I’d also like to know how other developed countries control their costs. You don’t usually hear Canadians, Australians and Europeans wishing they had the American healthcare system in their countries. It would be interesting to hear from Mustachians abroad how we could fix or at least mitigate this issue. We could learn from their perspectives. Do they think the ACA was a step in the right direction? They might have ideas we never even thought of.
1) Less patent protection for name-brand prescription drugs.
2) Less litigation.
3) Insurers have negotiating power. In the U.S. the government is actually banned from negotiating lower prices and required to pay whatever the drug companies are bold enough to ask. Lobbyists pay for political ads in return for this favor and Americans vote based on what these ads tell them, perpetuating the system. This blank check increases prices for all consumers.
4) More support for the education systems that produce medical professionals. When doctors don't have a half-million in student loan debt to pay off, they can charge less.
5) Fewer subsidies for activities that harm population health, such as roads/driving, sprawl/fast food joints, sugar/meat subsidies, etc.
6) More subsidies for activities that improve population health, such as bike paths, investments in urban density and walkability, better education, poverty reduction, etc.
7) Less care provided in the last few weeks of life. Less emergency heart bypass surgeries for 90 year olds and more hospice care.
8) Less administrative overhead coordinating payments, insurance records, etc. There is a single payer.
9) Resolution of the incentive problem, where providers get paid for whatever they can sell the patient, who is not the end payer and doesn't care about the net value.
10) Less spent advertising drugs and treatments.
11) Fewer violence-related injuries. The U.S. is an outlier among developed nations in terms of violence.
12) In some developed countries, lower rates of addiction to illicit drugs and alcohol.
The #1 thing they do is treat healthcare as a challenge to be solved pragmatically instead of making it a big ideological fight. Americans think of electricity distribution, firefighting, or other logistical issues pragmatically, but when it comes to healthcare we bicker over ideological abstractions (socialism! death panels! greedy corporations!) without ever solving a problem (or should I say, insisting our leaders solve the problem and then getting rid of them if they fail).
I personally like the employer subsidized model of health care insurance. It was not that high at my previous employer, and I'm currently paying less than $60/mo in premiums (for myself only) and have a $100 deductible (although co-pays apply, like $25 office visit.)
I'll soak ACA for a PCT and maybe a little CSR if possible by regulating my MAGI when I FIRE.
My employer also pays ~90% of the cost for my family. However, I am under no illusions this is "free money" any more than I think of my income tax refund as a gift. The reason middle class wages in the U.S. have stagnated for three decades is because the cost of employer-sponsored health care has eaten up the gains. Had the cost of healthcare risen at the rate of regular inflation, you would be earning thousands of dollars more right now. Instead, your employer takes a bit of your raise each year and uses it to offset the rising cost of your health insurance.