Here is the fundamental problem with the US healthcare system as seen by someone with a couple decades experience as a provider:
Imagine as a metaphor someone came to a web developer and said you know I would like to have an online business. But I don’t know anything about the internet, or programming, or layouts or marketing, or e-commerce. I want you to provide me with a complete education about how to use a website to make income, I want you to plan and execute the entire endeavor, I want you to show profitability, and then when all the work is done, I want you to hand it over to me to reap the benefit. Then I will pay you whatever it’s worth at that point in time.
Imagine a second customer that comes in and says, here is my idea for a website, I’ve already story boarded the whole design layout and link tree and have figured out the monetization. I’ve purchased a domain, have an idea about a logo, and have some ideas I can show you of other websites I would like the navigation to be modeled after. Here are my preferences one the front end and the back end and the functions that are required. I would like to pay you to do the coding.
Now predict what the cost quote disparity would be between the first customer and the second. The first customer has put forth no effort whatsoever toward their goal, and yet expects to be handed the keys to the kingdom. The first patient is the typical US healthcare customer. It every patient in the US falls into this category, but all the median and below customers do. Not only are they doing nothing whatsoever to maintain their health like being physically active or eating quality food, but they are actively sabotaging their health constantly with drugs and alcohol and tobacco and unmanaged stress and lack of sleep, etc ad infinitum. Not only are they making no effort to correct the source of the problem, but they expect you to rescue them every time they break down like a mechanic does for someone that never changes the oil and strolls in behind a tow truck with a seized engine every year.
In the US the very concept of preventative care isn’t even lifestyle modification by and large, but rather to be on the right concoction of thirteen or so maintenance medicine to counteract and temporizing the deficits of healthful living like three different antihypertensives, a cholesterol lowering agent, a blood thinner, a diuretic, inhaled steroids, an anyihyperglycemic, multivitamins, an antidepressant, something to manage chronic pain, something for neuropathy, thyroid hormone replacement, testosterone and a laxative or stool bulking agent. It’s no wonder people come in broken down all the time. Their entire lives are barely duck-taped together in a tenuous balance of medications all with potential side effects and interactions, and all with a physiologic consequence to their action, many times being reduced tolerance of physical activity, and more broadly the suppression of all life functions. If you’re on enough of these “medicines” you may not actually have to do or feel anything with the remainder of your hollow shell of a life.
So why does US health care cost so much, quite simply because the patients aren’t even actually trying to be healthy. By and large they are doing the opposite with the expectation that health is something that can be purchased and done completely for them.
In case you are wondering, what I do for a living is getting patients that so desire and are willing to embrace some lifestyle change out of this rut.