America's healthcare system. We all know it's broken. We pay too much money, still get terrible outcomes, and along the way get stuck in endless bureaucracy. How did this happen? How did the wealthiest country in the world get this so wrong? Well, it's obviously all the fault, the big corporations that are trying to exploit our sickness for profit. Wait, sorry, what we meant to say is that it's all def fault of the government bureaucrats who gave us socialized medicine. Wait what? Neither one of those things is really accurate, and no one actually knows how the healthcare system works. And you can't even call what we have a system all right. Folks guess we're figuring this one out together. 

There are two things and look, maybe only two things you can say for certain about the healthcare system of the United States, number one, we all hate it and number two, none of us have any idea how it actually works. For nearly 30 years, polling has consistently shown that somewhere between two-thirds and threequters of Americans think that our healthcare system has major problems, and one of them might be that no one has any idea what the hell is going on. A study in the Journal of Health Economics found that only 14 percent patients understand even the most basic aspects of their insurance plans, which okay, this stuff is complicated. Maybe it's too much for patients to wrap their head around. But at least we can rest easy, knowing that the people who provide our medical care know how everything works. Right. 

Well about that research has found that 92 percent of doctors agree that they have a responsibility to control costs for patients, but that only about 37 percent of them have any real idea. How much things are actually supposed to cost. 

Isn't this kind of weird a system we all have to use, and yet none of us knows what's going on well. At least part of the problem is that even the most basic talking points we hear about American healthcare are themselves often wrong. For instance, depending on who you listen to, the problem is either that our healthcare system is heartless. Dogeatog capitalism. 

Or that it's bureaucratic government-run socialism. And honestly, it's adorable that anyone thinks we have a system that coherent. In reality, we have something you might call capital socialism. Here's what we mean on paper. It looks like there's a tidy distinction. In 2021, over one-third of Americans got their healthcare from government sources. Medicare. Medicaid, or the VA. The other two-thirds, meanwhile, had private plans simple enough right. No nothing about healthcare is allowed to be simple. In reality, the public and the private are always blending together. Medicare, for instance, may be government healthcare, but there's a whole class of plans called Medicare Advantage, in which the government is paying for people to use private insurance. This works the other way, too, because even if you have private insurance, the specific rules around your plan, what's covered, how much it costs, even what kind of treatment you receive are themselves heavily shaped by government rules and regulations. 

Not public, not private, just kind of a mess, speaking of messes. Another claim we hear all the time is that America spends way more on healthcare than the rest of the world and still gets worse outcomes. And that claim is well, it's complicated why, because it's healthcare al right, it's always so damn complicated. It is the case that the US spends more per person on health care than other wealthy countries and that we nevertheless have the lowest life expectancy amongst those countries. But here's where it gets tricky. While the natural assumption is that those terrible numbers are a reflection on the quality of our healthcare, the data suggests that a lot of it is actually a reflection of our own behavior because Americans lead riskier lives than people in those other countries. 

Obesity were Number one, smoking deaths were Number one, murders were Number one, suicides were number one, opioid overdoses were Number one, auto accidents were number one. Fatal selfie accidents were number one, don't actually have a source for that one, but feels like it's gotta be right. 

Now regardless of what exactly the problem is, it's still the case that a lot of Americans would like to see the country move to a different healthcare system. After all, we hear all the time that America is the only advanced nation without universal healthcare, and that claim is painfully soul-crushing. Complicated. Maybe we should go back to the days where we just pay doctors with chickens. Here's why it's so confusing. Americans often think that being like those other countries would mean moving to a single-payer system where the government essentially runs healthcare. But here's the thing. A lot of those other countries have universal healthcare. They cover everybody, but they do it without single-payer systems run by the government. Single-payer does exist in countries like Canada and the UK, but it can have real drawbacks. Those systems tend to be plagued, for instance, by long wait times. As of 2021, the wait for neurosurgery in Canada was nearly a year. In 2022, nearly 40 percent patients in Britain were still awaiting treatment two months after being diagnosed with cancer. 

And it's not as if they're necessarily getting better care once they come off the waiting list. The survival rate for Americans diagnosed with breast cancer is actually higher than in either Canada or England, so what have other countries done differently? In places like France and Australia, there are mixed systems. The government provides some healthcare, but since they can't afford to cover at all, there are also options for private insurance. Meanwhile, in countries like the Netherlands. Switzerland, the healthcare system is privately run, with the government merely adding subsidies to make sure it remains affordable. In other words, lots of countries have been able to make sure their citizens have healthcare without turning the system over to the government. So is healthcare easy to understand? Absolutely not we're going to need a nap after this, but if we can cut through these misconceptions, we can start finding our way towards making it better for everyone.