But also, sometimes people from other countries-- I am thinking parts of Europe-- underestimate how well paid people in the US often are. They compare the averages, like the US only makes 20% more per household, why do they put up with this or that. But that comparison is for the whole country, so imagine if you were comparing all of Europe or China.
I had a friend in Spain at a similar company as mine say, how can you put up with no safety net, etc. But I look at his company and every one at my company at any level gets paid 2-5x as much. So like these are less serious issues if you are paid an extra $1-200k/ year. It doesn't explain the inaction, but I believe it is why a lot of politically influential people don't care.
Yes, in USA you get much more money, like you said 2x~5x, but then:
University is expensive as fck. Health care is expensive as fck. You have 5 days of paid sick leave per year in most companies. You have 10 days of paid holidays per year in most companies.
In contrast, in Europe: University was cheap or free. Healthcare is cheap and universal. If you are sick you are sick, either the company or the health insurance pay. You have between 20 and 30 days of paid holidays.
This is why quality of life in Europe, is so superior. And again, I am saying this as a non-European.
One thing that's hard to understand from the outside is that almost nobody actually pays those mind-blowing $60K/year tuition prices. US universities charge on a sliding scale based on the applicants' families' ability to pay.
For an extreme example: Harvard's tuition is nominally $60K per year, but for families earning $200K or less it's $0. Many prestigious universities follow similar patterns resulting in a large percentage of students paying no tuition, the middle ground of students paying some fraction, and a small number of students from wealthy families subsidizing everyone else.
For those who don't attend the prestigious universities with large endowments, average in-state state-run University tuition is under $10K, though again a large percentage of students receive some form of aids or grants to bring that number down even further.
That said, it's entirely possible or someone to go out and sign up for bad investment private university with no aid and rack up $300K of debt by graduation if they're not paying attention to anything, but it's a myth to think that everyone does this.
The average US college student graduates with around $30-40K debt depending on whether they go public or private, which isn't all that hard to pay off when our wages are already significantly higher than other countries. We're especially lucky in tech where our compensation differential relative to other countries more than makes up for the cost of university education.
As someone from a country (Sweden) that to a larger extent has decreased people’s reliance on their families, and grown the welfare state instead, it’s weird to think that your parents wealth or income should have any impact on things like tuition, once you’ve reached the age of majority
Once I finished high school, my parents had nothing to do with my business as far as any institutions were concerned, and vice versa. But uni was tax-funded and free at the point of use. And when they get too old to care for themselves, it will likely be the government supporting them financially, not me (unless I strike it rich first, in which case I suppose they’ll spend their sunset years in style)
I'm not saying the European system is bad. Certainly there's a lot to complain about with a system that asks 18 year olds to make life-defining decisions about both their career and their financial prospects. But the differences do go beyond whether or not you're on the hook for your tuition.
Personally I think the government should get out of the business of these loans, fully fund state schools to make them all free, and let the private schools and the private banking market deal with the rest of it. We were going down that path in CA until Reagan killed it when he was governor. [1]
[1] https://newuniversity.org/2023/02/13/ronald-reagans-legacy-t...
https://en.wikipedia.org/wiki/Public_Service_Loan_Forgivenes...
This is an extremely important point that keeps getting ignored. People keep comparing _public_ schools in Europe to _private_ schools in America.
To further your point, just about every place has a community college where you can do the first two years of your education for about half the price of the state school. The total tuition for this route (2 years at community college, 2 years at a state school) is going to average just under $30,000 for 4 years. Which is definitely in the "work your way through college" range.
And this is before any financial assistance, which the majority of students receive.
Foreigners talking about how crazy expensive college is in the U.S., but they're likely mislead by people who took out large loans to go to extremely expensive private colleges. There's an easy way to stop this kind of debt - don't allow federal loans for private institutions. But no one is really interested in stopping it.
Not necessarily the case. In Sweden private schools are paid for by the government, assuming they have been approved by the CSN (central agency for study-support(rough translation))
I don't know how that works in the rest of Europe, because I've never studied outside of Sweden. But in Sweden it doesn't really matter if the school is private or public. The only instance you have to pay yourself is if the school isn't sufficiently good to pass muster.
Also, again in Sweden at least, but possibly other parts of Europe as well, the tuition isn't effectively $0. The government will pay any student enrolled in higher education a monthly support. Back in my day it was 10k SEK per month (roughly 1000usd), no strings attached. Not sure how it currently stands but I imagine it hasn't changed much.
