- There is an artificial limit on the number of medical student openings at US accredited medical schools ("rent-seeking")
- US medical licensing organizations don't recognize almost any overseas schools
- The cost of US education has skyrocketed in the past few decades, along with health care costs (probably somewhat correlated due to the university degree needed to practice medicine)
- The Constitution gives Congress the authority to create Intellectual Property laws and regulate patents, which then become the focus of lobbying (@see Disney lobbying to extend copyright TTLs)
- The US is wealthy and US consumers end up subsidizing medical R&D costs because most other wealthy countries have centralized pharma purchasing contracts
- 68% of all health care spending in the US is done by governments (think MediCare, MedicAid, VA, government employee contracts), but those governments are largely prevented from using their size to negotiate better drug prices
- Something like 50% of medical costs are currently spent in the last year of life. @see "How Doctors Die", a famous article where a Doctor describes how doctors and civilians handle their wishes / medical proxy decisions very differently
- We, as a society, don't want to to die. We have unrealistic expectations of what doctors can do and our quality of life.
- Medical consumers (err, humans) very much undervalue preventative care investing in {healthy food, exercise, mental stimulation, mental health}. We Americans are generally too arrogant when it comes to our bodies and stigmatize people with physical/mental abnormalities, thus we reject reality when we are confronted with the possibility of becoming "abnormal".
- We very much overvalue doctors, hospital rooms, and drugs / pills that do the equivalent of "magic"
- There is no shortage of medical need. Medicare only pays ~60% of the market price for many procedures, so many doctors simply won't see MediCare patients as they can make more by charging the wealthy
- Recent consolidation in hospitals and health insurance leads to even less competition
- Hospital pricing is opaque. The cost to get most procedures can't be compared apples-to-apples with other hospitals.
- Health care in the US is charged by the cost to attempt a procedure, not to fix an ailment
- The principal–agent problem occurs when {health insurers, hospital admins, doctors, and patients} are at odds when it comes to unnecessary procedures. I just heard a podcast where a man tried to interview doctors to see if he wanted to change and a doctor tried to give him a CAT scan to be able to charge for his interview time
- Employer-sponsored health insurance is tax-deductable for the company in the US, so there is a huge bias away from individual plans which reduce wasteful premium spending
- FDA doesn't rubberstamp approvals and actually requires new drugs to perform better than the placebo effect
- The public stock market is currently biased towards short-term profits
- The cost of sterilized equipment made to exacting standards is far higher than in countries where exacting standards aren't required
- Entrenched interests always throw a wrench in any proposed legislation that might aim to change the status quo
- Opportunity costs: many entrepreneurs are turned off by the heavily-regulated nature of health systems (EHR, apps, software updates, etc) and many other industries (apps, games, social media, finance) can be much more profitable
- Regulation drives up price and it tends to "mission-creep" over time in the US.
- Lots of people complain that medical litigation is out of hand and tort-reform could lower costs, but the impact of tort reform varied by whom you talk to
