I wonder what the US is going to do about health care?

This above graph (one of many) shows the US in dead last position against other countries.

In racing one design sailboats when I was a teenager, I recall a very important lesson - if someone is going faster - copy them. My performance dramatically improved.

In my view, it's not whether or not the US Taxpayer is paying for health care - they are:

According to PNHP:

Tax-funded expenditures accounted for 64.3 percent of U.S. health spending – about $1.9 trillion – in 2013, according to new data published today [Thursday, Jan. 21, 2016] in the American Journal of Public Health. The Affordable Care Act will push that figure even higher by 2024, when government’s share of U.S. health spending is expected to rise to 67.3 percent.

The Affordable Healthcare Act in my view is a step in the right direction - however is an insurance based scheme which does not address the core reasons why the US is dead last among OECD nations. Insurance schemes like Medicare or ACC in New Zealand - while they can make a positive difference they are not the same thing as actual health care. And it's the number of publicly funded hospitals, doctors and other medical workers that separates the US from other nations. The difference is not about funding - it's about health providers being focussed on profits (and liability) rather than services for all of the people.

In my view the difference is how the system is set up. Most analysts fail to acknowledge how that insurance is a driver of costs and inefficiency in the US. People working in an insurance dominated systems pay more. What insurance does is removes the actual purchase decision from the patient. As a result, there are huge variances in costs, while there are not-so-huge variances in the procedures.

Though the average cost for a total knee replacement procedure (without complication) was $31,124 in 64 markets where claims data was reviewed, costs for the same procedure dipped as low as $11,317 in Montgomery, Alabama, and rose as high as $69,654 in New York City. Stark cost variations also exist within the same market in some cases, like in Dallas, where the cost for a total knee replacement could range from $16,772 to $61,585 depending on the hospital - a difference of 267 percent.

Imagine there being a 200% difference in the cost of a certain model of car. Because the purchaser is directly involved, true competitive practices exist. If the perceived price is too high - the customer simply takes their business elsewhere.

This does not happen with health based insurance services. In fact, in the US, I believe that existing practices have elements of anti competitive behaviour because patients are locked into having health services carried out by 'approved' providers.

It's not all a one way. Not all of US health care is private - most publicly funded institutions appear to be at the state level. The difference between is that there is no national health care, other than military hospitals. In my view, leaving individual states to address the issue does not work. Any state that offers advantages becomes a magnet for persons located in other states - providing an incentive for states to do less.

It's striking how much the US psyche is about competition - yet the most competitive model appears to be shunned - federally funded healthcare which is not insurance. There are many examples of it working in other nations alongside private healthcare so there is a pathway for it to be introduced incrementally.

I'm not an expert in health care.

However I do know what last place looks like.

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Bruce Hudson is New Zealand writer based in Los Angeles. More of his writing can be found on Medium.