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For decades, it has been a secret from most Americans that the average European was given benefits that most of us couldn't imagine ever getting. Much longer vacations, better (and cheaper) health care, free (or nearly so) higher education, secure jobs, high pay and Illy coffee.

This was made possible, in large part, by the ability to spend only a token slice of their GDP;s on their military - first because of the very obvious placement of US troops and weapons on the continent to counter the Soviet Union, and following its collapse, the perception that Russia's military was in no position to threaten Western Europe - especially considering the unshakable confidence of being militarily backed up by the US.

The current US administration has made it clear that "America First" means that Europe had better be prepared to go it on their own.

Italy’s Il Manifesto criticizes the militarization of the EU:

It’s not just a specter that is haunting Europe, but a juggernaut that is mortgaging its future. It is the militarization of the political debate and the economy. This is now beginning to determine long-term decisions, prepared and made ‘self-evident’ by a forceful rhetoric that turns fear into consent and the defense industry into the inevitable future. ... This is a brutal and dangerous political decision at the expense of the peoples of Europe. We are facing a structurally planned rearmament, not just a temporary phase characterized by an increase in military spending.

It is easy to see the social structure a Europe being stressed as fund which previously supported a superior life-style for the common man to used to arm their respective countries - as well as those who see that life-style evaporating demonstrating to hold their grip on it.

Jeff

We Americans have always claimed the Europeans live better, not footing the bill for the military.

I doubt that is the main issue. Claims by Americans are spurious at best.

The Europeans paid higher taxes. Oh! The Americans do not want that discussion.

I will go a step further. The welfare state makes the first world very wealthy. Americans are scared of that discussion.

The Europeans paid higher taxes. Oh! The Americans do not want that discussion.

This. Folks say they want single-payer healthcare, like the UK, and I agree.

Let's also have 40% income tax for the middle class, 20% VAT, and gas at $7/gallon. Folks shy away from that...

"The Europeans paid higher taxes. "

Americans are very irrational when it comes to paying taxes. The mind-games
propaganda sent out like a firehose have brainwashed Americans into
believing we are highly, oppressively taxed. In comparison to the past 60-70 years,
we are most definitely not taxed in a stifling manner.

If Americans could wrap their heads around taking all of the money they pay for their health insurance ( premiums and co-pays ), and used those funds to pay into a national healthcare system, they might start to realize that national health care is a better solution for the majority of citizens, in comparison to this mess we currently live with. And if all of the healthcare premiums and co-pays went to a national healthcare system instead of private insurers, then it might not be additive to the deficit, which is 1 of the 1st talking points the lobbyists spit out.

Americans quite possibly have some very tough consequences to deal with, as
a result of what they allow themselves to believe, and how they vote.

If Americans could wrap their heads around taking all of the money they pay for their health insurance ( premiums and co-pays ), and used those funds to pay into a national healthcare system, they might start to realize that national health care is a better solution for the majority of citizens, in comparison to this mess we currently live with. And if all of the healthcare premiums and co-pays went to a national healthcare system instead of private insurers, then it might not be additive to the deficit, which is 1 of the 1st talking points the lobbyists spit out.

Aye, but, you know, government bad...

Saw this on NPR today:
U.S. health care is the most expensive in the developed world and the price point is only rising. Last year, the average annual premium for an employer-based health insurance plan for a family of four was over $25,500. Of that average total, employers contributed about $19,200 and workers contributed the rest. Total premiums have risen over 24% since 2019 and are widely expected to surge next year.

Yep.
https://www.politico.eu/article/france-downgraded-...
France downgraded by S&P as budget uncertainty ‘remains elevated’
The ratings cut comes after French Prime Minister Sebastien Lecornu committed to suspend an unpopular law that raised the retirement age.
Likely Germany rating cut will soon follow.

I would go further and say the EU as a economic force is on the decline as well as high energy costs leads to production cuts and factory closure and reduced industrial plant partially due to increase international competition.

https://www.ft.com/content/d0de519c-257e-4721-98f8...
Europe is the biggest loser in US-China rare earth wars
Its dual dependence on America’s digital services and Beijing’s critical mineral processing industry leaves it highly vulnerable

Also The US-EU trade deal was brutal upon the Europe's economy with the a 15% tariff on most European exports while also committing to massive purchases of American energy, chips, and military equipment.

