Paradoxically, the US government spends a lot more per person in healthcare than comparable countries that provide full healthcare coverage to their citizens. It spends the most in the world, in fact.

The huge difference isn’t a function of the quality of care or its outcome (in fact, the US has shorter life expectancy than other rich countries) but on the sheer cost of services, which goes up according to the market in a privatized health environment. Since healthcare isn’t dispensable—customers will pay what they have to—there is no incentive in a privatized market to keep prices down.

Radical changes, such as the introduction of a single-payer system like Medicare for All, would make the system more similar to that of countries, where a single public provider has the negotiating power to control the prices.

Obamacare, however, doesn’t do that. Instead, it essentially uses government subsidies to help individuals pay for overpriced coverage, but doesn’t have any leverage to keep prices down. The promise that Obamacare would help lower the cost of healthcare, through the marketplace and with a reduction in healthcare inefficiencies, simply didn’t come true. Healthcare spending continued to go up since Obamacare subsidies were first applied in 2014, both as a percentage of GDP and in terms of absolute dollars.

Biden is no fan of Medicare for All, though he promised to create a public option, essentially allowing individuals to buy into Medicare if they wish to. Were he able to do that, it might help keep the cost of healthcare under control—something merely expanding Obamacare subsidies hasn’t been—and won’t be—able to do

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