How would you reform this system to bring the prices down?
— Paramendra Kumar Bhagat (@paramendra) May 8, 2025
How to Fix Health Care in America: Lower Costs and Cover Everyone
Health care in the United States is both the most expensive in the world and among the least efficient when it comes to covering everyone. Despite spending nearly 18% of GDP—more than any other country—tens of millions remain uninsured or underinsured, and medical bankruptcies are a uniquely American tragedy. The system is fragmented, profit-driven, and bureaucratically complex. But reform is not impossible. Many countries around the world provide universal health care at far lower costs while achieving better or comparable outcomes. It's time America learns from them.
🏥 The Two Goals: Lower Costs, Universal Coverage
To reform American health care effectively, two fundamental goals must be pursued in tandem:
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Dramatically reduce costs
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Provide universal health care to all Americans
Achieving both requires systemic changes that go far beyond tinkering around the edges with insurance subsidies or provider networks.
💡 Five Core Reforms America Needs
1. Universal Public Insurance or Regulated Nonprofit System
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Either implement a single-payer system (like Canada or Taiwan) or tightly regulate a network of nonprofit insurers (like Germany, France, and the Netherlands).
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Eliminate or restrict for-profit insurance companies, which currently absorb billions in overhead and marketing.
2. Standardized Pricing for Services and Drugs
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Introduce national or regional fee schedules to eliminate wild variations in pricing.
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Use bulk purchasing (as other countries do) to drastically reduce prescription drug prices.
3. Administrative Simplification
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The U.S. spends 4 to 5 times more on health care administration than peer countries.
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Streamlining billing, coding, and insurance verification can save hundreds of billions annually.
4. Preventive and Primary Care Focus
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Shift investment from expensive emergency and specialist care to primary care, preventive services, and public health.
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Incentivize value-based care instead of fee-for-service.
5. End Employer-Based Insurance
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Decouple health care from employment to increase labor mobility, entrepreneurship, and equity.
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Replace it with publicly financed insurance funded via progressive taxes and employer contributions (as seen in Japan and Germany).
🌍 Which Countries Are Doing It Better?
Several nations provide excellent health care at half or less of the U.S. cost:
| Country | % of GDP on Health | Universal? | Key Features |
|---|---|---|---|
| 🇹🇼 Taiwan | ~6.7% | Yes | Single-payer, smart card system, low overhead |
| 🇩🇪 Germany | ~11.7% | Yes | Multiple nonprofit insurers, employer/employee-funded |
| 🇫🇷 France | ~11.2% | Yes | Public insurance with supplemental private plans |
| 🇸🇪 Sweden | ~10.9% | Yes | Tax-funded regional health care system |
| 🇯🇵 Japan | ~10.7% | Yes | Employer-based with strong government regulation |
| 🇬🇧 UK | ~11.3% | Yes | NHS: government-funded and operated |
These countries differ in structure but share common traits:
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Universal coverage
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Government-negotiated prices
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High public satisfaction
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Lower administrative costs
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Focus on primary care and public health
🔍 What the U.S. Can Learn
From Taiwan: Adopt a smart card system that centralizes medical records and billing. Use global budgeting to control total system costs.
From Germany and France: Allow pluralistic insurance models—but strictly regulated, nonprofit, and universally accessible.
From the UK and Sweden: Invest in public infrastructure and staff, especially in rural and underserved areas.
From Japan: Use price controls without stifling innovation, and support healthy lifestyle education as a core policy tool.
🔚 Conclusion: A Healthier America is Possible
America’s health care crisis is not a failure of medicine or technology—it is a failure of political will and economic justice. The solutions are not secrets. They exist, and they work in dozens of countries today. By prioritizing health over profit, simplifying administration, and ensuring universal access, the U.S. can finally achieve what every other advanced country already has: health care as a human right, not a privilege.
The question is not how to fix American health care. The question is when the political courage will catch up to the moral urgency.
How to Fix Health Care in America: Lower Costs and Cover Everyone https://t.co/Cg9M5t3l8L
— Paramendra Kumar Bhagat (@paramendra) May 8, 2025