Combine the above with Europe demographic issue

Apparently the US has read the tea leaves and while not cutting Europe loose; but is deemphasizing the strategic importance of Europe. Our eyes are turning increasing toward Asia and the Pacific.

" Last year, the average annual premium for an employer-based health insurance plan for a family of four was over $25,500. Of that average total, employers contributed about $19,200 and workers contributed the rest."

I seen that,too. Was a bit surprised, I thought the employer/employee split
was closer to 50%, but it's approximately 75%.

It's surprising that corporations aren't using the power of their paid-for
access to Senators and Reps to push for national healthcare, and remove
that direct 75% burden from themselves. I get that all of the insurance companies,
hospitals, etc would fight it like a cornered grizzly bear, but they are out numbered.

The continuing status quo shows me that the healthcare industry must be paying
out the most protected-free-speech money to the Senators and Reps, since they
are able to maintain the status quo. I expect that, but am disappointed
in American citizens not being able to see thru the BS that the media hype
machine spits out at them. The Senators and Reps feel no danger to their
cushy and lucrative position, not at all worried about being voted out.
We'll see if any lessons have been learned in 2026, assuming that the gov
shutdown will not succeed in eliminating the subsidies set to be cut from
the ACA. And I truly hope the post 65 bloc, of which I am a part, doesn't
think they are in no danger of seeing and feeling accelerated medicare premiums,
like the under 65 bloc is staring at.

It is easy to see the social structure a Europe being stressed as fund which previously supported a superior life-style for the common man to used to arm their respective countries - as well as those who see that life-style evaporating demonstrating to hold their grip on it.

Maybe. But it's important to keep a sense of proportion about it. Most European nations currently have government spending a bit north of 40% of GDP. More also have military spending at between 1.5% and 2.0% of GDP, give or take. The U.S. has about 3.4% of GDP spent on the military. We're talking about a point or two of GDP, which itself will only be few points of their overall budgets.

So while moving a point or two of GDP away from butter and into guns isn't nothing - and it's probably a lot of money in absolute terms - it isn't likely to "end Europe's welfare state." To be sure, it will require some difficult choices, and will stress some aspects of their welfare state. Perhaps that inspires some bigger changes... but the magnitude of remilitarizing shouldn't be large enough to itself force Europe to actually end their welfare programs.

It's surprising that corporations aren't using the power of their paid-for
access to Senators and Reps to push for national healthcare, and remove
that direct 75% burden from themselves. I get that all of the insurance companies,
hospitals, etc would fight it like a cornered grizzly bear, but they are out numbered.

The data has been shown, repeatedly, that western European countries offer better health care than the US, at lower cost. We could have a single payer system, providing care for everyone, and getting the providers paid promptly, and *reduce* what we spend vs the current system.

Yes, I agree. One would think that the "JCs" would jump at the chance to offload the expense, and the bother, of administering a health insurance plan for their employees.

Seems the insurance industry has more juice where it matters, than all the rest of USian employers, combined.

After all, under Socalistical health care, everyone dies!

A Message From Harry & Louise

https://www.youtube.com/watch?v=1-7A8d2wptI

Steve...am I going to get flamed again?

U.S. health care is the most expensive in the developed world and the price point is only rising.

I am pretty sure I have this figured out. When I did a little research on the subject, both book learned and observational, I found:

Doctors in the US are paid significantly more than in Canada or the EU: half again as much as Canadian doctors, and double, even triple the salaries of doctors in the EU.

We have more layers of rent seekers in the US: from private insurance companies to labs associated with doctors’ practices, not to mention lawyers, all seeking a bit of the health care dollar.

I have also noticed that every single one of my health care providers - and at my age I now have several (GP, Urologist, Dermatologist, Eye, etc.) have spanking new facilities, shiny equipment, newly painted walls, gleaming tile floors. OK, I am not advocating that hospitals and doctors offices should have grimy hallways, it’s just interesting to me how “new” and “gorgeous” all the buildings are for anything medical, as opposed to even luxury retail or elsewhere.

Everything, and I mean everything, is disposable now. I used to lay on a sheet, get a cloth wrap to keep me warm: now it’s all paper. The doctors unwrap every tool and toss the packaging in the trash like MJ dunking a slam at Home Court.

I’m not sure how you get ahead of this trend without a lot of pain and anguish, but explaining the cost side is easy. Explaining why the results aren’t better than other systems in advanced countries, maybe not quite so simple.

