> I think the rest of the developed world would cheer on if the US just copied any of the dozens of other models for universal healthcare that produce better outcomes cheaper than the current US system.

"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.

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.

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.

> To give one example that I personally find shocking: That Medicare has restrictions on the extent of its ability to negotiate drug prices. I get your point that this is in part due to entrenched interests as seen with the attacks on the recent attempt to fix this issue by using powers under the Inflation Reduction Act, but that even chipping away on things like that is proving as hard as it is, is bizarre seen from the outside and the new ability to negotiate prices is still ridiculously limited.

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.

The issue is drugs under patent.

The way the patent system is supposed to work is that if you invent something you can patent it and then charge the monopoly price for a limited time in order to recover your R&D. The monopoly price is based on the value of the invention. You can patent some dreck and try to charge a million dollars for it and nobody will buy it from you. But if you cure some fatal disease, the value of the cure is very high, which allows you to recover the cost of developing the cure, which could also be very high.

This is obviously not going to be efficient when the drug is being paid for by insurance or Medicare. If the drug company patents something which is only marginally better than the generic, anyone paying out of pocket would just choose the generic and save a lot of money. But if the doctor prescribes the patented one, the insurance is now expected to cover it and by law only the patent holder can make it, so they can charge high prices even though the person choosing which drug to take isn't the person paying the bill anymore.

This is dumb but it's not completely crazy. Sometimes drug companies get away with charging a lot because they patented "existing drug, but with Tylenol" and then convinced doctors to prescribe it. But it also means they can recover their costs for actual life-saving drug research. It's not serving its purpose efficiently but it's still doing something of importance.

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.

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.