Regarding insurance: I'm an American who was laid off my job after the property market collapsed (I was in civil engineering) and I got married. My wife got pregnant a year later, and we had no insurance. Fortunately, my wife is from the Philippines and we had the baby there. I paid for her care out of pocket. She received good quality care and the baby is healthy and happy. Having the baby in the US would have bankrupted me at the time.

Two of my three kids were born in Indonesia for that same reason. The one that was born in the US, even with Insurance, left us with medical bills we were paying for years.

Insurance in US and Canada are different than that of Indonesia.

In US/CA, certain type of insurances == loan. Insurance companies also try hard not to pay you either due to the number of scams or just trying to scam you.

In Indonesia, insurance is actually what insurance should be: someone will pay your liabilities, without too much hassle or questions.

Also, depending on your pocket money, in Indonesia, you can get the medium-to-best quality of health care. In US/CA, for whatever reason, I heard more horror stories when it comes to "visiting specialists" (be it long multi months queue, or left with debt)

Out of pocket no more than $3000 for some of the best OB/GYN's and a standard labor. Maybe $1k more for a C section.

Also in the case of the kid born in the US, the insurance did pay what they said they would. We still ended up with around $10k in debt for a relatively uncomplicated pregnancy and childbirth.

Part of the problem though is that US health care is expensive. It's not just insurance. It's not just the idea that single payer would be cheaper (I am not sure it would necessarily be--- the devil is in the details), but rather it is the fact that everything is stacked against the consumer, against the doctor as an individual, and towards the direction of big companies (big pharma, insurance, textbook publishers, etc). The only thing a single payer system brings to the table (and most such systems are a world away from anything the US would consider even if such a plan was on the table---- for example, Canada has separate systems per province, and in Denmark everything is run by local governments) is some counterbalance by the collective consumers against such a model.

To give you an idea of how much more expensive it is in the US than in anywhere else, if medical care cost the same in the US as it did in Canada or the UK, what the government currently spends (on government employees, on the VA, on Medicare and Medicaid) would be enough to fully cover every American.

So why is it so expensive? Could it be monopoly/oligopoly interests? Conspiracies against market transparency on the part of medical service providers and insurers? Regulatory games? All of the above? I suggest it is, in fact, all of the above.

Yep, all of the above.

Even the little things cost a lot: nurses cost a lot in US/CA compare to Indonesia (where they are probably on the low-medium end of the salary range).

There are a few issues with health practitioners in Indonesia, here are some of them:

1) Preferred C-section over natural birth

C-section brings more money

2) Preferred anti-biotic over natural healing

The answer to almost everything is anti-biotic. If they can't "fix" you in 2 days, neighbour will spread rumours that a particular GP isn't that good ("he/she can't heal me, but I went to Dr. Foo and he gave me a medicine and I'm back to work the next day")

Yeah, I don't take antibiotics when they are prescribed most of the time over here.

But doctors in the US are also far more into defensive C sections. You can avoid the issue in Indonesia by doing a little research about the doctor ahead of time.

Yes, but in the US they also tend towards C-section for the same reasons.

"For the wealthiest, the taxes approach 30% of income and instead of a tax bracket system, you have a series of compounding taxes (something like 5% of income over 40k + 5 % of income over 50k etc). Every additional dollar you make puts something in your pocket. No nasty "I moved up a tax bracket and so I took home less this year!" surprises"

Is this not precisely how the American tax system works? At no point will you ever lose money by making an extra dollar. Each tax bracket is marginal; taxing only the money in that bracket.

My error. You are correct. However, the total tax rate is less, and there are no income taxes that are not progressive (social security is non-progressive because of the tax cap in the US).

But more to the point the taxes are easier to fill out, and payment terms are a lot easier than in the US. If you have ever been self-employed and struggled with taxes because of sudden business increases partway through the year, you will know what I mean......

You do make good points, but I'll counter that the US is the place for startups because that's where the customers are. The countries you list do not have 200 million internet-connected individuals with first-world levels of wealth. Western Europe is similar, with a bit more friction in crossing jurisdictional boundaries, most notably in accepting and processing payments.

That said, it's certainly possible for a startup company to exist in Singapore or somewhere but target and sell to US customers. The communication and regulatory hurdles will be higher, but not insurmountable.

Those are important advantages.

I would also say that my experience also suggests that US primacy in world banking contributes to it too. If someone wires money from Colombia to the US, the price is not expensive, but Colombia to Indonesia is ($100 USD per wire? WTF?).

Also wiring ringgits from Indonesia (national currency is the Rupiah) to Malaysia (Ringgit) requires conversion into dollars and then wiring through New York. Some work on local banking connections would go a long way. That's probably one thing the Eurozone was intended to do for Europe. I am not sure you need a multinational every day currency though so much as an international reserve currency for the region....

The tax system in the US works exactly as you describe the Indonesian tax system.