This money is meant to ease the burden on students, so that they can put more focus on studies.
"Working your way through collage" over here means you'll have a 20% job to pay for your cost of living minus the 10k SEK mentioned above.
The difference in cost of study is quite real, even taking your comment into account
(I don’t mean to belittle your comment about universities which is factual and helpful. I’m just pointing out that US education system is just as fucked up as the US healthcare system the OP is talking about.)
Even people in the US don't understand why those $200K hospital bills aren't real.
Insurance providers (including government programs) have a fixed limit for what they pay for procedures. They pay min(billed_amount, allowed_amount) so providers don't want to risk leaving money on the table by having billed_amount < allowed_amount. To ensure this doesn't happen, they bill an arbitrarily high number with the expectation that insurance will lower it down to some much smaller number.
So every time you see posts on the internet where people talk about their "$200K hospital bill" they're always talking about that arbitrarily high value. If you have to pay cash for some reason, they will reduce the value to the cash pay amount which is in line with the insurance paid numbers.
Nobody ever pays those high hospital bill amounts.
This is such a weird excuse for bad policy. Making more money[0][1] somehow means its okay to saddle students with an average debt of $30-40 thousand dollars. A downpayment on a first home would be a much better use of that money, for example.
Really, the average US citizen is nickel and dimed to death with this sort of thing, from health insurance, to dental, to lots of other required but not accounted for as required costs (like cars and associated car insurance).
Not to mention, we have little safety net in the US, you're really going to hurt if you have a bad run of luck after job loss. No qualms in allowing people to become homeless as a matter of policy.
If someone were to ask me, I would say that we in the US have it completely backwards in respect to how the average citizenry is expected to live. Its not thriving, its constantly having some kind of lingering potential disaster to plan for.
[0]: which I sincerely wonder about the true veracity of this statistic
[1]: Don't forget too, that more and more struggle to pay their student loans each year and the trend has generally been that its getting worse, not better.
Granted, none of the top universities in my country even makes it to the top 500 in the world, so maybe this isn't a completely fair comparison? Actually, it's expensive by some other EU country standards - public schools in France and Germany, including PSL (ranked 28th in the world) and TUM (ranked 22nd), are free for all EEA applicants, with some nominal yearly registration fees (amounting to $1k in total for a 4-year degree). A more expensive school, like ETH Zurich (rank 7 in the world), is $4500 total for a 4-year degree if you're a Swiss citizen or EEA citizen with a Swiss work permit; it's triple that for an international student.
So yeah, when we say "university is crazy expensive in the USA (and probably UK too)", we're actually talking about the $30-40k numbers you're looking at. $200k and so are almost inconceivable to us.
That's the cost over 4 years. Most people will be able to get financial assistance to help pay for that and you easily manage to make 30k (or less with grants) in 4 years to pay for school. People making below 35k per year are going to pay practically zero taxes. You can work about 15 hours a week making $10 per or full time over the summer to pay for that.
There's no need to take on any debt.
People in the US make considerably more money than those in the EU and, generally pay less taxes so there's a lot more disposable income available. I think people here prefer to be able to just get what they can pay for rather than hope the government will let them pursue the education they want (there are aptitude tests and quotas in some EU countries).
It's not really better ir worse, it's just different.
This is not true at all.()
You quote tuition at the school with the highest endowment in the country. The college cost situation is absolutely still high at the less endowed second tier, and “ordinary” (non-generational wealth, two full time earner) families are paying full price.
(
) Except in the sense that “almost nobody” goes to any of these schools, comparing to the 50k enrollment at large public institutions.I went to a 2nd tier in-state school 20 years ago and even that cost 10k a year by the time housing, food, and books, were paid for.
Plenty of people who can barely avoid it end up paying a large chunk of $.
I wouldn't be surprised if this changes in the future, I am talking about the period of my life to date.
The reverse is not true. European nations aren't very immigration friendly by comparison. On top of that, the US government, assuming you keep your citizenship, does not make it easy to live abroad. US government tax policy for citizens who live overseas is much more aggressive than any other western country, from what I understand.
Combined with the fact its alot harder to go the other way, and the US government does a fair amount to discourage it, I'm not shocked more US citizens aren't moving to Europe.
[0]: At least before Trump returned to office, I'm unsure how much of this has changed.
> The US has for a western country, relaxed standards for immigration
First, let's start with the "Anglo-American sphere" (my term): US/UK/CA/AU/NZ. Of those five, US is the hardest to get a working visa for skilled individuals. The rest are "points-based" system where you can apply for a working visa even before you have a job (95% sure about this -- pls correct if wrong). They are much more friendly. Also, the rules are simpler, clearer, and applied more consistently.
