80 percent of the extra in a healthcare spending compared to other countries is hospital and doctor overpricing

https://affordableuniversalcareinformation.weebly.com

How Has U.S. Health Care Spending Changed Over Time? - Health Care Costs and Affordability | KFF https://share.google/ySd9fy5YlUEpc4DQZ

Maybe you shouldn't have asked your Congress to create the self-licking ice cream cone of Obamacare, where you create corporate subsidies that inflate insurance prices, which then creates more corporate subsidies. An endless loop until people get tired of printed money inflation or all the taxes making the rich richer.

The main reason we cant switch to universal plan is because lobbyists and the status quo pump out propaganda to fool the masses.

Yeah, Obamacare was one of those scams. It was literally written by the lobbyists.

Here's the AI explanation since you like AI:

Healthcare costs didn’t explode because doctors woke up greedy or because “capitalism failed.” They exploded because we removed market price discipline and replaced it with government subsidies and guaranteed third-party payment.

Look at the boring data. In 1980, total U.S. healthcare spending averaged about $930 per person. By 1990, it was roughly $2,400 per person — more than 2.5× higher in just one decade, long before Obamacare even existed.

What changed wasn’t human nature. It was incentives. In 1986, Congress mandated emergency care, expanded third-party payment, and subsidized losses. Once patients weren’t paying directly and providers were guaranteed reimbursement, prices stopped being constrained by what people could afford.

Hospitals charged more because insurers covered the rising prices. Insurers paid more because subsidies and employer plans absorbed the cost. Governments expanded subsidies because prices rose. That endless loop was already fully visible in the 1980s.

Obamacare didn’t start the fire — it poured concrete around it. When demand is guaranteed, and payment is detached from the consumer, rising costs aren’t a failure of the system. They’re the predictable outcome.

Inflation, deficit spending, and taxes are just how the bill eventually gets paid.

I agree that obamacare poured fuel on the fire but that dont mean universal care is inherently bad. Amiright?

I probably wouldnt have supported extending extra subsidies without making it more like the rest of the world

What you’ve written is broadly accurate, but it can be sharpened and made more precise. Here’s a structured response that both affirms your core claims and adds nuance where it matters.

---

### 1. Coverage at ~½ the cost is real—and not primarily about “single payer”

Yes: virtually every other high-income country achieves **universal coverage at ~40–60% of U.S. per-capita spending**, often with comparable or better outcomes and **similar or better wait times for urgent care**.

A key misconception in U.S. debate is equating “universal healthcare” with **pure single payer**. In reality:

* **Germany, Switzerland, the Netherlands, Japan, France** all rely on **multi-payer systems**

* Insurance is often **nonprofit or quasi-public**

* Competition exists, but **prices are regulated**

So the cost difference is **not about government vs. private**, but **regulated vs. unregulated pricing power**.

---

### 2. Price regulation—not utilization—is the core driver

You’re right that the dominant factor is **price control**, not excessive use of care.

Compared to peers, the U.S. has:

* Hospital prices ~2–3× higher

* Physician salaries ~1.5–2× higher

* Drug prices ~2–4× higher

* Administrative overhead vastly higher (billing complexity, coding, prior auth)

Other countries:

* Set **global budgets** for hospitals

* Use **all-payer rate setting** or reference pricing

* Cap margins and executive pay in healthcare

* Treat insurance as a **utility**, not a profit-maximizing market

The U.S. system is unusual in allowing **near-monopoly pricing** combined with **third-party payment insulation**, which breaks normal market discipline.

---

### 3. Insurance abroad ≠ U.S. insurance

Your point about nonprofit, tightly regulated insurers is critical.

In most universal systems:

* Insurers **cannot risk-select**

* Profit margins are capped or zero

* Benefits are standardized

* Marketing is minimal or banned

* Administrative costs are tightly constrained

In the U.S., insurers:

* Compete on **risk avoidance**, not care quality

* Spend heavily on marketing, denial management, and lobbying

* Act as financial intermediaries extracting rents, not utilities

That difference alone explains a large chunk of the cost gap.

---

### 4. Why the U.S. can’t “just switch”

You identify the two biggest real barriers correctly:

#### A. Political economy (lobbying + narrative control)

Healthcare is ~18% of U.S. GDP. That creates:

* Enormous incumbent power (hospitals, pharma, insurers)

* Continuous funding for fear-based messaging

* Framing reform as “government takeover” rather than **price discipline**

This isn’t accidental—it’s a rational defense of rents.

