There is a reason that doctors in the US make multiples of what doctors in Europe makes: the AMA lobbied the US CMS, back in the 1990s, to limit the number of residencies opened up every year, to avoid a "glut" of doctors. We have artificial scarcity of doctors.

The standard GP consult fee in Ontario Canada is $77.15. (just over us$50). That's gross, the nurse, receptionist and rent have to be paid out of that.

Some doctors will do 4 of those an hour, but most will do 6. And they'll try and find ways to bill additional codes above the consult.

> There are too many layers in the system making a fortune off the public's back while adding little to no actual value.

Yeah, it basically all comes down to the bureaucratic nightmare that ultimately benefits the owners of all things medical. Prices have nothing to do with the value of the good or service and everything to do with the maximum amount of profit that can be extracted from a 3rd party.

One of the worst moves in the last 30 years was Clinton adding private insurance options onto Medicare. In the last 60 years was making medicaid a state run program rather than a national program (or just medicare all together). It's actually crazy that we have 53 different government healthcare options. 1 for every state, medicare, and the VA. It's even more crazy that the government doesn't simply directly employ doctors and medical equipment. It's so crazy inefficient to involve 3rd and 4th parties into something that should be direct care.

The US remains one of the only wealthy nations in the world without nationalized healthcare. And we pay through it through the nose.

You're exactly right but it runs contrary to the narrative being spun.

A quick search reveals the best ER wait times worldwide are in the US, Germany, and Switzerland, with most the rest of western Europe dead last along with Canada and Australia.

The average ER wait time in the US is 24 minutes. In France 2h21m. Italy 2h44m.

Everyone likes to say how great Canadian healthcare is, but talk to actual Canadians and the cracks start to show, you're waiting months for a CT scan, and most need employer-provided health insurance anyway to fill gaps in coverage.

Wouldn't you expect to see that reflected in outcomes? TFA mentions that the only studied country with more avoidable mortality than the US was Mexico. If you aren't seeing it, maybe its not as big a problem as all the people who cannot afford any access to care at all while the country spends more per-person.

Anecdotally, I spend a lot more time literally in waiting rooms in Germany than I did in the US, but getting a specialist appointment is much faster here (getting a therapist absolutely excluded, but I was able to get a psychiatrist to write prescriptions for ADHD meds within a month).

I just moved from a medium sized US city and any specialist provider I contacted for myself or my parents was 5 months or more. It's not good everywhere.

US healthcare is generally superior as long as you can afford it.

US wait time for many: infinity. why? because current system is profitable.

I mean, in rural America short of a trip to the ER with whatever wait time they have, getting a primary care doctor is barely possible and only affordable if your employer provides medical care, which many many don't.

It's the chief complaint put forward by fox news.

It's just a blatant lie.

I've experienced healthcare outside the US (in the UK) and it's on par with US healthcare in terms of wait times. Seeing a GP was same day with walk ins. When not busy, it was just a 5 minute wait.

Seeing a specialist can take time. I knew people that saw a 3 month wait to see a specialist in the UK. In the US, I just experienced a 3 year wait getting a specialist for my kid with autism. I had to go out of state to get the initial diagnosis, but to get local followup care I had to do that 3 year wait. After that, we were able to get a bunch of referrals to other issues.

What constrains wait time is how many doctors and specialists are working in a field. That has almost zero to do with the underlying payment system of a healthcare system.

This is my favorite thought terminating cliche when the discussion of American healthcare comes up. Wanna see a specialist? You're waiting. Can't afford insurance? You are waiting even longer.

But prisoners have socialized medicine?

There are many examples of for-profit systems that don’t have this problem, it’s really the heavily regulated for-profit systems that have this “cost disease” issue. It seems to happen whenever there isn’t a transparent market, like the tuition price of a university, the cost of your surgery, or the cost the government will pay for some infrastructure. The buyer doesn’t know what they’ll pay or what product they’ll get for it, so it’s basically not a free market at its most fundamental level.

If it's expensive and in a for profit system, why aren't competitors on the supply side undercutting each other to increase sales?

Not every for-profit system is this way so it doesn't fully explain it.

