This is kind of a rambly doc, but if you're interested in why healthcare is so expensive in the United States, this'll give you an idea.

>98.5% less
Before anything else, let me correct this. It's only 46.5% less. Google gave me the wrong answer, probably because I gave it a weird ass word problem. Sorry for the misinformation.

>this can't be justified
No, no it's not. The costs of Medicare and Mediaid exceeds the GDP of 94.5% countries AND IT'S NOT EVEN NATIONALIZED HEALTHCARE. Just IMAGINE how much national healthcare would cost us!

Now, I'm not expert, but I've identified what appears to be 5 contributing factors to the healthcare prices. I'll start with the government spending on healthcare: 

Yeah, as it turns out, it had the same effect as government-supplied student loans. We gave people money to spend on healthcare through government programs. Healthcare facilities went "oh, people can pay more!" and raised their prices accordingly. This is capitalism 101. Companies sell products at prices they know they can sell at. 

The United States government has repeatedly ignored this little factoid historically, even as far back as 1863 with the transcontinental railroad project. It's not reasonably called ineptitude at this point, it's full blown malicious corruption. It's an open secret that Medicare and Mediaid, as well as Obmamacare(the Affordable Care Act, an expansion to Mediaid) are all unbelievably corrupt.

On the subject of Obamacare, we've also got the fact that, for a short period of time, Obamacare forced you to pay a penalty fee for not having insurance. This ended in 2018, but the effects are sitll felt. Many states still have this penalty in place, like my home state of California.


Speaking of insurance, that's the second reason that healthcare prices are so high in the United States. Pretty much everyone has insurance(the history on why is complicated and starts with World War 2 and the wage freezes, so THANKS Axis,) and since hospitals aren't required by law to be upfront about their prices, it's led to some seriously shady deals behind the scenes. 

Now, I need to stress this before I continue: What I'm about to say is only a portion of the problem. This only covers hospitals, and does not cover drug costs. There is also another factor that affects hospice care pricing that I go on to list, as well as availability of healthcare in rural regions. However, this is the primary reason hospitals are so damn expensive.

With that out of the way, let me explain to you a quick scheme that is done behind your back in a hospital: The hospital sets completely arbitrary and high prices that they don't disclose. An insurance company approaches, and asks the "real" prices, which the hospital gives prices in return. The insurance company then figures out what portion of those prices to cover, and then leaves the rest for the paying customer(you!)

There's also a scheme involved with THAT scheme though! The hospital actually provides a secondary price to you after the insurance has paid for it! Why!? Because what amounts to RAMPANT (LEGAL) TAX FRAUD, that's why! Basically, if the hospital "loses money" after providing a service with insurance paying, it becomes a federal tax writeoff. These prices are typically TENS OF THOUSANDS of dollars! Yes, it's really, REALLY fucking stupid, but at least you aren't actually expected to pay that after the fact.



Now, remember how I said insurance wasn't the only contributing factor to hospital care being so expensive? We have a few very stupid rules when it comes to doctors which limit the supply. Obviously, when you cap supply, while demand remains the same, prices go up. Capitalism 102 baby!

We retrain ALL foreign doctors. Now, this makes sense if you are limiting doctors from, say, developing nations that don't have a great medical background(something the NHS doesn't do for some bizarre reason,) but it doesn't stop at that. Are you a skilled practioner with years of medical care experience from South Korea, looking to help the United States? Sorry, you HAVE to be retrained. Are you from Japan, wanting to bring some of your practices over? Nope, you have to go through the ENTIRE medical education system too!

The bigger bottleneck, however, is that the government requires you to complete a residency program to get your state issued license. Makes sense, except the way we do it is fucking retarded. 

We do it through Medicare, which had its budget for residency licenses limited to 98,143 in 1997. 98,143 POTENTIAL doctors. Not NEW doctors, POTENTIAL doctors. Based on some of my preliminary research, approximately 17,000 doctors actually get licensed per year. This is absolutely fucking retarded. Now, the good news is that Congress recently passed laws to add more residency slots. Unfortunately, this only amounts to 1000 new slots, by adding 200 per year(it's now the 3rd year of this.) There's a bill in the works to add 14k more slots over 7 years, but it's not enough.

Look, we have a massive doctor shortage, which is why medical centers that don't pay exorbinantly high prices can't GET them, such as rural hospitals or clinics. The AAMC projected that we are currently 202,800 physicians down throughout the entire country in 2024, while the AMA suggests we need 19,000 more physicians per year to keep up with demand. Demand is super high, but supply is fucking choking to death.


In terms of medicine itself, we have a rather hilarious problem that comes from abroad, especially from Europe. Basically, the United States is one of very few countries that actually allow pharmaceuticals to set their own price. Most other countries negiotiate a price, which is effectively a form of price control. That's why most other countries can somewhat afford nationalized healthcare(well, that and also they typically don't have to maintain a military because we take care of most of the piracy problems and will back a lot of them up in the event of war. Hey, no shame in that, but it's why 89.5% of all countries have a GDP smaller than our military budget.)

Now, the issue is that R&D of new medication is incredibly fucking expensive, and the prices struck with Europe often fail to cover the cost of the medications themselves. However, Europe is NOT going to budge on their pricing schemes, and neither is Asia for that matter. That means that all of the excess has to be dumped somewhere, or these companies will go bankrupt. Unfortunately for us, we are the only country that can SUPPORT more spending while also letting medical companies set the price. So, you can guess where all the medicine price hikes come from.


Y'know, at one point, we had some of the cheapest healthcare in the world. Granted, this was in the early 1900s, so effectiveness was limited, but still. It was called lodge doctoring, and it was based on fraternal societies. Very fascinating subject, but the quick low was basically clinical care between several neighborhoods were done by one doctor who was paid by a private welfare organization, and would be in every weekday(or could be emergency called in if you needed to be seen NOW.) Hospitals complained though, because their business practices struggled against this, and got them outlawed. The government never stops once it starts going though.