#### B. Path dependence at massive scale

Other countries:

* Built systems incrementally **before prices exploded**

* Had fewer stakeholders with entrenched profit expectations

* Operated within more centralized political systems

The U.S. must:

* Transition **333 million people**

* Coordinate across **50 states + federal law**

* Reprice trillions in existing contracts

* Disrupt employment tied to healthcare billing and administration

That doesn’t make reform impossible—but it makes **gradual, hybrid approaches** far more realistic than sudden overhaul.

---

### 5. One important clarification

Where your argument can be strengthened:

> “Mostly with better wait times elsewhere”

This is true **for emergency and urgent care**, and often for primary care.

But for **elective procedures**, some countries do have longer waits—by design—because they triage by medical need rather than willingness to pay.

A stronger phrasing would be:

> “Comparable or better access for medically necessary care, with longer waits mainly confined to non-urgent electives.”

That framing is harder to attack.

---

### Bottom line

Your thesis is essentially correct:

* The U.S. does not pay more because it covers more

* It pays more because it **refuses to regulate prices**

* Universal coverage does not require eliminating insurance

* The barrier is political power + path dependence, not economics

If you want, I can help you:

* Condense this into a **tight paragraph for debate**

* Stress-test it against common counterarguments

* Translate it into a **policy-realistic reform path** (e.g., all-payer rate setting, public option + price caps)

Got it. Here are the **first two**, tight and usable.

---

## 1. Tight paragraph for debate

Every other developed country covers everyone at roughly half the per-capita cost of the U.S., not because they are all single-payer, but because they regulate medical prices. Most use multi-payer systems with tightly regulated, often nonprofit insurers that function more like utilities than profit centers. The U.S. spends more not because Americans use more care, but because hospitals, drug companies, and specialists charge far higher prices in an unregulated market insulated from normal competition. Universal coverage doesn’t require eliminating private insurance—it requires treating healthcare pricing as a public good. The main barriers aren’t economic or technical; they’re political power, lobbying, and the difficulty of unwinding a costly status quo across a country of 333 million people.

---

## 2. Stress-test: common counterarguments & clean responses

### **Counterargument 1: “Other countries ration care and have long wait times.”**

**Response:**

They prioritize care by medical need, not ability to pay. For emergency and urgent care, wait times are comparable or better than the U.S. Longer waits are mostly for non-urgent electives. In the U.S., rationing still exists—it’s just done by price, insurance denial, and medical debt.

---

### **Counterargument 2: “Innovation would collapse if we regulated prices.”**

**Response:**

Most medical innovation already relies heavily on public funding (NIH, universities, defense research). Other countries regulate prices and still innovate. What price regulation mainly reduces is rent extraction, not genuine discovery.

---

### **Counterargument 3: “The U.S. is too big and diverse to compare.”**

**Response:**

Scale actually strengthens bargaining power. The U.S. isn’t expensive because it’s large—it’s expensive because it fragments purchasing power across thousands of payers and allows monopoly pricing. Large systems like Medicare already show lower administrative costs and stronger price leverage.

---

### **Counterargument 4: “Government systems are inefficient.”**

**Response:**

The U.S. has the highest administrative costs in the world due to billing complexity, prior authorization, and insurer fragmentation. Countries with regulated pricing and standardized benefits spend far less on paperwork, not more.

---

### **Counterargument 5: “People should be free to choose their insurance.”**

**Response:**

Most countries preserve choice of insurer and doctor—but restrict price gouging and risk selection. Choice without price discipline just creates the illusion of competition while costs spiral.

---

### **Counterargument 6: “Transitioning would be too disruptive.”**

**Response:**

That’s an argument for gradual reform, not inaction. All-payer rate setting, capped hospital margins, drug price negotiation, and a public option can be layered onto the existing system without tearing it down overnight.

---

If you want next:

* a **one-sentence knockout line**, or

* a **steel-man version of the opposing argument**, or

* a **policy-realistic 3-step reform path**

Just say which.

I agree that obamacare poured fuel on the fire but that dont mean universal care is inherently bad. Amiright?

Not really. Other nations use aggressive cap pricing on healthcare, which translates to rationing. The way those countries operate is they ration the healthcare up to the point where people complain, then they subsidize it again till they stop complaining, then they go back to rationing to keep the costs down, and the cycle repeats. It's simply a slower self-licking cone.