Every country has for-profit elements in their healthcare system. The USA is uniquely dysfunctional in its governance. There is regulatory capture at every level.

Among many, there is a zero sum attitude. This goes back to the founding and slave owning in the south.

As an American, no. Well aside from - yes a significant part thrives on seeing others than them suffer. Years ago, I spent multiple times a year at a B&B on the Hilo side of the big island. The host was one of the last "Grand Dame's" of Hilo. She was a cattle rancher that knew Roosevelt; her husband had been a friend of Linus Pauling. She did hikes in her 70s and 80s few in those ages can do now.

She was grandfathered under a form of medical insurance - I think older Blue Cross/Blue Shield - none can access now. At one point, the US did have better health care than we do at the moment. The fcking idiot boomers (including my parents) bought into the BS from Nixon, Reagan, etc. Hey - (good or bad) - let's stop allowing one to write off debt, but allow companies to do so, etc.

This country does have it's head up it's ass and a significant number blame everyone but themselves and how they vote.

We pay more (as a country) by a lot* and get significantly less for our medical coverage. Want to go self employed with a family of 3? Want a PPO? $4-6k/mo in California right now. Deductibles will be high.

If you research "amenable", "avoidable", "preventable", and "treatable" mortality, you will find similar conclusions from studies that focus on specific aspects of the effects of healthcare on mortality.

The results are not all that different. The USA lags other rich nations, and even middle income nations like Costa Rica and Chile. https://www.oecd.org/en/publications/health-at-a-glance-2023...

> The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating.

About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.

A thing people in the US have trouble keeping a bead on is that net compensation (after taxes) in Europe tends to be sharply lower in the US, so that white collar professionals with employer-provided insurance are generally coming out significantly ahead of where people in the NHS are, financially.

Mate, I don't know how long you have been here but you have another think coming.

NHS services are free at the point of care. I worked in the NHS for a good few years. Never swiped anybody's credit card.

In the USA, calling an ambulance will set you back more than $1,000. No insurance? Better not give birth. You'll need 20 grand. Maybe 50 grand for a C-section.

That's almost entirely due to how our private insurance industry works.

Any given health provider has to deal with thousands of different insurers, and it's not uncommon for individual patients to have primary, secondary, tertiary, and even quaternary insurers the provider then has to deal with to get paid for a procedure.

To keep health care workers focused on providing health care, providers hire a bunch of administrative workers whose job is to offload the work of haggling with insurance onto cheaper workers, but because there's so many insurers, and patients have so many layers of insurance, you end up with something close to 10 administrators per doctor.

Alas, because there's so much money sloshing around in the system, and because the US government is so thoroughly corrupt with bribes from special interests, there's no movement to correct the problem. The system is unsustainable, though, so it will inevitably collapse in on itself at some point, causing a lot of misery and probably death before anything is fixed.

> US healthcare industry needs to drop more non-essential workers, and invest more in workers that produce value.

Only problem is you can’t destroy the jobs program. Someone pointed out to me that the job market is propped up nearly by healthcare alone.

For someone without and particular skills, credentials, network, medical industry jobs provide one of the last few steps to a stable, middle class life that’s also accessible to working class. In other words, it’s one of the last vessels for any sort of social mobility.

Right, most of those 6 are not medical staff, they are probably there for insurance and billing. And compared to Europe we don't even have a lot of doctors, US has fewer per capita. So the money is going to the billing layer, not to actual care.

I think the industry itself would be more than happy to classify nurses and doctors as non-essential and drop them.

Imagine the profit margins where you don't have to pay salaries to them.

Those people may actually be saving money by offloading work from a $250/hr doctor to a $25/hr secretary.

Probably 3 of them just working to prevent you from going.

It will not change on your time horizon. If you want better healthcare, move to a developed country today. It will take a half decade or more for US healthcare to improve in any meaningful capacity, assuming the necessary events take place to enable improvement in the system.

(to improve US healthcare, laws will need to change; when those laws change is a function of election outcomes and cadence; those election outcomes are a function of the electorate, who they vote for, and the rate of cohort turnover; think in systems)

Cuba has a totalitarian government that exercises total control over the media and does not allow independent validation of its healthcare statistics.

