Why do Americans pay more for healthcare than people in other first world countries?

25 comments

1. It really comes down to the fact that the US never reformed their healthcare and allowed the status quo to continue. A status quo that created the monstrosity we have today. Also people, not just Americans, dislike change and often okay with bandage fixes (or tolerate it). If you look at many other countries that have social healthcare, they didn’t have an incumbent system really distracting them and there was an incentive to reform their healthcare to what it is today. Personally I credit these reforms to destruction caused by the wars in the 20th century removing a lot of incumbent roadblocks. A lot easier to implement a new system when the old system is destroyed or not working. The US healthcare system has always “worked”.

2. The system is rigged and heavily is for profit. I hav3 health insurance and if it wasn’t for some of the free benefits such as a free physical and what not I’d never ve able to use it. Insurance also helps with preventing full on medical debt and makes it a bit more manageable. Also worth noting that Americans pay more on average because of the lack of ability to afford said Healthcare. Instead people put off things that could be easily fixed or treated due to cost and go once it becomes an emergency, which of course increases cost significantly. I can tell you from my experience medical debt is no fun. I just paid around $5K to have a tooth repaired after it randomly died on me without warning. In my case it was either get the tooth fixed, wait for the infection to get into my blood and possibly face death, or the tooth’s nerve to decay and fall out.

3. You’re probably seeing pre-insurance costs, which aren’t the norm to pay out of pocket by a long shot.

   We also just don’t have any of the price controls most countries have, so yes those costs are significantly higher than insurance or government health services are paying in a lot of places.

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5. Because we pay far less in taxes and make more money.

6. >how do you manage it

   I have insurance. And not the cheapest possible insurance that most redditors seem to get.

7. Everything depends on what insurance you have. My employer provides a pretty great insurance plan, so healthcare is extremely affordable for me. $15 to see the doctor, $5 for prescriptions, $50 to go to the ER, and if I’m admitted to the hospital everything is free. Test, procedures, and check ups are all free as well.

8. First, we have a few different healthcare systems depending on who you are. A retiree gets Medicare, while a white collar professional typically has top tier insurance that has only minimal out of pocket costs. Most people get insurance through work, or they qualify for government insurance (Medicaid) or insurance subsidies. There’s also Veterans and military insurance. Almost no one ever pays the sticker price for healthcare.

   Second, we have substantially better/newer and more healthcare. Because the US market is the only market where drug and device manufacturers can sell without price caps or bulk nationwide contracts, new technology is available here first and becomes widely adopted because there is capacity to deploy it through physician training (so in effect we subsidize development of health technology for the rest of the world). For example, HIV prevention drugs commonly known as “Prep” became available here in 2012, but it took until 2018 before the majority of other OECD countries provided Prep. It’s common for new hips, cancer drugs, surgical techniques, etc, to be 10 or even 15 years behind in a lot of countries. So on a practical level, we are paying more because we get a different product.

   A lot of the negative outcomes you hear about, such as having lower life expectancy than Europe, often conflate cause and effect. When you control for socioeconomic background and lifestyle choices, our healthcare is truly impressive. It will save your life many times where others simply can’t.

9. Because costs are kept high to force you into an insurance because those companies lobby our government to make that happen. Doesn’t end there, though, because insurance premiums are ridiculous and with varying tiers of coverage. So you’re forced into something that may not even cover you for a specific treatment while gladly charging you for it.
   The whole thing is literally a scam.

10. The US is where a vast amount of medical innovation occurs. This includes everything from education and procedures to technology to pharmaceuticals. As Americans, we foot a large amount of that bill. Our medical care and prescriptions are not subsidized by the US Government like it is with a lot of other countries. What makes costs go up even more are three major factors- government, insurance and lawyers.

    The US Government gets too heavily involved in medical car administration and coverage, and they dictate to the hospitals and clinics how much to charge for Medicare (old people medical coverage). The problem is that they pay a set amount and if that’s not enough to cover the costs, the medical facility can’t charge more. Instead, the medical provider passes that along to patients with normal insurance.

    Insurance companies contribute to higher costs because of how much bureaucracy and logistics go into filings. Medical providers routinely have to go back and forth with insurance companies to cover a patient, and they medical provider has to justify every procedure if they want the insurance to pay for it. Medical providers then pass along the cost of this to the patient.

    Lastly, lawyers file lawsuits and make costs go up dramatically. The US has resisted medical tort reform for decades, and much of it has to do with the fact that most of our government is controlled by lawyers. A large number of politicians are lawyers, and they rarely pass legislation that restricts lawsuits (including frivolous lawsuits).