I know much less about other OECD-level (and G7-level) nations, but anecdotally, overall, the process is much more straight forward compared to the US. What the rules say, the rules do. Not so much in the US where they randomly delay or reject applicants without good reason. (Also: Google to find horror stories of what happens when you lose your job in US as a foreigner who does not have PR. Fucking nitemare.) You hear this much less in (to name a few): Ireland, UK, France, Germany, Belgium, Netherlands, Denmark, Norway, Sweden, Finland. (I don't hear as much about Portugal, Spain, and Italy, but quality of life looks awesome!) All of those countries are wealthy, highly developed and have excellent quality of life. All of them welcome skilled migration and have clear programmes (you can Google about them) to get a working visa. Again, strictly anecdotal: The US immigration system is much more adversarial compared to all of the other countries that I mentioned. Oh, and I forgot to add Japan: After PM Abe changed the rules, it is way easier these days to get a skilled worker visa in Japan.
Last point:
> European nations
People only live in one unvarnished (more or less) reality at a time. Americans live in America and get told stuff about “Europe”; Europeans live in Europe (or their respective countries if we want to get anal about it) and get told stuff about America. Only a very very small number of people get to live in multiple places and for long enough stretches of time to be able to compare them pretty fairly.
In what kind of dream reality do people come to have such perfect (I’m being hyperbolic) information about other places that they then are able to base their move-or-not decisions on? This is just not reality. People know what their own place is like. They “know” other places through propaganda, mostly.
But Americans are so propagandized that you have to teach them about their own propaganda.
In software the money difference you still end up ahead of where you would be on an equivalent salary in the EU. Also last time I was considering a move to the EU job market was weaker than the US. Also you still need to get all the necessary work visas which aren’t automatic. Even as a dual citizen I can’t just show up to work at a company in the EU.
If 50% of Americans spoke Polish by the shake of a wand, I bet there’d be more Americans in Poland than Poles in Poland.
I could see that the appeal of Ireland can be increasing and Poland sounds cool. I'm not saying that the USA is great, it has tons of problems.
That's very subjective, and I would rather have my freedoms instead of your/their liberties, thanks!
While healthcare is brought up all the time this is usually ignored. The idea of parents saving a 'college fund' for their child is something I only know from movies. It's such a strange idea that access to education would be something you either need to be able to afford or need to get a 'scholarship' for (another strange concept).
Like most things learned from movies, you're not getting the full picture. Most US universities charge on a sliding scale based on family earnings. For larger universities, tuition can actually be free depending on parental earnings. At the extreme end, some Ivy League universities like Harvard have $0 tuition for families earning less than $200K/year.
We also have community colleges and state-run universities with subsidized in-state tuition. It's still more expensive than free, but the tuition is in the range where as long as you're smart with your degree selection the ROI of getting the degree will more than make up for any loans you have to take on. That said, you can get yourself into trouble if you take out loans to study for a degree that doesn't translate to a job.
(By way of policy bona fides: I'd strongly support forgiving student debt for all for-profit schools, but would oppose forgiveness for degree-holders from universities, which would be a sharply regressive policy).
And which today must be read via internet archive
https://web.archive.org/web/20200404172130/https://likewise....
Basically explaining to Armenians at home why their relatives who moved to America don’t send better remittances back home despite their $X pay rate. Here’s why …
University isn't near as big of a problem. That's not something the blindsides you like health care expenses. Nobody is making you spend $300k on university. Got my engineering degree at a public university for ~$100k in total and had it paid off 5 years after graduation. But a $195k hospital bill is something I'd never be prepared for. Nobody chooses to go to a hospital.
There are still reasons why high university costs can be a problem. Teachers, for example, don't get paid near enough to be able to cover university costs in a few years like I was able to. But becoming a teacher requires just as much investment.
But even then, the cost of college loans is far more manageable for even teachers than an unexpected $195k visit to the hospital. University cost is a problem in the US, but I don't think it's comparable to the problem we have with health care costs.
Ha! I wish. It's not free. You will pay the same that Americans pay for Uni over your life many times over since tax rates in the EU are really high. Healthcare isn't exactly cheap either.
And everything you wrote is just the result of decades of prosperity that are now coming to an end. This will be a shock for many.
Is it? I pay 13.5% of my income as healthcare 'tax' for public healthcare. Overall, it is cheaper than US healthcare (as a percentage of GDP), but individually it is still a significant expense.
