U.S. Health Care Prices are the Elephant in the Room (opens in new tab)

I'm with Anthem Blue Cross in California. In 2011 they spent 79.9% of premiums on actual medical expenses and due to law changes had to issue a refund for 0.1% This year they raised premiums by 22%.

Various administrative expenses are hidden all over the place. eg the cost of an appendectomy also includes the cost of recovering the money charged.

The problem with the US healthcare system isn't any one part. Every single part is broken in some way, with the interoperations between them compounding to make the problem worse.

Not the insurance companies as the entity which takes all that money, no, everyone here knows that.

It is the insurance companies in the sense that the insurance companies are in no way brake on costs, they are an accelerator. They take a cut of the whole and have an incentive to keep the whole high.

And what is wrong with this exactly? We all get old eventually, so this subsidy is actually fair.

> You'll be paying significantly more, with no direct benefit.

Only true if you don't plan on getting old.

  Of course, that's an average covering every man, woman,
  child, pensioner etc. People in paid employment are 
  paying at least double that (in tax). 

I currently have awesome coverage (by USA standards) and still have to pay ~20% of visit out of pocket.

Actually, that last part I'm guessing. Because of the back and forth game played between insurers and providers, I get confused, and haven't expended the effort to figure out the actual monies exchanged.

This is not "free", far from it, but, first, by taking no margins and then having tougher cost review for infrastructure/equipment purchase help reduce the cost. Then using generics drugs instead of branded ones by default also help. Remember, many hospital and doctors have official or under the table deal with private providers.

Then there are side benefits. People live longer and healthier. Their kids don't have to live in fear of having to spend 100k$ if their parent felt ill. My grand mother (91 years old) broke her arm and pelvic bone a few weeks ago. Of course, at her age, it wont heal, so it had to be replaced. How much would it cost in the US? 200 big ones (including a month or so of hospitalizations, the 2 surgery, the drugs and follow up). How much stress would it put on my family on top of the accident?

At some point, even for those who can pay, some level of social security, both health and monetary one reduce uncertainty and reduce crime rate. To some point, I understand US mentality on this. I tried to create startups a few times, it seem a lot harder here than everywhere else. It is not even socially acceptable to both succeed and fail. If you succeed, then you are a greedy asshole and if you fail you are a loser. But even giving that, I still think having universal health care and the other "big government" goodies is a good thing.

The problem is US health care is for-profit and the "American way" is that there is absolutely no limit on that profit, so they charge whatever they want.

The idea that poor people do not get top notch medical care in the US is largely a myth. It might not be quite as nice but it is often nearly as effective. A large part of the reason medical care is so expensive for average people is that they are subsidizing the healthcare of poor people. This is why the average survival rates for most cancers are higher in the US than anywhere else in the world; people that cannot afford it still get treated with the state of the art and the cost is passed on to people with insurance.

A poor person with cancer in the US with cancer has a much higher survival rate than the average person in the UK. Poor people may not have official insurance but that does not imply lack of healthcare in practice.

(and in the UK, where I live now, things are even easier...)