    All that being said, we also pay for the convenience and timeliness. I’ve gone into an urgent care clinic with an ailment and received treatment and left inside of 60 minutes. When I tore my right quadricep muscle last year, I was able to get in to orthopedic urgent care and get seen and treated inside of 2 hours. I got an MRI done 4 days later after the weekend and the swelling went down. My total out-of-pocket expense for everything was around $700 after insurance paid their portion. I would rather pay $700 and get treatment quickly than to get free treatment but have to wait 8-16 hours to be seen. Canada, UK and other countries with nationalized healthcare are notorious for long wait times on non-emergency medical treatment. Preventive medicine is easy to schedule and acquire here. It’s not like in Canada where some people have to wait 5 years for a GP. I know a girl who got pregnant in Ontario and when she wanted to get an OB/GYN specialist, they told her it was an 11 MONTH wait for one. That’s beyond ridiculous for someone who is only capable of gestating a fetus for 9 months. In the US, a pregnant woman could find and begin to work with an OB/GYN of her choosing in as quickly as a week or two.

11. For *most voters*, the system works well enough. The people who really suffer…mostly don’t vote. The US is a very rich country, and the average voter is richer than the average American, so can afford expensive health care.

    On top of that, the system’s massive inefficiency protects it. We’re not talking about a few corrupt officials taking bribes or a few insurance company executives rolling in cash. Every hospital and doctor’s office has to negotiate with all the different health insurers over what gets paid for and how much. Both sides employ people to deal with all of that, and all of those jobs would disappear in an efficient system. Also note that the median US doctor makes $320k and nurses $77k. In France, those numbers are more like $100k and $43k. The US is richer than France, but not that much richer.

    Every part of the US health care system is more expensive than you’d expect for how rich the US is, and all of that excess money goes to people. Few of them are as unpopular as insurance company executives. People love doctors, “doctors need to take a 50% pay cut” is not popular even though it contributes to the problem. “The 600,000 health insurance employees plus 100-200,000 people in medical billing for hospitals and clinics, they all need to lose their jobs.” Yeah, that’s a real election winner.

    Voters also object to tax increases for government health care, even if you correctly tell them they will save money.

    And it’s both harder to get anything done in the US political system than a parliament where the prime minister usually has a functional majority, and doubly hard to expand the welfare state with the conservative skew.

12. Higher profits for companies.

13. >How do you manage it?

    From the perspective of a relatively healthy person, I don’t manage it. Insurance has covered the very few accidents I’ve had pretty reasonably (under 1,000 total) and all my regular checkups are preventative and therefore covered by insurance.

    The most expensive medical procedure I’ve had done was wisdom teeth removal. That was $1,350.

14. Paying for marketing, R&D, and private insurance kickbacks is expensive.

15. Since there are a wide variety of public & private fee structures, the logical thing to do is to overshoot with your immediate estimates and then immediately defer to that fee structure/cut that price drastically in what’s called an “adjustment”. Best not to pay attention to those initial prices; you have to wait for it to settle

16. One reason, to put it simply, is because several other countries negotiate the cost of drugs (as in, if you don’t sell it to us for this price, we won’t sell it in our country at all.) Those that don’t negotiate the price are paying more to make up for what the other countries don’t pay.

17. Our healthcare system is a for profit system. Most countries’ healthcare systems are more of a tax payer funded public service (like K-12 public schools). Over the past 20 years or so, our healthcare system has been acquired by large corporations and private equity funds whose sole purpose is to maximize shareholder wealth.

18. With my insurance, after I meet my deductible I don’t pay anything besides the copay. So I manage it quite well 🤷‍♂️

19. We have health insurance that covers most expenses. for example: My providers has me pay a $20 co pay for DR/urgent care visit and a $150 co pay for ER visit.

20. Yesterday I got sick.

    I was able to immediately call my doctor for a $20 copay

    He prescribed me Azythromycin and instantly sent it to my pharmacy who messaged me that it was ready and paid for with my card on file –$10.

    He also ordered me a full panel virus test that I was able to drive to any clinic to complete for free.

    From the time I left my house to when I got back with my medicine and after getting a test, it was less than 30 minutes.

    I have insurance, much like the vast majority of our country.

21. I go to the doctor when I need to and pay a $25 copay. When my son was born, we only paid a couple hundred bucks for the delivery and it was a c-section where my wife spent nearly a week in the hospital. For most people this is pretty normal where you aren’t burdened with insane medical bills.

    If you don’t have insurance and don’t qualify for Medicaid or Medicare (our social medicine options) then you do end up paying out of pocket. I know many people don’t know how to navigate the system, but no one should ever be paying those insanely high bills. If they choose to go to a for-profit health system that’s on them, but almost every non-profit/not-for-profit will work with you on your bill. If you go to a faith-based hospital, the likelihood for charity care is even higher.

    I work in hospital finance and the amount we “write off” every month is staggering. What gets me though is people who don’t even try to negotiate their bills down. One call to the number on your bill can do wonders, especially if you’re polite.

22. Healthcare spending in terms of GDP is higher in the US than other developed countries. We pay a very high premium for medical care (higher salaries for medical staff), as well as all the administrative staff that’s needed in the hospitals/insurance industry. There seem to be a lot of inefficiencies, in my limited opinion.

23. I have a job that offers health, dental and vision insurance. I pay $40 a month for it.

    It works for me

24. Last time I took an ambulance it cost 75$ so cost varies a lot.

25. You’re likely seeing pre-insurance costs. But also calling an ambulance doesn’t cost anything. Riding in one to the hospital does though.