US spent more on health care in 2022 than 6 countries combined with universal

Original Article ↗ Hacker News Discussion ↗

U.S. federal spending on health care now exceeds what the governments of Germany, the U.K., France, Italy, Spain, and Austria together spend to provide universal coverage to a similarly sized population, yet tens of millions of Americans still lack comprehensive care. Commenters probe why: high administrative overhead, expensive education and salaries for clinicians, aggressive pricing by insurers and drug companies, and poor public health metrics (e.g., obesity and chronic disease) all feature prominently. Many see single‑payer or stronger state bargaining power as a way to cut costs, but others argue that without deeper structural reforms and willingness to ration care, simply changing who pays will not be enough.

Headline & framing

  • Several commenters note the original article title omitted “combined,” which makes the comparison sound like “6× higher” rather than “more than those 6 countries put together for a similar population.”
  • Some still find the framing clickbaity or “unscientific,” arguing per‑capita or GDP‑adjusted comparisons and outcome metrics (e.g., life expectancy) are clearer.
  • Others say the headline is accurate and highlights the core point: the US government alone spends more than six European governments that cover everyone.

Spending comparisons

  • US government health spending ≈ $1.8T vs ≈ $1.2T in Germany, UK, France, Italy, Spain, Austria combined, for comparable total population.
  • Total US health spending ≈ $4.5T (≈16–17% of GDP), substantially higher per capita than any other OECD country; many European nations are around 8–12% of GDP.
  • Commenters stress this is government spend only; Americans also pay large private premiums and out‑of‑pocket costs on top.

Why US costs are so high

  • High physician salaries and limited supply (residency bottlenecks, expensive education) are discussed, but estimates peg physician pay at ~8–10% of total spending, so not the dominant driver.
  • Administrative overhead (insurers, billing, coding, prior auth, marketing) is repeatedly cited as huge, with estimates around 30% of costs and far above other countries.
  • Drug and device prices are markedly higher; US law often restricts public bargaining, and patent/evergreening practices are criticized.
  • For‑profit and quasi‑for‑profit hospital systems, private equity ownership, and non‑profit hospitals acting like businesses are seen as major rent‑seeking centers.
  • Several call the system a “jobs program” for administrative staff and intermediaries.

Single‑payer and reform debates

  • Pro‑single‑payer comments emphasize monopsony bargaining power, lower admin overhead, and international examples where universal systems cover everyone for less money.
  • Skeptics argue simply changing who pays won’t fix structural problems (education costs, supply constraints, corporate consolidation, patent regime, lifestyle disease burden).
  • Some contend the US also heavily funds global drug R&D, so even after reform it may remain expensive; others counter much extra revenue goes to marketing and profit, not research.
  • There is concern that any serious restructuring would destroy many white‑collar jobs, making reform politically difficult.

Health status & public health factors

  • Obesity is repeatedly raised: US obesity rates are much higher than in the comparison countries and strongly tied to chronic disease and cost.
  • Others note obesity itself reflects systemic failures: food environment, poverty, built environment, sedentary lifestyles, and weak preventive care.
  • Debate on GLP‑1 drugs (e.g., Ozempic): some see them as potentially cost‑saving via reduced complications; others question long‑term expense and industry responses.
  • Chronic illness prevalence in the US is high (e.g., large share with multiple chronic conditions), contributing to both worse outcomes and higher utilization.

Universal systems: benefits and problems

  • Defenders of universal systems say “universal” means everyone gets a baseline of care, even if rationed; they note the US also has wait times and access barriers, just stratified by insurance and wealth.
  • Critics emphasize rationing, long waits, and limited coverage in places like Canada, the UK, Poland; some report multi‑month or multi‑year waits and quality issues.
  • Several describe mixed systems (Germany, France, others) where public coverage is universal but private insurance and private care exist on top.
  • Many conclude no model is perfect: universal systems can underperform if underfunded or badly managed, but the US uniquely achieves both very high cost and incomplete coverage.

Politics & structural barriers

  • Lobbying, regulatory capture, and intentional legal limits on government bargaining are seen as central obstacles; some argue “too much money is being made” for major change.
  • Cultural factors (fear of “socialism,” emphasis on rewarding financial success) are cited as reasons Americans tolerate a system that works very well for the wealthy but poorly on average.