
Warren Buffett says health care costs are a bigger problem than corporate taxes - wojt_eu
https://www.nytimes.com/2017/05/08/business/dealbook/09dealbook-sorkin-warren-buffett.html
======
dalbasal
I’m not American, but I’ve been hearing about your health system for a several
years. Ironically, I know more about it than my own country’s (Ireland).

Several years ago, there seemed to be a lot of talk about how much The US
spends (private & public) per capita on health. It’s a lot more than
everywhere else. This was usually presented in the context of the health care
“regime” A UK-esque system, a Swiss-like system, etc.

Lately, that comparison seems to come up less. Obama-care, Trump-care or
Bernie-care would mostly deal with who pays & how, not how much.

The “who pays” question is a favourite ideological one so politicians and
commentators are comfortable with it. But, I think the “how much” question is
probably the more important one, and the harder one to solve. If the US could
get costs down to average European rates, then I’m sure a workable system
could be found within the confines of most ideological frameworks.

The problem is that getting costs down is almost impossible. Costs are
salaries of doctors & nurses, a giant pharmaceutical industry, thousands of
radiologists, ultrasound technicians, the machines they use (far more
frequently than europeans)…

Getting costs down to EU levels would be mean the medical industry shrinks
like manufacturing shrunk two generations ago.

I don’t have a solution to suggest, but I do suggest toning down the
ideological discussion. The problem is more of a technical one.

~~~
TallGuyShort
Amen! I tend to be more Libertarian than either of the 2 major parties, but I
would gladly pay personally for other people's health care if it was actually
being done rationally. But I've had major problems every time I've seen a
doctor my entire adult life, all related to the complexity of the billing, and
it got to the point where my biggest health risk was the stress of fighting
it. Go for an annual physical: $1200 bill for 2 physicals, blood tests I never
got the results for, and a test they never performed. Not covered by insurance
because the doctor's "wellness check up" wasn't the same as the insurance
company's "annual physical". Time to resolve: 8 months. Resolution: I paid
because the lawyer was going to be more expensive. That's not a system I'm
willing to pay for, and it's got nothing to do with whether it's my social
obligation or not.

~~~
emjoes1
Yes it seems the complexity of billing still has something to do with Who
Pays.

I had a similar issue where I was billed for a physical that my insurance
provider would not pay. My wife suggested I have the Dr. office re-code the
bill. Not sure what that is but I contacted the Dr. office and explained that
it was not a wellness check up but an annual physical that my insurance should
cover. After arguing for about 10 minutes they finally agreed to re-submit to
insurance under that code... and it ended up being covered by insurance after
all.

~~~
SilasX
Now, imagine how much is being lost by most people having to go through that,
most of whom aren't perceptive enough to notice this...

------
bedhead
There are many, many problems with healthcare in the US. Off the top of my
head, the big ones are:

* Endless number of middlemen and administrators. * Every player in the healthcare chain benefits from higher prices. * No price transparency. * Tacit collusion is rampant. * "Cost no object" mentality to treating the dying.

The last one, while insensitive, is true nonetheless, and it's alarming that
over 50% of all healthcare spending takes place in the last two years of a
person's life. We have basically decided that it's okay to spend literally any
sum of money on a dying person in order to prolong life by an average of a few
months. And the problematic word there is average, because some people do live
a lot longer, and that's what we all look to. I realize this is grim and
seemingly lacks humanity, but unfortunately that doesn't make it not true.
Charlie Munger, who is on the board of Kaiser Permanente, said this same thing
yesterday..."over-treatment of the dying" was the biggest problem they faced.

It's reminiscent of our approach to college education - justified at any cost.
So we push millions of kids into a schooling system that's not right for them,
and the result is a lot of crappy education, worthless degrees, student loans,
etc. Once we flip the switch to "there is no price you can put on _____"
things get sideways FAST.

~~~
olewhalehunter
Keep in mind US healthcare costs are almost %20 of GDP

Cutting the fat from that may mean a lot of folks lose livelihoods (and THEIR
healthcare).

~~~
bedhead
Besides being illogical (i.e. it's bad to eliminate waste), this exemplifies
the problem with change. Any time there is a ANY constituency that is rendered
worse off, no matter how justified it is, it is nearly impossible to
effectuate change because the affected group screams bloody murder.

~~~
bluesroo
But, wouldn't you? More importantly, shouldn't you? If the people in your
government are doing something that is not in your best interest then you
SHOULD speak up against it. After all, the word "representative" is based on
the word "represent". If they are not representing my interests to the
government then I should make that known.