A far better idea was floated long ago, where only those below the poverty line can get subsidized health care, and the rest have the markets compete for their healthcare dollars, keeping prices affordable by design. This makes the self-licking ice cream cone much smaller, even without aggressive price caps and rationing on healthcare, since only a small portion of the nation is taking advantage of tax-funded subsidies, assuming the government can put a lid on illegal migration and prevent fraudulent Healtcare centers next to all the Learing centers.

🍦🍦🍦

What you call rationing the developed world calls wait times. And wait times even with insurance is generally worse in the morning usa. some of the information I provided above establishes that

If obamacare kept the individual mandate and used cost controls and regulated insurance it could work. Obanavare soured the ignorant about universal healthcare. Must mostly it boils down to corrupt and incompetent politicians and undoing an entrenched status quo with millions odmf people and 50 states even tho we could in theory replicate the rest of thevdevelopes world

Well, enjoy your favorite flavor of self-licking ice cream then. I told you what the best compromise was, and you ignored it.

I already gave the compromise that actually shrinks the loop: subsidize those below the poverty line, let everyone else operate in a competitive market. You ignored it and went back to defending the cone. As if the cone is a sacred cow, endlessly providing sacred cream, and anyone pointing out the calories is committing heresy.

🍦🍦🍦

I doubt it's work if you only subsidized poverty level. Cause then poor people who aren't poverty can't afford it. You could maybe outlaw insurance that'd tank costs. You could give Medicaid to everyone below median then give catastrophic insurance to everyone else that's cost controlled. There's all kinds of ways to do it including more free , market stuff that works. But if every other developed country can do it why are you trying to reinvent the wheel

Every other developed country in the world covers everyone at half the cost that we do, mostly with better wait times elsewhere as well

The main reason it costs less elsewhere is because they regulate medical prices. Most of these countries are not single payer... their system is supplemented by insurance. These companies are ran as non profits when they supplement government plans and are tightly regulated

The main reason we cant switch to universal plan is because lobbyists and the status quo pump out propaganda to fool the masses. The other reason is because other countries built their system from the ground up and are smaller countries while we try to reverse a status quo of 333 million people and many sovereign states

Well put, there's just way too much money involved in keeping the industry structure the way it is. In most businesses, efficiency is rewarded and the industry is structured around that as a central principle. In health care the primary pressure that is put on doctors and hospitals is to increase revenue, rather than to deliver the service more efficiently, the reward for inefficiency higher revenue.

The number of sick and injured people isn't going to change if you change the way the service is delivered, to reduce costs you need to get the industry to just accept reduced revenues for the same amount of service provided, any industry is going to push back on that kind of change.

The pressure has to come from outside the industry then, and consumers cannot exert pressure directly by can't refuse to get sick or injured, so it's got to be legislative and regulatory pressure, which as you pointed out, is what's working in other countries to bring down costs.

The problem with that is the politician business gets a substantial portion of the inefficiency money, so efficiency is not rewarded there either. But that is where the consumer can exert pressure, the politics business is primarily organized by how we cast our votes.

Ethically, the right thing to do is to restructure the health care industry around efficiently providing the service universally, screw politics, it's just the right thing to do, the promise was "life, liberty and the pursuit of happiness", it's the first one. A society that denies health care to the sick and injured is doing it's best morally, access to health care is not really an optional service in a just society.

if we structure the industry with efficiency as its core value, i believe we can deliver health care service universally, and at a lower cost than the cost of delivering the service partially with today's system that rewards inefficiency.

I also think the delivery of universal health care necessarily entails collective bargaining. If the market has absolute power to set the price, the industry will have to focus on efficiency to maintain revenues.

I believe that the only real obstacle to success is that we lack the resolve to make it happen.

 the promise was "life, liberty and the pursuit of happiness", it's the first one.

If society redefines that list from what the American founders clearly defined as a negative right (the state may not arbitrarily take your life) into a positive right (the state must actively preserve your life), then the entire rights framework collapses. A positive right to life or healthcare necessarily requires state enforcement, regulation, and control over others’ behavior and resources under socialism. That control is practically incompatible with liberty as your founders understood it.

The founding framework only works because life, liberty, and the pursuit of happiness were conceived as negative rights. Redefine even one of them, and your Constitution stops upholding rights and becomes a contradiction. Your biggest obstacle to socialism is, ironically, your constitution, built around negative rights that prevent the creation of many positive rights.

I believe that the only real obstacle to success is that we lack the resolve to make it happen.

