Healthcare has been in the news a lot recently thanks to the United States’ current political circus. And I wonder, not for the first time, why the version of universal healthcare that we have here is so much more expensive per capita than anywhere else.

It’s a question I’ve tried to research anecdotally for decades, having grown up homeschooled behind the scenes of small clinics, helping nurses file charts and listening to doctors and staff talk among themselves. Many of the elevated costs have to do with American capitalism and many have to do with the fear of litigation. The cost of a test at one clinic is not the same as it is at a different clinic and it’s not even the same for different patients at the same clinic: the actual costs in staff hours are higher, especially for small clinics, when you have to navigate multiple penny-pinching insurance companies instead of having a patient pay up-front in two seconds. Additionally, if doctors order unnecessary treatments or tests, either for fear of being sued or because (as some but certainly not all are) they’re getting some kind of incentive to do so, that obviously drives costs up, and higher costs don’t correlate with better health care results. 

NPR reported in an April 2016 article that healthcare tended to be more expensive where hospitals had consolidated, for example, leading to monopolies. In 2016, the Health Care Cost Institute published a study showing that in some states, the cost of healthcare is over double what it is in other states, and even from city to city and hospital to hospital, costs for the same procedure vary by tens of thousands of dollars.

One would hope that more streamlined approaches to healthcare could be localized into the American system. Although that would almost certainly require a political and legal overhaul. In the meantime, there’s always more traditional localization to research in the healthcare field.