If American health care is exceptional, it’s in how it protects its inefficiency. Hospital systems merge to gain leverage. Insurers merge to counter them. Drug makers lobby to extend patents. The result is a market where no one controls the system, yet everyone profits from its disorder.
When Martin’s bill finally arrives, it’s printed on thick paper with four pages of explanation and one that matters: Amount Due $167.00. The rest is a cloud of codes and disclaimers—CPT 99213, “established patient, fifteen minutes,” and, at the bottom, “This is not a bill. You may receive additional statements.”
He folds it once and sets it aside. The paper smells faintly of disinfectant, and he wonders if Anna’s clinic in Copenhagen even owns a printer.
Later that night, he tells his wife, “The high cost of health care is just another subscription I can’t cancel.” She laughs, but the joke lands hard. Every month, premiums, co-pays, and deductibles siphon a quiet tithe from their account. Behind each charge is a policy choice someone else made long ago.
If the country ever decides to rebuild its system, it will have to do more than trim waste. It will have to confront the industries that profit from confusion, invest in primary care that prevents illness instead of monetizing it, and accept that universal coverage is cheaper than its absence. Other nations have already proven that lesson.
The paper smells faintly of disinfectant — a small, sterile reminder of a system that could be clean, but isn’t yet.
Bibliography
1. Centers for Medicare & Medicaid Services. National Health Expenditure Data for 2023. CMS, 2024. Comprehensive federal dataset detailing total U.S. health spending, per‑capita averages, and GDP share.
2. Commonwealth Fund. Mirror, Mirror 2021: Reflecting Poorly. August 2021. Comparative analysis ranking the U.S. last among high‑income countries on access, equity, and outcomes.
3. Reinhardt, Uwe E., Gerard F. Anderson, and Peter S. Hussey. “It’s the Prices, Stupid: Why the United States is So Different from Other Countries.” Health Affairs 22, no.3 (2003). Foundational study identifying unit‑price differences as the primary cause of U.S. cost excess.
4. RAND Corporation. International Prescription Drug Price Comparisons. 2023. Empirical comparison showing U.S. brand‑name drug prices average 2.8× OECD peers.
5. Himmelstein, David, and Steffie Woolhandler. “Administrative Waste in the U.S. Health Care System.” Health Affairs 39 (2020). Quantifies billing overhead at roughly 8 percent of national health expenditure.
6. American Medical Association. Survey on Prior Authorization and Administrative Burden. 2023. Reports physicians spend two hours on paperwork per hour of patient care.
7. Organisation for Economic Co‑operation and Development (OECD). Health at a Glance 2023. Paris: OECD Publishing, 2023. Provides cross‑country data showing U.S. health spending nearly double the OECD average.
8. Canadian Institute for Health Information. National Health Expenditure Trends 2024. CIHI, 2024. Chronicles Canada’s single‑payer cost trajectory compared with the U.S. over five decades.