Student Loans
Government subsidized and guaranteed student loans cause massive increases in the cost of tertiary education. Who in their right mind would give an 18 year old with no work history or finances to justify it a loan for hundreds of thousands of dollars? The answer is: Nobody. Unless the government guarantees you'll get paid. In which case you have nothing whatsoever to lose. Young adults have no clue what they are walking into and buy into the scheme, not knowing what awaits them.
One particularly sad example I have of this is a young lady who was a member of the FRC robotics team I mentored for many years. She was duped --I have to use the word, no other way to describe it-- into accepting admission into a university that was going to charge her $300K for a degree in mechanical engineering. I and other professionals mentoring the team advised her against doing this. We explained what $300K in debt for a degree in mechanical engineering was a formula for financial slavery for three decades, or more. Well, we could not beat the marketing machine. She graduated with a little over $300K in debt and is absolutely hating life today.
This is where we make a connection that starts with K-12 and culminates with university outcomes and the healthcare systems.
An MD, depending on specialty, graduates with about $300K in debt. That's actually a bad number because it is an average, and averages are horrible metrics to apply to a population. The number can easily reach $500K, particularly when you include all elements, not just tuition.
Here's the connection: There's an ecosystem of professionals, all of whom participate in delivering healthcare through their own specialties. The MD, nurses, PA's, radiologists, etc. are the most visible layer. The next layer is likely an array of engineers, biologists, chemists and other university-degreed professionals working either directly for the hospitals or for tech and pharmaceutical companies that are an integral part of the healthcare dependency tree.
When you are on the table in an operating room, the team surrounding you likely has a collective student loan debt in the order of two million dollars, if not more. One layer removed are other nurses and support personnel at the hospital. That is also likely debt that must be serviced in the millions of dollars. The people who build the equipment in that operating room, conduct research and develop drugs and other tools represent hundreds of millions of dollars in student debt.
One can follow that cost structure tree as far as one might wish.
This means that healthcare in the US has a non-trivial baseline cost of doing business that is inextricably linked to the quality and cost of our education. That's an important baseline to understand. You cannot fix healthcare costs in the US without fixing this complex element of a complex equation. At a minimum, the government should have nothing to do with student loans. University costs should not be subsidized. Students should pay fair market value for what their degrees can actually deliver. Curriculum would also be fine-tuned as part of this process. Nobody wants to spend thousands of dollars for a course on "Underwater Basket Weaving" when it is irrelevant and has no value. Let the student decide, do not force irrelevant material on them and charge inflated rates for it.
The journey to this point includes additional variables that have not been accounted for. One example of this is the fact that K-12 education is dominated and ruled by regional teacher unions, none of which truly exists as real advocates for excellence in education. The effects of such a structure ripple all the way up into university, graduation rates and the cost of remedial education. These result also dominate life outcomes for those who either don't attend university or drop out. They leave K-12 without marketable skills that could seriously improve their lives and improve society.
BTW, my wife is a doctor; we actually live the above realities. We is over 50 years old and we still have somewhere around $80K in student debt to pay for her degree.
Lawyers
While this isn't intended to be an exhaustive analysis of the problem of healthcare cost in the US, it is important to bring this element into it, because it isn't trivial. Doctors in the US have to spend tens of thousands of dollars per year on professional insurance to protect from lawyers. Hospitals have to spend millions of dollars per year on legal costs. Companies serving the healthcare industry have to do the same. Pharmaceutical companies have to spend billions of dollars.
The baseline costs I mentioned above are, in fact, just the tip of the iceberg. Every single element of the healthcare story in the US, be it people, supplies, equipment or drugs, has massive legal and liability costs associated with them. If your medical practice has to protect against a potential hundred-million-dollar lawsuit, there will be a non-trivial cost associated with this. Same with hospitals, the EKG machine manufacturer and even the company making the pillows you put on the beds at the hospital.
One turn of the crank and all of these baseline costs add-up to a situation where the "system" has to charge insane amounts of money for everything or it will collapse under its own weight. Doctors have to order two, three, ten times as many tests for everything, just to cover their ass in case there's a lawsuit. Companies have to spend tens, hundreds, billions of dollars for similar reasons.
When your baseline costs are driven by such cost structures, there is no amount of income redistribution that is going to fix any of it. Making me pay four times what I was paying before Obamacare does absolutely nothing --not one thing-- to fix the fundamental issue of a seriously fucked cost structure to deliver healthcare.
I'll stop here. The topic tends to be emotional for some because it is human nature to pretty much just care for self rather than to take a higher level view, explore root causes and take the pain required to actually solve problems for everyone.
Objectively speaking, in the US, we need to fix education at every level, stop subsidizing ridiculous university cost structures and curriculum, fix our laws to reduce and mitigate the horrendous costs of doing business and focus on delivery quality care for everyone at a reasonable price. At this juncture, if we fired all politicians and did the right things, it could take 25 to 50 years to see the results. That's part of the problem and an indication of just how messed-up things have become.