Health-care spending is consistently rising around the world, but the United States is the worst performer when it comes to controlling costs. A lack of  coverage in the U.S. and a fragmented and heavily commercialized system leads to rising costs and excessive spending

Healthcare spending is rising around the world as far back as we've been measuring this, healthcare spending has always risen. Overall spending on healthcare has doubled over the past two decades, reaching 8.5 trillion dollars in 2019, which comes out to 9.8 percent of global GDP. The US spends about twice as much on healthcare than other large and wealthy countries do. The US healthcare system is not as effective when it comes to controlling costs compared to systems in other countries. The way the system is structured now it is cure driven system, not preventionriven system. So there is not one access model here in the United States, and so for preventive services for treatment, it really depends on people's insurance status where they're located and the provider network mirror them. It is extremely frustrating for not just patients but physicians. Also, the way we do it by definition makes things much more expensive for the question. So why are US healthcare costs rising more than anywhere else? And can it be stopped? 

Healthcare spending made up five percent of total US GDP in 1960. In 2020, spending hit almost 20 percent of total GDP. So what that means is that for every dollar that people spend in the US, about 20 cents is going towards its healthcare. This rise in spending can't be attributed to inflation alone. Healthcare almost alwayss outpaces inflation, and so healthcare cost grows faster than the economy. That's why it's representing a larger and larger share of the economy.

The United States spends more per person on health carers than other high income countries, but still has a lower life expectancy. We have poor outcomes relative to other countries. We pay twice as much as any other country, we pay more and get less. We see that people in the US use a similar amount of healthcare to people in other wealthy and large countries, but we pay more for each interaction, the moneys in hospitals and doctor. That's what makes up the big difference between what we spend on healthcare in the US and what other countries spend. 
Hospitals, physicians and clinical care made up more than half of total healthcare spending in 2019. So when we talk about ways to reduce spending, you can either look at ways to reduce the amount of care that people are getting or to reduce the price that people are paying for their care. And in the US it seems that there needs to be more of a focus on the prices of care because that's where the real difference is between what we spend in us and what other people spend. In other countries, drivers of the rise in healthcare spending has focused mostly on the symptoms of the rising health carers spending. So when we are talking about hospitals, prices are very high or drug prices as very high. These are not the causes of the high spending. These are the symptoms of high spending. 

One of the causes of high spending is the fragmented nature of the US system. Some Americans have incredibly comprehensive and affordable health insurance coverage, while others have little to no coverage. For some people, they might spend a very small share of their income on health care, and that's usually because they're healthier. People who are sicker will spend a very large share of their income on healthcare, especially if they're in private insurance coverage with a high deductible plan. Over 11 percent of the US population was uninsured in 2020, with a large disparity when it comes to race. 51 percent of Americans said they have delayed or skipped medical care due to cost. That number jumps to 63 percent. Among those living in a household with an income of less than 40 thousand dollars per year. 

Even those covered by insurance say they've experienced financial trouble. About 46 percent of insured adults reported difficulty affording out-ofpocket medical costs. The WHO argues in a 2021 report that universal coverage would limit catastrophic health spending. This lack of universal coverage can make costs rise while also leading to worst healthcare outcomes, specifically when it comes to preventative care when cost become prohibitive for patients to seek care is that number one preventative care and preventing diseases from getting worse is always going to cost less and the cost meaning to the overall system it's always going cost less. 

Let's say somebody has no insurance or very little insurance and she feels a vague pain on the right side of her abdomen. You know it would cost her 100 and 20 bucks to go to the doctor. She's not going to do that, she's going to work through it. And three months later she's in the emergency room divers appendix that costs 60 thousand dollars and we'll treat her. We'll treat her. But if she could have gone to the doctor when she felt that first pain, the doc could have treated the infection, it would have cost a 100 bucks.