But yes, based on the unverifiable numbers put out by the state media organs, healthcare in Cuba is very good.

If you look just at differences in treatment, ignoring preventable deaths, the disparity in mortality between the USA and other rich countries is just as evident.

This is a long-standing fact. It's difficult to interpret without concluding that something is badly wrong with US healthcare provision.

Plenty of people out there trying, though

Basic exams cost $100K? Citation definitely needed. You either have a wild idea of “basic” or have no clue.

The ACA baseline plan has to cover a yearly checkup, basic screenings for things like blood pressure and cholesterol, and even more in depth screenings like colonoscopies or pap smears; all at 0 out of pocket cost.

Which only leads us to another problem: food.

You can't have a healthy society if all policies are dictated by corporations.

To be fair, the French riot in the streets when one of their teams win the Champions League[0]. I'm not sure it's a good metric.

[0] https://www.bbc.com/news/articles/c0r2ejg1w9xo

There are plenty of American protests happening all the time (see the ICE protests for a recent, well-known example). Americans aren't lazy about protesting, they just have a different understanding of merits protesting. Like it or not (I don't), a right to quality healthcare isn't one of the freedoms in our constitution or bill of rights, and therefore isn't going to get people turning out to protest.

> that Americans put up with such an inferior and expensive system

I agree but what is the alternative? Not buying health insurance? Moving to a different country? Please don't say voting (That has solved nothing.)

Our country is captured by the top 1% of wealthy donors who are making a killing off the healthcare industry. Americans as a population aren’t putting up with anything, they just have no control. A citizen shot a healthcare executive in the street a couple years ago, that’s what people are resorting to now.

>There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.

Its all just talk.

What's new is that health insurance is about to become an even bigger problem.

24 million Americans are insured under ACA. The current president has issued several executive orders that undermine the provision of ACA insurance and increase its cost. Millions are dropping coverage as the increases kick in. (https://www.nytimes.com/2026/05/01/business/obamacare-enroll...)

I really don't think this is the issue.

I've been overweight in my life and I hate it. You know how I lost weight and kept if off? I ate healthier, I walk a lot (to the grocery store, for example). US grocery stores have all the same healthy foods as every other country. You can eat healthy at restaurants too, if you must.

It's just people don't. There's nothing inehrently bad about food in the US. We at eat too much and don't exericse (walk). Now, if you'll look at all the other countries joining us in this because it isn't a US thing anymore.

You've added all these extra explanations (corn syrup, antibiotics, growth hormones) but it really isn't that complicated. BTW, I'm sure if you ate konbini foods every day in Japan and didn't exercise enough you'd get fat, too. There's nothing different about that food than a lot of junk/fast food in the US, it's just the Japanese seem to walk a lot more and I don't know how many people only eat out of 7/11.

Bro I don't think food causes autism but ok - I hear you about our food quality. Again it just goes to money for the corporations

> Waiting until your children has autism or asthma or cancer is not the solution.

One of these is not like the other.

Everything you address makes sense. I’m not a Texan by birth but most of my life here, have traveled overseas, learned French language, culture, and cuisine. The issue is, unfortunately, profit drives everything here. Now it’s driving the most successful post-war boom economy into debt, because, well, Boomers.

The saying is the US doesn’t have “health care” we have “sick care.” Preventing diseases? Not profitable. Giving people diseases then charging them for treatment? Profitable.

Fortunately the obesity epidemic has a cliff like tail end, as those people tend to eat themselves into an early grave and lack the resources to pay to prolong their participation in Planet Earth.

> The main problem the US has is food. As a Spaniard myself, every time I go to the US it is really hard for me to eat well. Good quality food is extremely expensive and inconvenient

What inherently prevents you from cooking a tortilla or baking bread in the US vs Spain? Do frying pans and ovens work differently? Has the US outlawed paella?

American food has issues, but obesity in America comes down to the simple fact that people eat too much and do too little.

Calories in > calories out.

The great news is that when you eat less, it brings down the relative costs of better food. Instead of pounds of low quality ground beef, 3 packs of Twinkies, and a case of beer; buy some higher quality organic chicken, or even better, some organic vegetables.