Many (most?) European countries have private healthcare systems. Switzerland has it and offers some of the best healthcare in Europe and in the world. Similar systems work great in many other European countries as well. The problems with American healthcare are not because it's market-based, it's because how that market is managed.
Some other countries have public universal healthcare. It can work well, but it requires a high-income country with both wealth in abundance and significant government efficiency. It only truly works well in Scandinavia so far. This is not "socialist healthcare" as some will dubiously claim, it's sort of the opposite, which is why it works.
Ok but to be fair most people in the US aren't making "extra $1-200k / year" over a person in Europe. They aren't even making $100k / year to begin with.
Although I have to say the rosy picture some paint here about the high incomes is counter to anything I ever heard - and saw, although I left the US in the early 2000s, after having lived there for almost a decade (still mostly paid from Germany, never ready to make a complete move).
"Medical Bankruptcies by Country 2025"
https://worldpopulationreview.com/country-rankings/medical-b...
"Healthcare Insights: How Medical Debt Is Crushing 100 Million Americans"
https://www.ilr.cornell.edu/scheinman-institute/blog/john-au...
By the way, Europeans don't quite all have a "nationalized healthcare system". Germany, for example, has "Krankenkassen" but also private insurance, and the "Krankenkassen" are private organizations.
We pay health insurance and get to choose the provider, those with higher incomes can switch to complete private insurance. We also have lots of our own problems and increasing costs because of immigration but more so aging population.
However, I personally know several people who had severe illnesses for a long time, and their normal "Krankenkassen" insurance never made any problems. One person with plenty of money, whose wife was dying, even asked US medical experts if he should come to the US with her, and those US experts said he should stay where he is, the German univ3ersity hospital right next door had some of the leading therapies in the field. She lived five more years instead of dying after less than half a year with the standard therapy, every single expense paid for with the standard insurance, additional private insurance unnecessary. Similar with my stepfather, who had soooo many severe conditions, and yet every single item down to the special medical bed brought into our house so that he could finally die at home was paid without question.
The problems are with more mundane expenses, e.g. glasses, or the dentist, where only some of the treatments are covered. The really expensive illnesses seem to be better covered than the more common and much simpler problems.
our blocs aren't that different
except in the US middle class and upper middle class
I'm from the eu and earn far less than these American techbros do, but far more than my American friends who work normal jobs. They work at the DMV, a supermarket, or general office work. You know, normal people. The vast majority.
In fact it's quite low, somehow people are expected to survive on several thousand a year, after the rent, utilities, transport costs are all paid.
https://www.fool.com/money/research/average-us-income/
These are official stats, but unofficial employment puts the number lower:
https://investorshangout.com/carlyle-group-unveils-alarming-...
Can we really say this is true about individuals in the US?
I think it's pretty clear the propaganda machine has successfully privatized health care to the great detriment of the populace and have the clamps on it.
After all, if you told everyone you had a solution where insurance rates would be cheaper, their healthcare system would cost less overall, and the health outcomes would be superior, they would all be like "sounds great". Then, when you reveal this solution is the complete destruction of the insurance "industry", insurance payments are "tax", and the health provider is the government, they would balk, scream about socialized healthcare, and say how they don't trust the government.
That's a trained response, not a real thought.
So when you're talking about how bad the American system is, you're really talking about a minority of its users. That doesn't make everything OK, but does highlight the political difficulty of enacting seemingly-popular changes.
It sure seems that way if a wealth family with top level insurance can still get bankrupt by medical bills. Examples of that are right here in comments.
https://www.npr.org/sections/health-shots/2022/06/16/1104969...
https://rooseveltinstitute.org/publications/medical-debt/
https://www.marketplace.org/story/2024/03/27/health-and-weal...
As for income distribution
https://worldpopulationreview.com/country-rankings/gini-coef...
State GDP figures are skewed by high earners. The US is massively and systemically unequal, with far less economic mobility than the EU.
If you had said the median tech worker? I might have believed you, but the median family? No way.
* Excludes everybody on Medicaid
* Excludes fixed-income seniors on Medicare
* Makes it overwhelmingly likely you have subsidized employer-covered health insurance.
Figure your employer "covers" half the gross cost of your $24k/yr health insurance (they aren't, really: that's money they'd be paying you directly without the distortion of employer-provided health care). Do the take-home pay math. Put them in, like, Ohio, or Iowa, or Colorado; just not SFBA or NYC.