If I have ailment X and a bill is being pushed that pulls funding/ assistance
away from ailment X, then I should make it known that I am unhappy about it.
What if it is now guaranteed that I will die from ailment X? You're saying
that I shouldn't kick and yell about it? I'm about to die!

However, if it is also helps people with ailment Y, Z, I, J, K, and L, then it
is the government's job to recognize that maybe I am less important to the
bigger picture. If enough people will be negatively impacted to the point that
I will not be reelected, then maybe it doesn't truly benefit my constituency
as much as I think it will.

Of course all of this is in an ideal world without accounting for the power of
advertisement funding and the fact that most of the voting population isn't
well educated about the issues.

------
pavlov
The middleman role of insurance companies in American healthcare seems
completely useless. They're not serving patients, doctors nor the national
economy by siphoning off enormous profits from the 17% of GDP that gets spent
on healthcare.

Getting rid of them would be extremely hard, of course, given how well
entrenched they are thanks to lobbying and regulatory capture.

Insurance companies are a massive-scale version of the car dealerships that
have managed to keep Tesla out of many US states by taking advantage of local
legislation -- nobody would want to deal with a car salesman or an insurance
company given the choice.

~~~
humanrebar
I think most people are fine getting rid of middlemen, but there is a deep
divide over who should actually be paying the bills.

Personally, I think health insurance should be, you know, insurance. For
catastrophic things you wouldn't wish on yourself and cannot save for. And
there's a definite role for government to make sure that market is solvent and
available to everyone.

For day-to-day healthcare, that should just be included in "cost of living"
calculations. General-purpose welfare programs (or ideally a minimum income)
would guarantee that people could afford checkups, birth control, etc.

Getting employers out of the business of all of the above is paramount and
what businesses should be lobbying for. I believe the slow recovery from the
recession has been affected by unintended (though not unpredicted)
consequences of the ACA's failure to address this issue. The Republicans
likewise seem happy to punt on the issue. It's this sort of thinking that is
making the American electorate disgruntled with politicians and each other.

~~~
mgkimsal
> Getting employers out of the business of all of the above is paramount and
> what businesses should be lobbying for.

Amen. I never quite understood what benefit (pardon the pun) it served,
although I've got some idea of the origins of employer-provided health
insurance.

The cynical part of me believes it's definitely a way for larger companies to
hold more control over their employees, and they may lobby for this because it
provides an extra advantage over smaller competitors.

I've known plenty of really sharp/talented folks whose talents may better
serve the economy by taking those skills to other companies (sometimes in
other parts of the country). "But I'll lose my health insurance" is almost
always a primary reason why people've stayed in their job (however crappy it
might be otherwise re: pay, commute, colleagues, boss, industry, etc). This
seems like it's been a real drag on labor mobility for some time now.

I would have thought 'conservatives' would be all over a 'free market' where
people make their own choices with their own money. They'll happily deride a
"nanny-state" as fostering people who just want the govt to provide them with
everything, but ... expecting people to _need_ employers to provide access to
basic services? Apparently there's no problem there whatsoever, and it doesn't
even seem contradictory to many I talk to.

~~~
heymijo
Employer-sponsored healthcare in the U.S. is an accident of history.

How we got to now: 1\. Roosevelt chose to forego nationalizing healthcare when
he introduced social security in the 30's, fearing it would doom both to
failure.

2\. The U.S. feared debilitating inflation during WWII. The legislature passed
a bill to limit employers' ability to raise wages for workers who were
battling for employees in a scarce labor pool.

3\. Unintended consequences ensued. To attract workers, employers began to
offer non-salary perks: employer-sponsored healthcare was one.

4\. The economic and labor boom post-WWII entrenched employer-sponsored
healthcare and has led us to where we are today.

------
heisenbit
In the US the health care cost since 95 went from 13.1 to 17.1 while in
Germany they went from 9.4. to 11.3. It is actually way worse than the article
tells if one considers the age structure of the two countries where Germany
has 21.7% over 65 vs. the US with 15.25%.

The non tangible cost are also non negligible. There is friction in the job
market as changing job risks incurring a potentially catastrophic coverage
gap. There are bizarre industries focused on renegotiating issued medical
bills, collecting those or managing the health related bankruptcies.

Pricing of pharmaceutical usually generally defies the laws of gravity as the
incentives of regulators, suppliers, distributors, doctors and insurers have
been distorted beyond anything resembling a fair playing field. In such an
environment playing games is superior than providing value and adhering to
generally accepted rules. When it comes to pricing the costs of providing the
service is often the least important input.

Steve Balmer recently: “If you look at these tax deductions for employer-
provided health [...], they’re really subsidies to the affluent, which I guess
I hadn’t thought about them.”

The biggest problem society faces at the moment is the vanishing middle class
and lower qualified jobs that are still providing enough to subside. For the
latter the cost of food, shelter, fuel and health are key. Lower the cost of
living and there will be more jobs that are worth taking.

