One has a quite different view of US healthcare when you live in the US.

70% of the people don't want a change because they think their care is better than the alternative. Are they right ? The US patient gets prompt care for whatever ails him/her whether or not he/she has health insurance or not. The huge majority of people without health insurance are young, healthy, and would rather spend their money elsewhere, and it usually works out for them. If they have a medical catastrophe they still get immediate care, and if the costs are high relative to their savings and income, they become elgible for public assistance, have their bills reduced or eliminated, or in the worst case,declare bankruptcy, which allows protection of their house, if they own one. If you are uninsured and need a new heart, or kidneys, or hip replacements, or hernia repairs or anything else, the law says you get your care in the same way as anybody else. If the law is not followed, the uninsured patient has a cause for a lawsuit and damages, but one does not hear or read of many of these, because it is an outrage when someone is denied medical care - as well as being illegal.

American pharmaceutical companies historically have had a returrn on investment in the 15 to 18% range - not bad. If they charged 10% less for their drugs, the ROI would be from 5 to 8%, and they might well start looking for another line of business. So the pharmaceuticals can make low margin deals with other government health care systems, but they couldn't make comparable deals in the US without losing their profitability and ability to attract capital and fund research and development of drugs. Now, maybe, we have enough drugs, presently, but people who have incurable diseases might not view this in the same way, and the 15% + return on equity is the driver in funding new drug research.

So why can't the US just wise up and have a Canadian, British, or German system at a cost of 10 to 12 % of GNP ? THere are a bunch of reasons. THe first would be that the plaintiff trial lawyers are huge contributors to politicians, and our laws are such that the lawyers can become very, wealthy when there is a result that is less than excellent from medical care. They also can sue drug manufacturers for any side effect that is real, or any side effect that is claimed by a junk science witness. An example would be the billions of dollars in awards to lawyers and patients who had silicon breat implants. Drug companies have enormous liability and liability insurance costs related to this as do physicians and hospitals. It is a very expensive way of doing business.

More than the cost of the insurance, however, is that practitioners in the American Health care system order far more tests than in a government system, often, to protect against lawsuits, even though the tests may not be cost effective in any way, but ,also, because the US patient expects this. A result of this is that the US has far more MRI machines, CAT Scanners, etc., per capita, than any other country and orders far more tests. THis adds a lot to the cost of treating patients, but does make the patient safer to some degree. THe US, also, has a huge number of unregistered aliens who receive health care for free and this skews the per capita costs, immensely. NO other country has anywhere near the number of unregistered, non-citizens cared for for free, which balloons our costs.

The US has many sociologic issues - drugs, gang violence, murders etc. that lower it's average life expectancy, but if you get cancer, have a heart attack, stroke, etc. you will get immediate, usually, excellent care, and the statistics will show that you will live a year or two longer than in socialized systems after many various types of catastrophic events. - - - And US citizens are very aware of all of this. THey understand that the most impoverished citizen, here, gets the same care that the richest and most influential people from other countries come here to seek.

THere are some nasty downsides to the US private insurance system that include the difficulty or inability to get insurance if you have a major pre-existing illness and want to start a new insurance plan. Also the co-pays can be irritatingly high, even though you're insured - etc. But, people being people, most voters don't want to give up what they consider to be their own, el primo, medical care. The US congess kept a special exemption for themselves, so that they did not have to give up their own private insurance plans.

Mosey