intense competition to do to do aggressive and innovative biomedical research
and product development.

~~~
FullMtlAlcoholc
with maybe 10% of products reaching market and a focus on blockbuster drugs,
not necessarily those which may save or improve lives

------
blubbermonkey
Other relevant reasons: single payer healthcare is less expensive because
otherwise hospitals have more market power, which allows them to charge prices
way above what it costs. Also, insurance companies here don't use cost
effective analysis as much as Europe and will pay for the latest experiemental
treatment, whereas Europe might ration its care for expensive relatively
ineffective treatments.

~~~
splintercell
> Other relevant reasons: single payer healthcare is less expensive because
> otherwise hospitals have more market power, which allows them to charge
> prices way above what it costs.

I am sorry but that's like the opposite of economic logic. Ceritus paribus,
more competition means lower prices.

Regarding the actual topic, I've long maintained that a single payer system in
America would be much more expensive than a single payer system in Europe
because of different priorities of the American consumers (for instance, old
people demographic in America, the pro-life nature where a big part of our
insurance expenses goes towards saving premature newborn babies). The only way
a single payer in America (or in any country) could be cheaper is by offering
a different product to the consumers.

~~~
norea-armozel
>I am sorry but that's like the opposite of economic logic. Ceritus paribus,
more competition means lower prices.

It doesn't hold under empirical study of firms of any industry. Competition
can be offset by jacking up prices or otherwise hiding the price. Prices are
never set by the market, so everyone pays a ransom for the good or service in
question, especially in healthcare.

------
joshuaheard
Maybe Americans pay more for healthcare because we underwrite most of the
medical innovation in the world.

[https://www.forbes.com/sites/matthewherper/2011/03/23/the-
mo...](https://www.forbes.com/sites/matthewherper/2011/03/23/the-most-
innovative-countries-in-biology-and-medicine/#403f5f5c1a71)

------
tmaly
I had a recent medical issue with my daughter in the Philippines. We brought
her to the emergency room in Manila at the best hospital that had US trained
doctors.

All the tests, the stay, the treatment all came out to a total of about $140.

Contrast this with a recent visit I had to the ER in the US. I have insurance,
and my copay for the visit was $150. There is definitely something wrong with
the pricing of healthcare in the US.

I am not sure how to solve it given all of the parties involved, but I think
adding transparency to the pricing would be a good first step. To those that
do not know, the medical industry in the US has an anti-trust exemption. What
that means is that they are not required to publish prices. That is why one
patient can get a totally different price than another patient getting the
same exact procedure.

How can you begin to solve something if you cannot even measure it?

------
Vnac
Based on my experiences as an American living in Europe, the premise of this
is entirely wrong. At least in some cases- I'm a freelancer without kids
living in Germany. For someone who is employed, older, has kids, or lives in a
different country, the calculation may be different. But overall, Europe isn't
the healthcare utopia people make it out to be.

The cost of living in Europe is significantly lower than the US, not higher as
the article suggests. Housing, food, everything. Overall I can live on much
much less money than I did in the US. This may vary from city to city, but I
think in many places in Europe this is true.

But health care is much more expensive in Europe. For me, part of this is due
to being a freelancer- the public system is unaffordable for me because I
would have to pay double, and pay double with my income calculated at a higher
rate than I actually make. The private system is similarly expensive. It costs
far more than health insurance in the US would for me. But in general, health
insurance is not cheap.

Insurance also includes far less here than in the US. It doesn't include even
basic preventative care when you are under a certain age. It also doesn't
include stuff like birth control or STD tests. And even for things it covers,
it's difficult to get any reimbursement at all from private health insurance.
I've also found the medical system in Germany to be atrocious when you
actually go to see a doctor. If you end up in the emergency room, you can get
good care. But doctors seem to just wait until it gets that bad before doing
much and often spout nearly-superstitious nonsense to justify not providing
medical care. Maybe they just do this to me because I'm an immigrant though-
possible Germans get better care.

As a result, I only have cheap, crappy insurance here. It's currently cheaper
and more effective for me to have decent insurance in the US, and fly home
whenever I need to go to the doctor. The US medical system under the ACA is
amazing, better than nearly all Americans realize.

~~~
socialist_coder
Hmm, something here seems off. I've been living in Germany for the last 5
years, I'm self employed with a wife and 2 kids, and I'm on the public plan.
It seems great. It scales with your income so it should always be affordable.
Why are you having to "pay double"?

The 2nd component here is that your premium is 99% of your total health care
costs. And, very little arguing with the insurance company. Much nicer to deal
with than back in the US where it's rarely 100% coverage and the insurance
company is trying to screw you at any opportunity.