~~~
fetbaffe
Yes, remove the tax deductions for employer-provided health care is good
start. Employers should not decide what kind of health care you have access
to, as little as for food.

~~~
maxxxxx
That was one thing McCain had right in 2008. Removing employer health
insurance would also remove a lot of political controversy like whether
contraception should be offered. It's simply should not be the employer's
business.

------
wojt_eu
“If you go back to 1960 or thereabouts, corporate taxes were about 4 percent
of G.D.P.,” Mr. Buffett said. “I mean, they bounced around some. And now,
they’re about 2 percent of G.D.P.”

By contrast, he said, while tax rates have fallen as a share of gross domestic
product, health care costs have ballooned. About 50 years ago, he said,
“health care was 5 percent of G.D.P., and now it’s about 17 percent.”

~~~
euroclydon
It's interesting to consider what it really means for something to be a drag
on the economy. I mean, every dollar spent on healthcare is literally part of
the economy -- it's not siphoned off into some void. Companies make a lot of
money in healthcare. Healthcare employee a lot of people. Folks like being
healthy.

~~~
Retric
Broken window fallacy.

Total Money spent on heath care has very poor correlation with outcomes.
Largely because it includes things like medical billing and advertising which
increases costs without providing any benefit. You also often do more
dangerous and unnecessary procedures and give more drugs risking poorly
understood interactions.

Something like 80% of the benefit of modern heathcare comes from the first 10%
of spending. EX: Sanitation and quarantine are cheap and amazing tools to stop
the spread of disease where hospitals are extremely expencive and gather sick
people together to spread disease. A vaccine is vastly cheaper and more
effective than dealing with outbreaks.

~~~
larrysalibra
Bastiat for the win!
[https://en.m.wikisource.org/wiki/Essays_on_Political_Economy...](https://en.m.wikisource.org/wiki/Essays_on_Political_Economy/That_Which_Is_Seen,_and_That_Which_Is_Not_Seen)

------
shaqbert
Good news is that the amount of health care spending is a choice. E.g. other
western countries are running a health care cost to GDP ratio from 10%-13%,
sometimes offering vastly superior and equitable outcomes than in the US.

The bad news is that this is a choice Congress and Senate are taking on behalf
of the American people. And with the partisan divide and lack of agreement on
fundamental values, things won't really change.

Add in a rapidly aging population, and being cognizant of the per capita
health care spending steeply increasing at later stages of life, kicking the
can down the road won't make the later adjustment any easier...

~~~
panzer_wyrm
To bring us costs to western europe levels you need to have 1\. Slash labor
compensation 2\. Slash medicine prices. 3\. Reduce amenities in hospitals 4\.
Reduce medical student debt. 5\. Reduce equipment cost 6\. Reduce somewhat the
freedom of patients to choose doctors and doctors to choose patients. 7\.
Outright kill hospital prices. 8\. Reduce malpractice insurance. Reduce
malpractice compensation. 9\. Forbid direct medicine marketing to consumers
and doctors.

Any of those is hard on its own. Combined - it is impossible.

~~~
rileymat2
Why suggest reducing malpractice insurance and reducing malpractice
compensation instead of reducing malpractice?

~~~
panzer_wyrm
First because reducing malpractice is a goal that does not depend on the way a
system is funded. We should reduce medical errors full stop.

The two you mentioned give direct costs increase and indirect in the form of
defensive medicine. UnNecessary treatments because the doctor is scared of
potential lawsuits could event hurt patients since there is no such thing as
procedure without risk or complications.

------
british_india
The real problem with health care is that it's a gravy train for all involved.
Doctors, who don't invent anything new and who just practice garden-variety
medicine are wildly overpaid. They don't like it be known, but the average
doctor earns a quarter-million a year. Totally unjustified.

Then there are the medical device manufacturers, big Pharma and the hospitals.
They all are getting rich off the current system. That's what needs to change.

~~~
potatote
I believe that the big pharma and the insurance companies are certainly part
of the problem, but rarely do we mention doctors as a contributing factor
(albeit relatively small) to the high cost.