The data has been shown, repeatedly, that western European countries offer better health care than the US, at lower cost. We could have a single payer system, providing care for everyone, and getting the providers paid promptly, and *reduce* what we spend vs the current system.

Not unless we sharply and dramatically cut the amount that we pay providers for services. The U.S. doesn't just pay more than other countries in the private system. We pay more per capita to cover our seniors, and they're entirely within the public system:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7411536/

You can't pay less for health care without paying less for health care. That means paying all the people who provide health care less. There's not enough money that goes out of the system to health insurance companies to make a dent in health care spending. Heck, not even a third of our health care spending is even in the private insurance system anymore.

You can't achieve European countries' spending levels by getting government control of health insurance; you need to have the same level of government control over pricing of health care services.

And that's why you don't have single-payer systems in the U.S. Maybe, what, around 10% of voters in any given Congressional district work in the health care industry? In any given Congressional district, the biggest hospital might not be the largest single employer - but it's probably in the top ten or fifteen? Our health care spending is currently around 17% of GDP; do you think anyone wants to face the economic displacement that would result if you tried to cut that in half over, say, a ten year period? Shaving almost a full point off of GDP growth each year for a decade?

One would think that the "JCs" would jump at the chance to offload the expense

Expenses are one thing--which are 100% tax deductible for the pseudo-JCs. Why NOT do it? EASY.

The pseudo-JCs surrender their POWER OVER EMPLOYEES when healthcare is no longer an employer benefit *LIMITED TO EMPLOYEES*.

When healthcare is a national program, employees can tell the pseudo-JCs to take a flying F at a rolling donut--and there is NOTHING the pseudo-JC can do about it.

It also becomes FAR harder for the pseudo-JC to hire workers because workers can look at a lot more important factors than just pay and healthcare. Telework? Where would the job be located? Schools (if relevant)? And so on. Suddenly, the pseudo-JC has to spend a lot more to find and KEEP employees.

do you think anyone wants to face the economic displacement that would result if you tried to cut that in half over, say, a ten year period?

The money would be spent elsewhere. Where? Look around and see how many different areas are substantially underfunded....

You can't pay less for health care without paying less for health care. That means paying all the people who provide health care less. There's not enough money that goes out of the system to health insurance companies to make a dent in health care spending. Heck, not even a third of our health care spending is even in the private insurance system anymore.

There used to be an expat Brit, living in France, on the Fool METaR board. He talked about how the French have wrung the administrative overhead out of their system. Because there is one payer, there is no blizzard of different forms. When he checked out, after seeing his doc, the clerk would swipe his health insurance card, type in a few codes for what the doc did, and the payment would be in the doc's bank account, before he was out the door. He also talked about how the health system made sure facilities were not standing idle. Wait times were continuously monitored, and spending on additional facilities would not trigger until wait time reached a set level. Seems about the same in Canada. When Tim went in for his gall badder surgery, he was in the OR at something like 2 or 3 in the morning.

As someone said on this thread, there are lots of "rent seekers" trying to skim the cash flow. iirc, when Part D was enacted, it was specifically written to prohibit Medicare providing the coverage directly, so all the money went through the hands of private insurance companies and PBMs, where it could be skimmed.

Someone mentioned what doctors charge. They have facilities to pay for, and they have their own administrative overhead to deal will all the insurance company interactions. How much did they spend on education to be qualified? Cheap, or free, education would help a doc's balance sheet.

Western European countries have been working these systems for over 70 years. It should not be that hard to pick and choose the best practices to design a USian system....except...the money, and the influence it buys.

Steve....dreamer

Western European countries have been working these systems for over 70 years. It should not be that hard to pick and choose the best practices to design a USian system....except...the money, and the influence it buys.

Again, it's not hard to figure out what works. It's the price chart. Their costs are lower because everyone gets paid less to provide medical services.

There's rent-seeking in our system, but it's not anything close to large enough to explain away the discrepancy. Medical school costs? We graduate about 20K new doctors a year, which even at $500K a pop for med school (which is too high) is "only" $10 billion per year - a rounding error in medical expenditures. Take the largest health insurance providers and look at their total profit in a year, and it's "only" around $25-30 billion for the lot. Again, a rounding error, less than a point of health care costs. The delta on Medicare Advantage vs. regular Medicare (another bugaboo) is about $80 billion. Now we're getting into a little bit more real money, but in a world where total U.S. health care spending is $4.9 trillion, it's still a drop in the bucket towards getting us closer to other countries.