 
There is a phenomenon in healthcare called the cost shifting. Cost shifting happens when healthcare organizations shift the cost of those who cannot pay the bill to others who are covered by insurance providers by decreasing the prices. Somehow, we also have to take into consideration the concept that you know maybe 30 percent of these bills will go unpaid, which can be thousands of dollars. So at some point, if you want to keep your practice afloat, those have to be recouped in a different way. This is a factor of the US healthcare care system where how much people end up paying is going to depend on your insurance. A lack of universal coverage and a fragment and healthcare system also mean that people don't have the same insurer for their whole lives, which means that insurers have less incentive to provide preventive services or to ensure that you don't get sick later. 
The majority of Americans don't have much of a choice when it comes to their insurance plan. More than 54 percent get health insurance through their employer. Capist View works when the market is free. 

Healthcare is never a free market. 

Instead we have insurance companies bidding on patients behalf which limits patients ability to bargain with their healthcare providers. We have what the insurance companies call narrow networks where they dictate which doctors you can go to. Patients also can't bargain because they usually don't know how much care actually costs. One key requirement in a free market is to be informed about the price of the product or good you are purchasing. But in health care, patients are in the dark about what would the cost be when they seek their care. Insurance makes prices even more opaque not just for patients but also for doctors. Sometimes it is difficult to know upfront what a patient's cost are going to be for whatever services that they're getting. At the end of the day we are actually not the ones controlling the rate for each different company. And even if we have a whole list of every single possible charge, we don't know if people have met their deductibles. Yet we don't know where they are with respect to out-ofpocket maxims. We don't know you what their copay might exactly be if it's a percentage. A lot of care is delivered through what's called fee for service. That means for every. 
Service that your doctor delivers to you, that doctor is billing for each individual thing and that can create an incentive called providerinduced Demand which is basically that your doctor has an incentive to do more things to you. 

But it's more complicated than just greed. America's litigious culture can play a role in excessive testing. I do think that in the United States we do order more tests simply because one, there's a fear of missing something. Of course, that comes from a human aspect where you don't ever wan misdiagnose a patient. But then there's also the malpractice side of things where if you do miss something, what are the consequences? Since there isn't true free market competition, insurance companies will try to re in the spending by either denying claims or requiring preauthorization. Most physicians are doing the right thing and choosing the right treatments for their patients, but sometimes there are instances where the procedure that's being requested may not always be the most effective treatment for their particular patient. And sometimes the prior off process also serves as kind of a gatekeeper, so to speak, of whether that physician has tried everything that could potentially help the patient. 

There are proponents for completely overhauling the heavily commercialized system. You have to make the commitment to provide health carers for everybody. That's the destination. It turns out there are many different routes to that destination. One of the more popular policy proposals is Medicare for All, which would replace for-profit insurance companies with government-f funded health insurance. I am a strong supporter of Medicare for All. 
Because it is our principal goal in this country. 

To give everyone coverage at the lowest possible cost and Medicare is the best way to do that. President Joe Biden is instead focusing on expanding the Affordable Care Act to enable more people to get insurance. There has also been a bipartisan push for increased price transparency. Congress passed the No Surprises Act, which went into effect in January 2022. The goal of the legislation is to help Americans avoid surprise medical bills. Now people who inadvertently go to an out-of network provider, for example, by going to an in-network hospital but being seen by an out-of- network doctor, that patient is held harmless, and then it's up to the insurance company and the doctor to kind of work out how much it get paid to them. Researchers and economists are still debating what exactly is driving these costs in the US, it's very hard for people to know how much healthcare is going to cost them before they get it. Some of that can be addressed through price transparency efforts by basically posting crisis on hospital or doctors office websites. Research has to be intensified in this area to clearly identify. 

The root causes of the high spending and the interrelationship between the different rootes. There's a lot of moving pieces here and there's probably not going to be one single solution to U healthcare costs and access and quality of care and insurance coverage, but there's a lot of different directions that policy is starting to go in terms of actually addressing healthcare costs in the US. 

Attention America: There Is A Better Way