The American Medical Association (AMA) does its duty to restrict the supply of
doctors [1]. Countries like India, which produces plenty of high quality
doctors, does not require aspiring doctors to go through an additional
(unnecessary) 4 years of undergrad education. That would hugely cut the cost
down in training the doctors.

Secondly, doctors on average makes $200K/year [2] or more. I have four
housemates, who were trained in Myanmar (went through five years of medical
school there right after high school) and scored above 95th percentile or more
in all three steps of their USMLEs, to get into the residency programs in the
US. One of them is going into general practice (family medicine) in Virginia
and her starting salary is: $210K/year. I have no doubt that she (or anyone
who has been trained 5 years in a decent med school--without the 4-year
undergrad prior to that) is more than capable of treating generic diseases and
illnesses. But this shows that we can train doctors cheaper and that we can
reduce their pay by quite a bit (no hard-working person in other profession--
except maybe Banking--could easily earn $210K/year to do such a relatively
uneventful--in my opinion--job).

I regret quitting med school in Myanmar in the third year. Then, I thought med
school training involves too much rote learning (a lot of memorization in
organic chem for example) and that I'd rather do something more 'exciting'
like tech or math. I was wrong.

[1] [https://mises.org/library/how-government-helped-create-
comin...](https://mises.org/library/how-government-helped-create-coming-
doctor-shortage) [2]
[https://www.theatlantic.com/health/archive/2015/01/physician...](https://www.theatlantic.com/health/archive/2015/01/physician-
salaries/384846/)

~~~
elefanten
We probably don't hear about doctors' salaries as part of the problem because
they're not a huge problem. A cursory web search indicates theres about a
million doctors in the US. If you cut each of their salaries by 100,000 (which
probably isn't feasible) then you would save 100 billion.

Sounds like a lot, right? Until you note its just $300 out of $10,000 spent
per person each year.

And what's the trade-off? Despite your opinion that it's boring or potentially
not very challenging... there are pretty logical reasons why people would
still want a relatively disciplined, intelligent and careful person as their
doctor. The lengthy and onerous requirements for schooling are filtering for
more than just the ability to perform a series of carefully defined
procedures.

------
ransom1538
Americans unable to afford healthcare are just waiting in line to become
bankrupt.

A study done at Harvard University indicates that this [medical costs] is the
biggest cause of bankruptcy, representing 62% of all personal bankruptcies.

[http://www.investopedia.com/slide-show/top-5-reasons-why-
peo...](http://www.investopedia.com/slide-show/top-5-reasons-why-people-go-
bankrupt/)

------
brohoolio
Healthcare costs create huge problems across the economy, increasing the cost
of everything from manufacturing to higher education.

Between myself and my employer, it costs about $20,000 to insure my family a
year. My employer shares much of the cost breakdown and it's interesting how
goes to prescriptions and how much of that goes to specialty drugs to keep a
handful of people alive.

$500 million dollar spend on healthcare.

$120 million goes to prescriptions.

$40 million of that went to specialty drugs, representing 1.7% of the
prescriptions.

"The average ingredient cost of a single-source brand prescription increased
by 14.9% in 2016 to an average $745 per prescription, mainly driven by high-
cost specialty drugs. The average ingredient cost of multiple-source brand
prescription increased by 49.5% to an average $585 per prescription. The
average ingredient cost for a generic prescription decreased by 10.9% to an
average cost of $34.04 per prescription. "

~~~
slackingoff2017
Drug prices are high in the US but drug spending overall is nothing compared
to overall healthcare costs. With a handful of exceptions, even the most
expensive drugs cost 10k a year.

In contrast a few weeks in the ICU can easily top 100k. A visit to the ER is
usually 1500 just to walk in the door. Healthcare costs are largely a result
too many middle men and overhead from extremely high healthcare provider
salary.

~~~
chii
> overhead from extremely high healthcare provider salary.

may be there isn't any competition (which could be because it's quite hard to
establish a new healthcare clinic/hospital)? Also, are there limited supplies
of health care professionals that cause their salaries to grow to such a high
number?

------
kauffj
The most insightful and thought provoking analysis of health care I've seen in
the last several years is this one:

[https://randomcriticalanalysis.wordpress.com/2016/09/25/high...](https://randomcriticalanalysis.wordpress.com/2016/09/25/high-
us-health-care-spending-is-quite-well-explained-by-its-high-material-standard-
of-living/)

It argues that the high cost of health care in the United States is explained
by its extreme wealth and that health care is a superior good
([https://en.wikipedia.org/wiki/Superior_good](https://en.wikipedia.org/wiki/Superior_good)).

This is a much different explanation than what is given by either political
party.

Anyone have any points in support of or against this argument?