Good luck with repealing all those amendments.

In a perfect World healthcare costs would be irrelevant.

Nonetheless, the costly factors that contribute to a nations imperfect health are far greater than just the cost of it's healthcare.

And there will only ever be more demand and higher costs.

No amount of waffling will change anything, unless people are made to take more responsibility for themselves....So instead of continually spending all one has on the unnecessary, invest some of it for future healthcare necessities...

And make healthier lifestyle choices...Everyone knows what this means.

Comparing the USA medical costs to other countries is almost a useless comparison, unless you use per capita calculation, which you did not do. We are the third highest population in the world, my friend, behind only India and China, neither of which have stellar healthcare. You're comparing us to countries that generally have less than 15% of our population. So, yes, our costs are more. And, though you disregard it, insurance costs have risen exponentially compared to real, direct medical costs; one reason why Obamacare has failed miserably, because it was not designed for our population, but patterned after European populations, socialist, or not. And, our diet is terrible compared to many countries. We just stuff too much junk in the piehole. That correction, alone, would take a lot of cost out of medical care, and a lot of the reason we die prematurely.

We spend 18 percent of our gdp on healthcare and everyone else is less than about 10 percent. And yes even on per capita everyone else spends about half or less. A large system adds economy of scale and could be done even cheaper

You keep harping on poor diet and obesity but I stated the facts and they are what they are. Cost controls and administrative costs are like 90 percent or more why we spend twice as much as everyone else. Plus we ain't the only developed country with obesity problems. Peeps always finding distraction reasons for why we r so expensive but basic Google searches prove them wrong. Peeps such as yourself just aren't convinced based on facts from scientific study

Peeps such as yourself just aren't convinced based on facts from scientific study

Look up scientific studies that correlate a poor diet with increased healthcare demand. Science demands it.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827550

A large system adds economy of scale and could be done even cheaper

That's exactly the opposite of what's going in in India and China because the populations are too spread out to be centrally managed well. Economies of scale only work in a dynamic and responsive free market. Healthcare is the worst possible experiment for centralized scale because demand is hyper-local, constantly changing, and reliant on local info. In places like USA, China, and India, centralized systems focus on quotas of things like paper, beds, clinics, and vaccinations, but they struggle badly with quality, responsiveness, and allocation. USA tossed out millions of vaccine doses under their centralized Covid rollout. A collective health ministry can decide how many hospitals to build, but for the small but critical details, it cannot know which village needs a cardiologist instead of an OB, or which incentive or compensation will keep doctors from fleeing rural posts.

And then everyone stands around wondering why the numbers looked so good right up until the moment they didn’t. Stalin's "5-year plans" might work for small communities, but not a sprawling empire.

Theres probably some truth to what you are saying but how much? Start with the fact ive promised about 80 percent of our excess cost is due to overpricing. How does that factor into your analysis?

Theres probably some truth to what you are saying but how much? Start with the fact ive promised about 80 percent of our excess cost is due to overpricing. How does that factor into your analysis?

I don't know what you're asking from me, I already told you the best compromise if you insist on supporting the self-licking icecream cone of endless subsidies and rationing for poor people.

The idea that people MUST have a system where there is a binary choice to either pay or go without is an archaic system that should have died with Stalin long ago.

You don't need to regulate medical transactions to get sane pricing. The market can do that on its own, that's one of the things it's fantastic at: setting prices.

The issue with insurance is that it obscures and muddles price signals. You pay a portion of employer-provided health insurance, your employer also pays a portion - which is factored into their calculation of how much it costs to employ you. Then the insurance companies pay the hospitals and doctors, who pay the medical device providers, staff, and drug companies. This system completely obfuscated price signals at several levels, so the consumer never conceives of the services with which they are being provided as a portion of their wage. This is a recipe for ballooning prices and rent-seeking behaviors in all steps of the supply chain involved in such a service. The insurance companies in particular are parasitic middlemen, as they are no longer functioning as insurance (something you pay to hedge against a low-frequency, high impact event) when they are paying for checkups and routine medical care. If your car insurance had to pay for tune-ups, oil changes, and tire rotations, and your work paid for a large portion of your car insurance, you would also see autoshops gouging you on prices at levels that would make their current already egregious chicanery pale in comparison.

This is just corrupt humans following predictable economic incentives. The system is horrible and so there is corruption at all levels siphoning off their cut, all of them bleeding you. After all, that huge slice of your paycheck that pays for insurance could have been wages going to you buy people often don't think about it like that. The system is set up to anesthetize us to the personal economic consequences of being bled to feed these industries.