> It doesn't include even basic preventative care

My public insurance includes an every 2 years skin screening from the
dermatologist, and dentist checkups / teeth cleanings pretty frequently. Other
preventative care, I'm not sure of.

> I've also found the medical system in Germany to be atrocious when you
> actually go to see a doctor. If you end up in the emergency room, you can
> get good care.

I've been sick a few times. I've gone to a family doctor and an ENT specialist
and both I thought were very good. Comparable to treatment I've received in
the US. It's unfortunate your experience was so bad but I don't think that is
the norm.

I have 2 children so we have quite a bit of experience with the German system
and it seems absolutely wonderful from my perspective. One of my kids was
premature and I have 0 complaints about how they handled that. She also
developed a very serious medical condition a few years later. She was on
chemotherapy and required multiple surgeries. I don't know how the health care
for this would be in the US but the German health care system handled it
great, in my opinion. We've never had to fight with the insurance company on
anything except for a $7000 club foot brace which took us a few back and forth
letters to get. Not so bad though.

~~~
socialist_coder
amendment to my original reply:

I thought about this more and I think your "problem" is that you are young and
healthy and have no kids. You do get kind of screwed in that situation since
you are basically subsidizing everyone else. But, it has to be like that
otherwise health care would be prohibitively expensive for people who actually
need it.

If you have kids over here, you will pay the exact same price for your health
insurance as you do now but it will also cover your children. At that point it
will be a great deal for you =)

~~~
Vnac
Yeah, as I mentioned, the calculation is a bit different when people have
kids. And that's great, but for me it's unaffordable and cheaper to fly back
to the US whenever I need to go to a doctor or refill prescriptions and keep
insurance in the US. And that's absurd. It works pretty well though, but that
may become unworkable too with the changes to the US system.

By pay double, I mean that I would have to pay the employers half as well. And
on top of that, most public insurance companies seem to have a minimum amount
of money that they assume freelancers make, which is often above what I
actually make. So health insurance would come out to be 1/3 of my income pre-
tax a lot of the time.

There does seem to be some preventative care for older people, but a lot of
the stuff my doctors check at yearly visits in the US (basic exams, blood
tests, even getting a free yearly checkup at all) doesn't seem to be covered
at all if you are under a certain age. There's a lot of nice things about the
US system under Obama that I took for granted. Certainly isn't perfect or
better in all situations, but there are some areas where it seems
significantly better than the system in Germany. So I'm always surprised when
I see Americans talking about how great the German system is and treating it
like an ideal. It seems like it's good in some situations, but the US system
is better in many situations too.

I've heard that care is quite good when people end up in a hospital (and
people seem to be kept in the hospital much longer and more easily here than
in the US), but from everything I've seen, it can be very hard to get any
treatment until it gets that bad. May just be a bad sample set though.

------
_nalply
As a tourist in SF I got whitlow. I went to a medic. He looked at my finger
and then gave me a box of antibiotics. Then his assistant asked for $300. I
balked and they reduced to $200.

This sample of size 1 (one) is enough to tell me that something is off in the
US.

~~~
highpass
Increasing this sample size to two:

One heated day I punched an object that ought not be punched. Little finger
swelled up and didn't quite work correctly. A few hours later said finger was
bandaged, and holding a bill for $3,400. No medication. Just looked at,
x-ray'd, and bandaged into recovery position. $3,400. US. It would have been
cheaper to fly back to the UK and have it looked at - three times over!

~~~
la_oveja
This is insane. I can't understand how Americans see this normal.

~~~
ac29
Most Americans dont see that as normal, healthcare is one of the top political
issues in this country. However, the true costs of healthcare are extremely
opaque. I'd guess the cost of the little anger incident above would be an
order of magnitude less with insurance.

To add another anecdote, I got a kidney stone ~5 years ago. The cost for ER
admission, a CT scan, some lab work, prescriptions, etc was about "$20,000".
However, nobody paid anybody $20,000. I paid something like $1000 and my guess
is my insurance via their negotiated rates paid something like another $1000
on top of that. How we got there as a country is a long, complicated story.

------
mahd43
"Free" childcare, tuition etc in Europe is a myth. There's no such thing as
free.

on a salary of $150,000 you pay more than $75,000 in income tax in many EU
countries, then add to that various other taxes like real estate tax etc.

For that you get poor public schools, poor healthcare etc.

Last time I scheduled an appointment at the FREE doctor I had to wait 4 weeks
for him to see me.

So I had to go to a private one and pay cash, after already paying huge sums
of money for this supposedly cheap and awesome european healthcare.