~~~
zip1234
Health care costs have an incentive and price transparency problem. If
hospitals had to post their prices on the internet and people had an incentive
to save money, the costs would go way down. There may be some truth to the
argument, but the author ignores the ability of a market to drive down prices
and improve products. As it stands, we have a market, but the lack of price
transparency causes significant inefficiencies. The government should tweak
the current system to require open data standards. This would allow a value-
for-money comparison when people choose physicians/treatment and increase the
efficiency of the system.

------
ralfd
Obligatory Slate Star Codex Link:

[http://slatestarcodex.com/2017/02/09/considerations-on-
cost-...](http://slatestarcodex.com/2017/02/09/considerations-on-cost-
disease/)

Scott Alexander examines "cost disease" in the sectors of health care and
education.

~~~
brownbat
Strongly recommend the work on Random Critical Analysis linked to by SSC
there.

Approx. zero people reading this will believe the conclusion, but RCA argues
that the US is not really an outlier on healthcare costs.

There's a dizzying amount of data and statistics levied for the argument. It's
a fascinating read even if you don't agree just because of how much is put
into the argument.

[https://randomcriticalanalysis.wordpress.com/2014/11/24/nati...](https://randomcriticalanalysis.wordpress.com/2014/11/24/national-
healthcare-expenditure-united-states-versus-other-countries-the-us-is-not-
really-an-outlier/)

[https://randomcriticalanalysis.wordpress.com/2016/09/25/high...](https://randomcriticalanalysis.wordpress.com/2016/09/25/high-
us-health-care-spending-is-quite-well-explained-by-its-high-material-standard-
of-living/)

~~~
akamaka
Incredible.

This blogger indeed uses a dizzying amount of graphs, but doesn't mention
until the end that he has built his entire argument on the assumption that
Americans "choose" to spend their higher income on health care.

~~~
rcafdm
That was mentioned at the very start of the 2nd link (see "superior good") and
it's true virtually everywhere in the long run (especially in developed
countries with reasonably reliable growth in disposable incomes and where we
have pretty reliable data). If we want to identify _systems_ that might allow
us to contain costs on the margins knowing who spends least or the most is not
informative in and of itself. Rather we should be interested in residuals with
the best model, as in, who is furthest below trend (as a function of
comprehensive consumption or disposable income), what plausibly explains this,
and whether are we actually willing and able to implement those sorts of
features in our system....

Incidentally these patterns are not only found in health care, the basket of
goods has changed and continues to change as countries get richer:
[https://randomcriticalanalysis.wordpress.com/2017/05/09/towa...](https://randomcriticalanalysis.wordpress.com/2017/05/09/towards-
a-general-factor-of-consumption/)

~~~
akamaka
It's his interpretation that people "chose" to spend more money as they got
richer. Many other people interpret it differently, when the alternative to
paying might be death.

~~~
rcafdm
Right, it's just a coincidence that disposable income correlates nearly
perfectly with health expenditures at a national level in the long run (and
quite well at a subnational level) and that when disposable income falls NHE
tracks it and so on and so forth.

P.S., I wrote the blog post.

~~~
akamaka
Perhaps that indicates how effective the healthcare industry in the US is at
maximizing their revenue. If the choice is paying or dying, people will pay an
unlimited amount.

~~~
rcafdm
Except the rich and poor spend pretty similarly in the US and elsewhere. The
income elasticity > 1 occurs at a national level....

[http://mason.gmu.edu/~rhanson/EC496/SOURCES/LUXURY.PDF](http://mason.gmu.edu/~rhanson/EC496/SOURCES/LUXURY.PDF)

And the _better_ data on price suggests US actually isn't unusually expensive
for a high income country and so on and so forth. Much data points to higher
volumes of _health_ goods and services as we chase diminishing returns as a
society.

~~~
akamaka
I meant my comment about unlimited spending as an philosphical argument, not
as a literal data point.