Now move that same family to Manchester, take the wage hit for moving to the UK labor market, and work out the take-home pay. They'll of course pay $0 for the NHS.
Are they better off or worse off?
I'm not valorizing the arrangement, I'm making a point about how political tractable changing it is.
And it would be exactly the kind of political engineering minmax scheme large corps in the US are great at: petition legislators to cut regulations so you can cut costs and maximize profits, but keep juuuust enough of the right perks in the right places so that a slim majority of people in Wisconsin, Michigan and Georgia oppose shaking things up.
That doesn't make M4A bad policy (I think it's bad policy for other reasons), but it does take "people are being irrational" off the table in a discussion like this.
The US spends nearly as much in taxpayer funds as a share of GDP as other developed countries (and vastly more on a per capita basis), with even more in private costs on top of it. It is simply dishonest to say that the "wage premium enjoyed by many Americans and the lower tax level offsets the cost of insurance and copays", because neither the US wage premium nor any lower tax burden are attributable to differences in healthcare systems, but rather are in spite of the far greater burden of the US healthcare system.
OTOH, it is true that a major challenge is that people respond with this line to any proposed major structural changes to the US system.
I'd appreciate if you'd avoid using language like "simply dishonest" with me in the future. It's easy to tell me I'm wrong about something without accusing me of commenting in bad faith. This is in the guidelines. Thanks in advance!
It's a bit out of date now but the book The Healing of America found that Germany, France, and Japan had world-leading healthcare results, measured by things like survival time after major disease diagnosis, but spent much less of a percentage of their GDP on healthcare. None of them had single-payer. Their systems were pretty close to the ACA, with private insurance companies and a mandate.
They were also different than the US in certain ways. Probably the biggest was a national price list for services. A lot of healthcare isn't really a functioning market; in many cases you're in no position to comparison shop. A result of the price lists was that doctors made a lot less money, but this didn't seem to affect quality.
Other differences included: no claim denials allowed for anything on the price list (which saves a lot of administrative staff), effective national digital records systems (ditto), and the insurance companies had to be nonprofits.
All three countries actually got better bang for the buck than Canada's single-payer system. Japan was the cheapest, spending only 5% of their GDP on healthcare, despite an aging population of heavy smokers. Germany was the most expensive at 13% (compared to US 18%) but covered things like week-long visits to the spa for stress relief.
The author did a spot check on the user experience by seeing a doctor in each country for a shoulder problem, and those three countries worked out really well for him. In Japan the doctor offered surgery the next day, at a very modest cost. They did make do with simpler equipment; the MRI machines were bare-bones but they got the job done and a scan cost $100.
Yes, you can just do the math, and changing nothing about the US except transition to a European style universal system, the median family would face lower aggregate tax, out-of-paycheck, and out-of-pocket costs than they do now, with less health insecurity around unexpected events (either health or employment), unless the tax increases necessary were deliberately and perversely targeted to avoid that.
That’s a direct consequence of the difference in the macro-level costs: they aren’t separate, orthogonal concerns. People just have a hard time accepting that the US health care system is structurally constructed right now to waste vast hordes of money preventing people from accessing health care, but that’s exactly what it does.
* Free tele psycho-therapy. Not sure what the limit is but it's >= 2 hours per week. I even cancelled same-day once with no fee. The quality of the care was also very high.
* I developed wrist pain from typing, holding a Steam Deck, starting pull ups. I was able to see a physical therapist at the Google office (through an embedded One Medical) after 1 week. No referral needed. Saw them once per week for 5 weeks paying $20 co-pay each time. They fixed my issues permanently.
* I also occasionally used the Google One Medical locations (and public ones) for injuries from a low speed bike crash, vaccines, etc. Don't think I ever paid more than $20 for anything. On a Google income that amount is completely inconsequential.
In both systems, the upper X% can afford it. But it makes no sense to focus on that. What matters is how many don’t have access.
That number is much larger percentage-wise here than in Europe. And it will only increase the way things are going.
But the bottom 90% do badly. Society is very divided, and most people lack social mobility, they lack a voice on the national and international stage, they lack the security that either a social safety net or high pay would give them.
The UK is similar, although much less pronounced. I moved to Australia about 18 months ago and society here is much flatter, the difference between the top 10% and bottom 10% is much less. There are still problems here, it's not a utopia, but it's very noticeable how most people are struggling less, and how the top 10% of earners aren't living that different a life.