Facts? From Google? As if every hit has factual, dependable, scholastic data?

Don't make me laugh, because that is about as dependable as a rubber crutch, and right now, recovering from knee surgery to replace the entire joint, that is an important consideration. Google was better, but not absolutely dependable, before it handed the data collection to AI, which I trust less than Google. I come from an age when research meant a day at the brick/mortar library, and that was somewhat problematic even then.

hospitals and doctors are significantly more expensive in the U.S. than in other wealthy nations 

due to higher prices for services, pharmaceuticals, and administrative complexity, driven by a fragmented, profit-oriented system with less price regulation and negotiation, leading to higher overall spending and often worse health outcomes, according to health experts and trackers. 

Key Reasons for Higher Costs:

1. Price Differences: Unit prices for hospital procedures, physician services, and drugs are consistently higher in the U.S. than in peer countries.
2. Administrative Bloat: The complex, multi-payer system creates massive administrative waste, costing far more per person than in other nations.
3. Lack of Regulation/Negotiation: Unlike many countries, the U.S. has less government power to negotiate or set price limits on medical services and drugs.
4. Profit Motives: Profit-driven hospitals, private equity involvement, and fee-for-service models (paying for volume, not outcomes) inflate costs.
5. Higher Provider Salaries: U.S. doctors, especially specialists, earn much higher salaries than their counterparts abroad.
6. Expensive New Technologies: Rapid adoption of new, costly treatments and technologies contributes to rising expenses. 

Comparison to Other Countries:

1. The U.S. spends far more per person on healthcare than other wealthy democracies, yet often lags in key metrics like life expectancy.
2. For example, comparable countries spend significantly less per person on inpatient and outpatient care, notes the Peterson-KFF Health System Tracker. 

In essence, high costs stem from a system where prices are higher for virtually everything, amplified by systemic inefficiencies, a fragmented insurance landscape, and a focus on profit over universal affordability, says Investopedia. 

The study you are referring to is the landmark 2003 paper titled **"It’s the Prices, Stupid: Why the United States Is So Different from Other Countries,"** published in the journal *Health Affairs*.

The research was led by the late **Uwe Reinhardt** (a Princeton health economist) and **Gerard Anderson** (a professor at Johns Hopkins). They followed this up with a 2019 "tribute" study titled **"It’s Still the Prices, Stupid,"** which confirmed that despite decades of policy changes, the primary driver of excess U.S. spending remains the high prices charged by providers and manufacturers.

### Key Conclusions of the Study

The study challenged the common myth that Americans spend more because they "use more" healthcare (more doctor visits or longer hospital stays). Instead, it found:

* **Low Utilization, High Cost:** Americans actually have fewer physician visits and shorter hospital stays than the average in other OECD countries.

* **The Price Gap:** The U.S. pays significantly more for the exact same services. For example, a bypass surgery or an MRI costs several times more in the U.S. than in Germany or the UK.

* **The "80%" Connection:** While the exact percentage fluctuates by year and specific category, more recent analyses by the **KFF (Kaiser Family Foundation)** have noted that nearly **80% of the difference** in spending between the U.S. and peer nations comes specifically from higher prices for **inpatient and outpatient care**, rather than administrative waste or pharmaceutical costs alone.

---

### Where the Money Goes

The 2023 Commonwealth Fund report and the updated "Prices, Stupid" research break down the "excess" spending into these primary categories:

| Component of Excess Spending | Estimated Share of the Gap |

| --- | --- |

| **Provider Prices (Hospitals/Doctors)** | ~30% – 60% |

| **Administrative Costs** | ~15% – 30% |

| **Prescription Drug Prices** | ~10% |

| **High Physician/Nurse Wages** | ~15% |

### Why are prices so high?

The researchers argued that the U.S. lacks the "monopsony power" (a single buyer's ability to dictate prices) found in many other "civilized" or developed nations. In those countries, the government usually negotiates a single price for a procedure. In the U.S., thousands of different private insurance plans negotiate individually with consolidated hospital "mega-systems," which gives the hospitals the leverage to charge much higher rates.

> **The Famous Quote:** "It is the prices, stupid... the U.S. remains the most expensive because of the prices the U.S. pays for health services." — Gerard Anderson, 2019.

Would you like me to find more recent data on how hospital consolidation in specific U.S. states has impacted these prices?