And yes, the biggest problem in the US is unneccessary tests, procedures, drug
consumption, etc., and the cause of that problem is a system which is built
around maximizing revenue instead of maximizing public health.

~~~
rcafdm
But if you look carefully you will find most of this behavior plays out
similarly in those few countries with somewhat more comparable wealth (e.g.,
Norway). The issues that many people think of as being particularly "American"
problems are problems that _mostly_ have to do with our high material living
conditions (as in, diminishing marginal utility attached to other forms of
consumption and increasingly high values attached to human life). Overall
health expenditures are increasing equally rapidly in these countries as a
function of AIC, disposable income, etc and there is no evidence they are
getting any more value for their money (having a healthier populations helps
naive comparisons of life expectancy, IMR, etc a ton).

Here are some papers that touch on some of these more fundamental theoretical
issues:

[https://web.stanford.edu/~chadj/HallJones2007.pdf](https://web.stanford.edu/~chadj/HallJones2007.pdf)

[http://mason.gmu.edu/~rhanson/showcare.pdf](http://mason.gmu.edu/~rhanson/showcare.pdf)

------
CWuestefeld
By this argument, we should also be examining why we spend so much on
education. In 2010, the United States spent 7.3 percent of its gross domestic
product on education, compared with the 6.3 percent average of other OECD
countries.

Surely spending dramatically higher amounts than other countries, with no
better effects, is enough to drive us to consider how we can reduce the costs
of education - and should make us think long and hard before considering
proposals that we should throw even more money at this.

It's surely true that having a well-educated workforce improves productivity,
but it's also true that having a healthy workforce does the same. I'm having
trouble finding much difference between the two examples.

------
bischofs
I really think health care costs in the US are a byproduct of Americans
obsession with convenience. Most lifestyles can be lived without any physical
activity - the whole country is designed around the car.

Traveling around a bit I've seen other cultures still require people to walk
somewhat to get places and people will also just go on "walks" whereas
Americans will go for a "drive"

Food culture is also responsible, just jamming food into your face as quickly
as possible rather than enjoying a meal is for sure and American thing.

Add all this up and you get 60% obesity rates in adults and getting worse.

------
psyc
There are no sane constraints on the prices. Instead of "price is what the
market will bear," it's "the market will bear whatever price." This creates an
irrational drain on the rest of the system. Whoever is sucking on that drain
is doing well, though.

My grandfather used to get a shot that was $12,000 a pop, and didn't do
anything.

------
ivanhoe
Looking from the outside, it seems to me that the root of the problem is not
about the health care in US, but about the prices of health related services
and products? Prices are so inflated, hospital and medication bills are huge
compared to what the same things costs in Europe or elsewhere.

------
pow_pp_-1_v
I had kind of hoped that Trump would stumble into single payer health care as
a solution for healthcare needs of his base and would somehow get it passed
through congress with support from democrats. Alas, nothing of that sort seems
likely.

------
RichardHeart
Health care costs would be lower, if more people were able to provide health
care service. If the world focused less on rate my sandwich apps, and more on
fixing humans, the prices would be much more affordable.

------
ChicagoBoy11
Yes, this is an academic article, but I can think of no better resource for a
pretty sane discussion on all the insanities in our healthcare system:
[http://faculty.chicagobooth.edu/john.cochrane/research/paper...](http://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca_published.pdf)

The thing that is pretty remarkable is that you unfortunately realize just how
far either political party is in addressing any of the issues brought in the
piece.

------
faragon
Amazon could disrupt providing Health Care services in the US. Current price
overhead versus over developed countries is huge, so an efficient provider
could shock the whole HC market.

------
chaibiker
And entirely ignored seems to be the demand side of the question, why is that?
Could expenses be higher than we want if we are less healthy that we should
be? I see a lot of unhealthy habits associated with the subsequent associated
costly interventions required. Just because we see no path forward to affect
demand, leaving it out of the discussion will ensure the debate is framed only
as which system can provide that volume of healthcare for a little more or a
little less.

------
alistairSH
Question for y'all... Have your health care providers started being more
conscious or out-spoken about cost? Mine definitely have, both for
prescriptions and procedures.

------
jcfrei
Would it be a worthwhile idea to open up health care internationally? Maybe
insurance companies could create global standards for medical procedures, so
that clients could choose in which countries they want to perform a procedure
and then receive or pay the difference with regards to the cost of a national
procedure. This could introduce some level of competition without jeopardizing
quality - or am I missing something?

------
hudu
The pharma industry should open up; it is dominated by corporatism and their
monopoly patents driving up prices, which make individual spending on drugs
rise till an unaffordable level for the lower income.

------
moomin
Frankly, I just stubbed my big toe and that's a bigger problem than US
corporation tax.

------
ewood
Why the U.S. pays more for health care than the rest of the world

[https://www.youtube.com/watch?v=gXBPKE28UF0](https://www.youtube.com/watch?v=gXBPKE28UF0)