The propaganda spin on the health care system in the US has been on overdrive ever since Hillary Clinton wanted to implement some reforms in the 1990s, leading to absolutely massive resistance to any change whatsoever. Even the changes implemented by Obama, which were a HUGE improvement in access, barely made it across the legislative line, and dismantling that access to the health care system has been a huge rallying cry for one of the major political parties. I won't say which one because mentioning that fact results in people turning off their brains and downvoting.
The US healthcare has optimized for availability and higher access to the most treatment options. This does not mean evenly distributed treatment options, but that people have the chance to get access to things more quickly.
And for most people, the healthcare system works fairly great. There are exceptions, like the denial described in this thread, and they usually get lots of attention because holy hell is that a messed up situation. But the everyday care that most people get is better than adequate.
The insurance death panels already existed at the time. It didn't even happen after.
That's what made the whole thing so ridiculous in the first place.
As an individual who has lived in multiple countries in three continents, I dispute that “the care most people get is better than adequate”. Perhaps better than the world average, but certainly not better than in most first-world countries. And that’s not even counting the impact of delayed decisions and denied care, and the stress of dealing with the system overall.
And if you’re looking for more than anecdotes, there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health care costs.
> there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health care costs.
Americans aren't dying earlier of diseases that are solvable with a doctor visit, surgeries, pills, or other easy medical interventions. The medically related early deaths are primarily because of overnutrition and lack of exercise leading to pre-diabetes, diabetes, high blood pressure, and heart disease. That comes from public policy mandating car dependence throughout society and huge subsidization of empty calories in the food system. Overeating and lack of exercise are problems that have been stubbornly resistant to the medical system's efforts to change behavior. There's also other heightened early death risks like car crashes, drug overdoses, and suicide, but few of these deaths could be prevented by increased access to the medical system.
This ignores the outsized influence of lobbyists, especially post Citizens United.
The majority (depending on which polls you cite, seems to range anywhere from 57% to over 70%) favor a universal healthcare solution for all citizens. Yet like many other majority opinions, this doesn't translate into legislative action in that direction, in large part thanks to lobbyists and dysfunctional partisanship. None the less policy is not reflecting the majority.
Oddly enough, all the plots I have seen of cost increases don't show a massive skyrocketing of costs since the profit caps were introduced. If anything, they have been somewhat reduced.
However a reckoning must happen at some point, health care can not consume the entire economy's efforts.
That is the definition of not worth it.
I don’t know if this a case of ideological delusion to go along with political impotence or just the usual upper middle class playing their part in obfuscating the on-the-ground realities. Structurally the latter is more likely.
What is there to disagree with? Are there any option other than introduction of universal healthcare?
Obamacare attempted to make the US healthcare system into a universal system by mandating that people purchase coverage, heavily subsidized to become affordable to every income level, in addition to massive expansion of Medicaid to those with the lowest levels of income or no income at all. Automatic enrollment in health insurance exchanges, even if people did not make their own choices on the health insurance exchanges, is what would make the US system universal health care.
Universal means that everyone has coverage, that the question to the patient is "what insurance plan are you on," rather than "do you have insurance." And making coverage universal has no connection to lowering costs. We need larger structural changes in the logistics of how care is delivered and how the money flows.
Single payer is another choice to be made, but that doesn't necessarily mean that health insurance is cheap, that all the care gets delivered that people want delivered, etc. Medicare is often cited as one direction for this, but most don't realize that private health insurance costs are partially high because they help subsidize the care of those who are covered by Medicare, because Medicare reimbursement rates are far lower than any of the private insurers have been able to negotiate.
Other routes are full decoupling of insurance from employment, full price controls that normalize Medicare and private insurance rates, which either make health care more free market or less free market depending on how you define those terms.
However every year that passes makes any of these reforms more difficult because administration of the costs and billing is getting more complex each year. ICD codes, PLA codes, all that stuff grows in complexity.
HMOs, like Kaiser, may provide a route towards greater simplicity of administration of health and costs.
But implementing any large change will require political buy-in of people, and when we have our current low-trust, high-misinformation political system there's been no way to make any political traction for changing anything. Until we regain a functional democracy or turn to full dictatorship, it seems unlikely that we will see structural changes that improve anything. Hell, we had Republican states actively trying to prevent poor people from receiving coverage from federal dollars. How can we ever come to terms with a change unless that sort of attitude no longer has traction?
I really don't understand this sentiment. It's not like the current state of the US insurance market were based on the principles of a free market. On the other hand, not coupling your health insurance to an employment contract that can be cancelled at will has nothing to do with socialism.