~~~
analyzethis
Counter example from Denmark, a European country: two weeks ago my son had a
rash (no other symptoms), preventing me from dropping him off at daycare. I
called the doctor at 8.30 a.m., had an appointment at the FREE doctor at 11.
Problem solved in less than three hours.

~~~
mahd43
Yeah, sure, there's going to be positive counterexamples.

Waiting times (specially for say for some types of surgery are an issue in
Denmark also).

Look, I have extensive experience from inside the the system, maybe I can
write a more detailed post about how this works and some reasons why US
healthcare can be so expensive, if anyone is interested in that.

But just a quick example, health care costs on national levels fluctuate
through the years, and so do collected taxes and hence how much of that pile
is allocated to healthcare.

This can result in a doctor treating your son differently in 2016 than in
2017, an neither the doctor or the hospital will tell you this.

For example he might need a surgery, which will be done with an invasive
surgical procedure (opening up a person with a scalpel), even though a non-
invasive laser procedure is available and the hospital has all the necessary
equipment & and the doctors trained.

\-- In short, examples of generally best health care systems in Europe are
Switzerland, Netherlands, and NOT England (NHS) or France.

------
namlem
In urban areas, housing in Europe is typically cheaper than in the US. Rural
and suburban housing is much more, though of course the US has a far larger
supply of land.

------
dmh2000
for one thing, we Americans demand instant service even for the more expensive
things. For example, I live in a small-ish town, and yet there are 3 clinics
with an MRI machine within 15 minutes of where i live. If I needed one, I
would be on the slab in the amount of time it took me to drive there and fill
out the paperwork. Maybe an hour or two if someone was there ahead of me. I
would never have to wait a day or more. I don't have the stats on other
countries, but I bet most are not like that.

And that shit is expensive. The way medical competition works in the US is
that prices go up when there is more competition because the competing clinics
need to keep purchasing the latest technology to keep up. As long as insurance
covers the alternatives, we go to the best and most expensive.

In the US we have WAY too much health care.

~~~
24gttghh
I'm not sure I believe "more competition drives medical costs higher".

~~~
toast0
It's pretty plausible. We don't have price transparency or price competition;
generally when a doctor asks a patient to get an expensive test, if insurance
covers it and it's not inconvenient, the patient will get it. So, if there are
more places to get expensive tests, that's competition, but also is likely to
lead to more expensive tests being done.

This raises the question of efficacy of the tests for patients who wouldn't
have had the test done when there was less access. If spending more for the
tests improves health outcomes, that's valuable, and if it saves money on
treatment that's even better.

------
nroets
Sad, but true: "the fact that this treatment is more readily available means
U.S. patients (insured ones, anyway) who might not need it go under the knife
just to be safe"

I only had to make that choice once, namely with the removal of my wisdom
teeth. I'm glad I insisted on local anesthetic.

~~~
maxxxxx
I have noticed that in the last year a few coworkers had their wisdom teeth
removed despite having no problems with them. It was sold as a prophylactic
thing. Is that the latest trend? One coworker got a pretty bad infection and
was miserable for weeks afterwards.

~~~
stantaylor
It's actually a very old trend. Only recently have researchers begun to say
that you should only have wisdom teeth out if they are causing problems, not
prophylactically.

[http://www.nytimes.com/2011/09/06/health/06consumer.html](http://www.nytimes.com/2011/09/06/health/06consumer.html)

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IshKebab
Don't worry, the Tories will make our healthcare as expensive as yours soon
enough.

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dgudkov
What stops US from adopting the Canada healthcare system? It's not perfect but
at least reasonable. Why re-invent the bicycle?

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vladimir-y
Because imho insurance companies is a sort of mafia, for me it looks like a
conspiracy to rob people out is happening.

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donatj
Because the healthcare costs are pushed onto everything else in Europe.

~~~
kobeya
I'm not sure that's the whole story. Do European doctors and hospital
administrators make $350,000/yr, plus kickbacks from the pharmaceutical
companies? There's a lot of structural inefficiencies in the American system
that are not incentivised to go away.

~~~
maxxxxx
The healthcare bureaucracy in the US is insane. Every doctor seeems to have
several people whose only job is to deal with insurance. And every insurance
must have a ton of people who evaluate and deny claims.

~~~
maxerickson
Every practice has those people. But billing complexity is one of the factors
driving doctors to work for hospitals and large organizations rather than in
their own practice.

~~~
maxxxxx
And hospitals are even worse at billing. They pretty much just make up charges
and let the patient figure it out.

