Any bureaucratic system is going to be inefficient. You see it in countries with universal healthcare. In Canada, some provinces now have wait times of over a year from referral to treatment. Many European countries face similar access issues, though France and the Netherlands perform somewhat better.
The U.S. is a different kind of mess. It’s a patchwork of heavy government restrictions, large public programs like Medicare, and for-profit corporations, all thrown together without a coherent design. It’s no surprise it’s expensive. In 2023, healthcare spending was nearly 18% of GDP. Another factor could simply be wealth: higher per capita GDP tends to correlate with higher healthcare spending. To be fair to the U.S. healthcare system, it is highly capitalized, with much higher concentrations of diagnostic equipment like MRI machines than other OECD countries, and it does have some of the highest five-year survival rates for cancer and heart disease.
Even so, all of these healthcare systems are heavily dysfunctional in many ways.
In contrast to all of this, cosmetic surgery and laser eye surgery are the only fields of medicine where prices have actually fallen in inflation-adjusted terms, which is extraordinary, as prices in healthcare in general have increased much faster than inflation. The superior performance of these fields is because of basic market dynamics. People pay out of pocket, so they’re price conscious, and providers compete. There are also fewer regulatory restrictions since these fields aren’t tied up in government programs like Medicare.
Innovation is the only thing that reliably drives prices down. But in most of healthcare, it moves slowly. Devices often take 10-30 years to cycle out. Compare that to consumer electronics, where turnover happens every 1-2 years.
If it were up to me, I’d make restrictions on medical providers much lighter. Anyone could offer medical procedures as long as they disclose they’re uncertified and include a government-mandated warning. That kind of freedom is necessary to solve hard problems. You can’t regiment innovation and industry development. Gatekeeping in the name of consumer safety is the worst thing that can be done to any industry, and unfortunately, there is heavy gatekeeping in healthcare.
That is not to say that I am opposed to government intervention in general. I think it can play a critical role in advancing healthcare. Where government intervention creates the most value is in funding research for the public domain: drug designs, medical procedures, and open datasets. These investments have enormous returns and are best handled by governments. If the private sector focused on delivery and innovation, with governments making strategic contributions in foundational research, healthcare would see revolutionary improvements generation after generation.