Moving up a tax bracket only taxes the additional income at a higher rate. This is the definition of a progressive tax.

Regarding insurance in the USA, I saw a paper by Milton Friedman in the 1970s who was evaluating the impact of government involvement in the healthcare industry. Prior to 1901, healthcare in the USA was completely private (charities are considered private as well, since they aren't controlled by government.) Between 1901 and the 1970s the US government at all levels started to take over health care, by funding hospitals, and by regulating everything.

He found that, as of the mid 1970s, this intervention had driven up costs 26fold, and had reduced availability, by an amount I can't remember.

Since then I'm sure the impact is even worse. But if you just use that number-- a $100,000 operation that might bankrupt you would have cost $3,846.15 if government hadn't gotten involved. So the impact of government is going from a cost you could afford to put on a credit card to bankruptcy.

Prior to 1901, healthcare was not very advanced. I'm guessing the rise of technology, doctor credentialing, and the development of most modern drugs may have something to do with the price increase.

That can only account for half the increase, since the countries with the next highest cost for health care spend roughly 50% per capita compared to the US......

I would instead say the problem is:

1: Monopolies and oligopolies (patents, letting the AMA control medical school accredation, etc). Solution is to charter mini-AMA's to provide competition, and to enact compulsatory licensing of patents in medical fields.

2: The fact that the health care and health insurance markets are both entirely consumer opaque. Consumers don't have any control over their money in these markets and the common-sense protections are missing. For example, when I go to get my car worked on, I have a right to a written estimate before repairs are begun. Why don't I have a right to a written estimate before non-emergency medical care is provided?

The first thing you have to recognize is that when Democrats and Republicans both talk about reforming our medical system to address these, they believe that more corporate power, and less consumer power will correct this problem. Unfortunately, pricing is a coercive negotiation, and so that will only accelerate the problem.

Empower consumers. Disempower corporations. Bring prices down.

Advances in technology drive down costs, not the reverse. They prevent diseases, reduce the need for more expensive procedures, etc.

Credentialling of doctors as it currently stands is an artificial guild system which restricts the number of doctors. It doesn't make medicine safer, but does increase doctor salaries. This is one of the ways government interferes with healthcare to artificially restrict supply-- the AMA did some effective lobbying once upon a time.

Drugs also reduce the need for hospital stays and thus costs by curing or preventing conditions that would otherwise get worse.

Do you happen to have a link to that Friedman paper?

It was a couple of years ago, and so my memory is off, and I can't seem to find the exact article I read. It appears there was a study done in 1992 which had similar results (I wouldn't be surprised at either possibility: I misremembered it as the 1970s, or there was a different study done in the 1970s by Friedman, as the particulars I remember are a bit different, 1901-1970 instead of 1944-1989.)

Found this, which gives a figure of 10X for a "hospital bed" "In 1992, the Hoover Institution published an essay by Milton Friedman titled "Input and Output in Medical Care," http://mises.org/daily/3793

And also: "Some years ago, the Nobel-laureate economist Milton Friedman studied the history of healthcare supply in America. In a 1992 study published by the Hoover Institution, entitled "Input and Output in Health Care," Friedman noted that 56 percent of all hospitals in America were privately owned and for-profit in 1910. After 60 years of subsidies for government-run hospitals, the number had fallen to about 10 percent. It took decades, but by the early 1990s government had taken over almost the entire hospital industry. That small portion of the industry that remains for-profit is regulated in an extraordinarily heavy way by federal, state and local governments so that many (perhaps most) of the decisions made by hospital administrators have to do with regulatory compliance as opposed to patient/customer service in pursuit of profit. It is profit, of course, that is necessary for private-sector hospitals to have the wherewithal to pay for healthcare.

Friedman's key conclusion was that, as with all governmental bureaucratic systems, government-owned or -controlled healthcare created a situation whereby increased "inputs," such as expenditures on equipment, infrastructure, and the salaries of medical professionals, actually led to decreased "outputs" in terms of the quantity of medical care. For example, while medical expenditures rose by 224 percent from 1965–1989, the number of hospital beds per 1,000 population fell by 44 percent and the number of beds occupied declined by 15 percent. Also during this time of almost complete governmental domination of the hospital industry (1944–1989), costs per patient-day rose almost 24-fold after inflation is taken into account." http://mises.org/daily/3586

The 24 fold figure above may well be where I got the "26 fold" claim I made. Since the government has been running a deficit for a long time, including the period of the study, taking inflation into account is appropriate. Inflation is what happens when the government spends more than it take in, it prints the extra money. The impact of inflation on an economy is the devaluation of the unit of currency, causing a rise in the prices of everything denominated in that currency, including health care.

I wonder what proportion of top-voted comments per article start with, "I know I will probably be down-modded..."

It's taking pains to point out that you don't care about public opinion, which is, at least here, a way of ingratiating yourself to public opinion.