Amazon Health

Similarly, costs are high because pharma and healthcare companies can charge that much. An insured patient, past a certain point, is price insensitive, since their insurance pays the bill. So why wouldn’t healthcare providers charge as much as possible? Raising price does not lower demand. The worst that happens is the insurance company disputes it, but that process is post-facto and there is no mechanism to punish providers for overcharging, so they have an incentive to “shoot first, ask questions later” when setting prices.

As an anecdote, I knew a guy who ran a “compounding pharmacy” business. Basically he mixed together multiple prescriptions into one or a few pills, for e.g. elderly people who would rather take one pill than twenty. When the insurance companies asked him to price each pill, they had no reference for how much it cost — each compound drug he made was effectively a “new drug.” The insurance companies asked him how much it cost and he was literally able to name his price.

> If you have a suspicious mole, or a woman reports pain in the uterus, in Europe you might wait one or two years before a doctor sees you.

If we ever came across a situation like that, we'd scream bloody murder to the nearest national newspaper. Maybe it happens some places, but my experience with healthcare in European countries does not in any way reflect what you describe. I'm in the UK now, and when I want to see a doctor, my experience is that I have never needed to wait more than a couple of days - most cases I've gotten an appointment same day. It's what I expect. If my GP can't see me fast enough, I have a number of walk-in centres I can go to (caveat is 2-3 hour waits). Out of hours or for something more serious but not an emergency, I can go to the nearby hospitals out of hours service. If I freak out, A&E will never turn you away (though they might scold you if you show up with something that you should know better about). If I'm unsure, there's a non-emergency number where an nurse will triage and either get a doctor lined up or tell you to get yourself to A&E.

Basically, if I have a concern that I think merits immediate attention, it will get immediate attention.

On the occasions I've needed to see specialists or have tests one, I've gotten it done within a week or two.

Yes, there are queues for some services, and especially surgeries, but after you've been triaged by primary care.

If it was like what you suggested most places, you'd expect takeup of private health insurance to be much higher, yet e.g. in the UK it hovers around 10%, most of which are employers offering it as a benefit whether or not you care about it (e.g. I have private insurance now; it made absolutely no difference to my evaluation of my employment offer, same for my ex). It's offered because it is dirt cheap (because most of them cover "add-ons" like seeing a specialist faster, and rely on the public system for most routine stuff) and perceived as worth more than it actually is.

> This payment-by-queue drives costs down, but is obviously a bad thing.

Queues are there because you are triaged by doctors, and clinical needs rather than ability to pay is what determines who gets treated first.

While mistakes happen, overall the high life expectancy in most European countries show that it's for the most part working very well. E.g. 2015 WHO data shows a life expectancy for the UK about 2 years higher than the US - in total 21 European countries in 2015 data had higher life expectancy than the US, including all of West / North Europe. The ones falling behind are the poorer Eastern European countries.

I'm sure there's room for improvement, and I'm sure occasionally people die because they wait too long, but the life expectancy shows the priorities largely work.

Another point is that the lack of queues in the US to a large extent is fiction: The queues are not there because a lot of people can't afford to use healthcare more. Even with insurance, if you have large co-pays etc., it doesn't take much before you use healthcare services less than you should. What a system that is free at the point of service does is give a full picture of the actual demand and ability to actually make decisions of funding and prioritisation based on clinical need. You don't have that in the US system.

> Another side effect is that the top notch specialists in Europe earns about the same money as an average or a bad doctor working for the public health.

I don't now of any place in Europe other than possibly Norway where this would be the case unless they themselves don't care to earn more, as most places top doctors can easily mix and match public and private services, and often do. E.g. in the UK a lot of consultants will do private surgeries, and will do so in NHS hospitals, as NHS hospitals can rent out spare capacity (and some run their own private clinics), and can earn a lot extra that way.

The problem with US healthcare isn't profit seeking, it's that years of regulatory technical debt starting with the employer tax deduction totally broke the market and the incentives to control costs are shattered like most things our interests-captive government pays for anymore.

I for one am cheering on the capitalists trying to come and do an end run around this political mess. There's no reason healthcare can't be like buying anything else in a competitive market other than the legal complexity dealing with it and daunting capital required to over come that.

Esoteric or non-physical things, mostly. The NHS really sucks at trans issues, for example, where a two year waiting list is not unusual. It's one of the few areas that US healthcare sometimes does better in, where the state is one which permits informed consent care.