> "Just pick one" isn't actually a method of choosing when different people disagree on what should be done. People don't even agree that "universal healthcare" is the right target, rather than e.g. a market-based system with actual price transparency that would introduce competition for non-emergency care.
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> This is also ignoring many of the factors that make the US system so expensive. For example, the AMA has lobbied for regulations that require doctors to do a lot of things that could reasonably be done by nurses. This has been exacerbating an existing doctor shortage, so then doctors get paid more (raising healthcare costs) while impairing outcomes (there aren't enough doctors to provide a high standard of care). This is a regulatory problem created by a powerful lobby.
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> It's things like that which in the aggregate cause the US system to be what it is, but you can't fix them by copying some different part of the system from another country. You have to fix that problem in particular regardless of what else you do, but fixing it is the thing strongly opposed by the lobbyists.

The point is that pretty much every other developed country and a lot of developing countries have managed to figure this out, the first over 130 years ago, and they've all had to figure out how to get agreement, overcome the objections to having it at all, overcome lobbyists, overcome medical associations wanting to keep tight control, and so on. Not one thing of this is new.

This US exceptionalism is a bigger part of the problem than each and every one of these objections. You're just not that special other than in believing you're that special and stubbornly refusing to learn from what has worked.

> You have to understand the context for things like this. Nobody is talking about negotiating the price of aspirin, which is a cheap commodity regardless of who you get it from.
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> The issue is drugs under patent.

This is not news. Every other country also has to deal with it. However, unlike the US, they have chosen to deal with it by negotiating best possible prices, usually by putting together portfolios of different drugs to negotiate over, and then deal with any perceived need to subsidise R&D into drugs that pharma companies aren't doing enough to address. The US is near unique in effectively letting pharma companies write public healthcare policy by making it a game of how to extract the most money from taxpayers.

It is, however, amazing how quickly the American belief in the free market collapses when someone suggests that Medicare should just act as one more actor in a market where the are already hundreds of other buyers negotiating the best possible prices.

> So now you want Medicare to "negotiate" these prices. Basically what you're saying is that you want to reduce the intentionally-created subsidy for drug research, or shift more of its cost from Medicare to private insurance and the uninsured. Which is bad policy, but is favored by people who want Medicare's numbers to look better.

The outcome is that you're misrepresenting the cost of providing care per patient by making the per-patient cost appear ridiculous when a huge bulk of it is an R&D subsidy that the entire world benefits from, that you're choosing to carry even for the half of the top 10 pharma companies that aren't even American, and that does not need to increase if the number of patients increase. If you want to pay that subsidy that's awesome, but when you're lumping it into Medicare it becomes an argument for not extending cover to more people because it artificially inflates the per-patient marginal cost of providing care.

> What you really want to do here is one of two things. Option one, give up on the model of patenting drugs and then having insurance cover the cost and instead just publicly subsidize drug research and immediately put the drugs into the public domain. Option two, make the patent system work as intended by exposing some of the cost to the patient, e.g. by having a 10% copay for prescription drugs. Patients would then avoid drugs which are extremely overpriced relative to their benefit and you wouldn't have Medicare paying high prices for "existing drug, but with Tylenol" anymore.

Or you can do what pretty much the rest of the developed world does: Publicly subsidise R&D (which the US also does - NIH grants for FY2023 are around $50bn) and negotiate best possible prices, so that you avoid creating perverse incentives to chase drugs to optimise the expected ratio of R&D expenses relative to ability to maximise costs to patients.

This willingness to actively defend a system that demonstrably is providing you substandard outcomes at the highest cost in the world is also fairly unique to American conditions.