Perhaps one area to start improving the health of the nation is the food culture in terms of quantity: a ‘small’ coffee / soda / juice sold in the United States equates to ‘large’ - if not ‘largest’  - size drink sold in most other countries.

That part about getting a healthier lifestyle is great advice. You might get so healthy that you won’t need health insurance ;-)

“Medicare for all” is a catchy slogan. But that kind of system in most developed countries is a universal “basic” care, with a menu fixe of essential medical services. People in those countries are allowed and encouraged to buy supplement private insurance as well. Almost every developed country’s medical financing system has gone through bankruptcy in the last 30 years, or been threatened with bankruptcy, and almost all have had to scale back.

The one exception is the UK, where the NHS remains in place to both run health care and pay for it. It’s a system everyone in the UK hates and no one wants to replace. It too went through wrenching changes in the 1980s and 90s.

“Universal basic” is attractive—certainly better than what we have now. The question is whether there won’t be pressure to keep expanding what “basic” covers. And notice all those other countries ... their debt levels and how they’re effectively insolvent.

“Universal basic” would require breaking the Medicare complex. The real reason health care costs so much in the US is because of how public spending on health care is heavily skewed toward the elderly. That is the big difference with other countries, which ration care for the oldest patients. (Ask anyone who works in medicine in Canada, or look at the disease survival rates by age.) That is where the biggest expense is and where the biggest potential savings are. Health care is very labor-intensive, more so the older the patient, and 80% of health care spending is for the labor, not the drugs, machines, or other technology.

The nicest thing about “universal basic” is that it would end the heavy bias of public spending on health care toward the elderly. Good luck crossing the Medicare lobby, though. No one wants the government to take away their Medicare!

I read the previous article about work force participation with great interest, but while it makes a valuable point about excessive incarceration rates and subsequent ‘death by despair’, that is far from the whole story. It is also true that Americans are genuinely sicker than the inhabitants of other OECD nations; they may be a mere 5% of global population, but Americans consume over 54% of ALL pharmaceuticals, with one in five US citizens currently dependent on more than 5 pharmaceuticals.

Yes, you have become heavier - but you are also suffering from more chronic inflammation. My research group, which has the largest data base of omega 6/3 ratios in cell membranes in the world, has shown that while 6/3 ratios are running at 15:1 in Europe, they have reached an average of 25:1 in the USA. This makes you more prone to vascular disease, joint and bone disease, cancers, liver and kidney disease, dementias, depression, reduced impulse control - you get the picture?

There is little point in trying to patch the rotten ship of American public health with high priced and toxic pharmaceutical pots of pitch, and the scientific developments you are referring to - which we are well aware of - are not a cost-effecive nor an appropriate answer. You need to get some nutritional basics right, and then your nation can steer a different and better course.

In order to do that, however, you will need to call your out of control food industry to heel. Good luck with that!

Like most of the “big” issues facing America, this one doesn’t lend itself well to sound bites or political argument.  That said, a list of the major components of the medical expense in America needing reform/regulation would include:
o Cost of medical training. In America, the debt incurred deters new MDs from primary care.
o Cost of malpractice insurance drives fees up.
o Threat of litigation leads to many unnecessary procedures, tests, etc.
o In Japan, every citizen MUST purchase insurance. Citizens can opt for a supplemental plan. There are 3400-ish insurance companies in Japan. The government insures a standard fee structure across ALL procedures, tests visits, etc. And the government regulates costs.
o Administrative costs in the American system are exorbitant as measured by their share of total expenses.  For example, research how much the Presidents of “non-profit” hospital make!
o We like to think of ourselves as technologically advanced, but the use of technology in the medical system is archaic to non-existent.

Of course, there’s more.  But imagine, in the political climate we have today, how any one of these issues would be approached and resolved.  It would never happen. So, my conclusion is that the author is correct.  There won’t be a “fix” until there is a crisis.  The crisis will be the excuse for not having done the hard work to design a better and evolving system. And I suspect the “solution” will move us more towards socialized medicine.

The country will eventually migrate to Bernie Sanders proposal of Medicare for all.  Unfortunately, Medicare typically covers 80% of the cost of virtually all care given and this is the Achilles heel of healthcare.  Simply put, we seek medical care for everything and our ability to treat everything has expanded exponentially.  Cancer treatment is a simple example where the cost of some effective biologic treatments now cost nearly $100,000 per year.  Medicare for all will work if it covers all the basics and includes palliative care for all chronic diseases.  Secondary insurance can then provide for above and beyond care through private markets.  Not everyone can receive all the care we can provide, but everyone can receive the care that is reasonable and affordable.

An interesting topic that seems to be getting the attention of a lot of newsletters lately. I appreciated the charts on life expectancy and health costs - an insightful grouping of charts.
For those that might be interested in one solution consider Harry Dent’s March 27th article in Economy & Markets. It should ignite some debate.
ECONOMY & MARKETS | March 27, 2017
It’s Time to Shatter the Stones
By Harry S. Dent Jr., Senior Editor, Economy & Markets

Me - I live in Canada so this issue isn’t the big elephant in the bath tub that it is for those in the USA.  I can’t help but thinking that collapse of the AHCA (Obamacare) may be the black swan event that will burst the “bubble” and initiate the next market collapse. Make no mistake - if the USA goes into a market collapse - so will the rest of us.

I also think that John Mauldin’s series of articles recently on budget reform is an interesting commentary on where things could go - if there was some leadership and people were willing to make some hard choices.

If you drive a car by law you must have car insurance. Good drivers subsidize bad drivers. By the same logic if you breathe you must have health coverage. Healthy people subsidize unhealthy people.

I agree with Patrick, the issue is cost, not coverage. Why do Americans pay more for drugs and implants(knees, hips), have the highest paid doctors, for profit hospitals and insurance companies.

It would be best to out source healthcare to the Japanese. Costs would drop in half, everyone would be covered, life expectancy would increase substantially and infant mortality would fall by an order of magnitude.

The information provided and prognosis is probably spot on.  I do think it important
to note that virtually all of the lower cost/longer lifetime countries on your chart
are single payer/basically free healthcare systems.  In only a few do private companies
play a role and not in a major way. It is also interesting that in one country, Russia,
that is not teeming with a crowded population, and with supposedly “free healthcare”
that costs for good solid treatment and care is costly beyond the public’s reach.  Is
that where we’re headed?  It is obvious that we’ve put the mechanism in place for all
who wish healthcare can get it, but not affordably.  In a nutshell, discard the government mandate (except for all but the smallest employers), forget blind throwing
of dollars at military waste (which exceeds that in the healthcare system) and use those funds along with a healthcare tax to cover everyone.  Coverage might be tiered (as are
Medicare supplements)to offer personal or family choices of more than basic necessary
coverage (vision, dental, pregnancy).  A surcharge for smokers might be considered also.
Just some ideas which will require bipartisan cooperation-certainly not the mishmash of
personal agendas being aired out.  I don’t really think that “conservatives” want a
healthcare system few can afford.  Our Congress is supposed to be a body acting “For the
People”, not a Corporation or group of Oligarchs!!