In order to pay less for health care, you have to pay less for health care. Fewer nice buildings, fewer single rooms, less slack capacity, more waiting and queueing for services, and lower compensation for providers - and not just those nasty drug companies.

https://web.archive.org/web/20250724221422/https:/...
https://www.statista.com/chart/29639/average-salar...).

To borrow a phrase, you can't cut the health care budget simply by targeting "waste, fraud and abuse." You have to actually make voters you care about worse off. Which is why it doesn't happen.

Let's also have 40% income tax for the middle class, 20% VAT, and gas at $7/gallon. Folks shy away from that...


Oh, we do pay the taxes after all. The poor play lottery tickets, get sick, and the system ends up costing close to twice the UK costs per capita.

I guess we can call that a win for lower taxes and higher costs.

How is that federal debt default going to help your assets?

but the magnitude of remilitarizing shouldn't be large enough to itself force Europe to actually end their welfare programs.

It's not but societal memory is only so long in time. EU is heading into supply side economics.

I think the RRE game right now going on is to get the EU into supply side econ before China can claim it. Making the EU into a larger global power with a military industrial complex, and a larger reserve currency. The game right now is coming up very quickly with RRE processing production.

To do this means cutting social programs to incentivize capital formation with lower taxes in the EU.

Capital formation is the opposite of manufacturing capacity, but the lies won't change just because of the facts.

Steve...am I going to get flamed again?

No Steve, the old guard here at this point have come to their sense, knowing us for a good long time.

"Doctors in the US are paid significantly more than in Canada or the EU: half again as much as Canadian doctors, and double, even triple the salaries of doctors in the EU."

Yep. EU doctor either get free or low cost education. Then the state sets the reimbursement rate I believe.

The data has been shown, repeatedly, that western European countries offer better health care than the US, at lower cost.

People live longer in Europe because the average person is wealthier. The elderly get less care in Europe, making the care less expensive.

America is a race-based medical cost conscious country. It is not just race, but a very disturbing idea that the other guy is a cost. It is like trying to hit your right hand as hard as hell with a hammer, but making sure the hammer can get to full force first on your left hand.

"Doctors in the US are paid significantly more

All things considered, doctors get the same pay.

Imagine being a doctor here and sending your kids to grad school.

Regarding the high costs of health care in the USA, one area I haven't yet seen mentioned in this thread is the legal expenses doctors and hospitals face due to malpractice legislation. The insurance costs are high, but maybe even higher are the additional testing that is done to build a defense against malpractice into the actual processes practiced.

Excess sanitation costs were mentioned - albeit a minor cost in the bigger scheme of things. But how do these compare with the costs of infections that result in a malpractice suit. And lawyers are constantly on the search for such events for which they can sue. Now extend this to all the other, more serious, opportunities where a negative event is the outcome. Why didn't you run this test before surgery? Why didn't you test for all these markers in the blood instead of just the key ones? On and on. How many doctors have dropped out of private practice to work as employees for a hospital - just to avoid malpractice suits and insurance costs? And what practices are they instructed to follow by their employer to try to avoid the same?

I have a granddaughter who just graduated as a pre-med major. She is now going through the very competitive battle for admission to a med school. I paid her undergrad tuition and fees, and will be doing so for her medical school years. By the time she finishes med school and a low paying residency, that's an additional 8 years of basically no income. Add living and other costs to that period - and also consider the earnings that might have been made during those years. Her earnings as a doctor had better be good if all that money is to earn a decent return. She's doing it because she loves what she wants to do. We can afford to help make that happen, so at least she won't be battling student debt issues. Most
med school students will.

Meanwhile, her older sister who earned a BS in physics at a good school is making six figures working for an internet data center company. She also loved physics, and wanted to practice or teach it. But not enough to get the required PhD and then earn an academic income. So she chose the "road best traveled" based on economics.

The medical cost issues are sufficiently complex and intertwined that a combination of Buffett, Dimon, and Bezos attempted to jointly address them. And, ultimately gave up.

That doesn't bode well for expecting any major improvements - especially in a country as politically divided now as the USA.

Doctors in the US are paid significantly more than in Canada or the EU: half again as much as Canadian doctors, and double, even triple the salaries of doctors in the EU."

Is this an apples to apples comparison. Are the doctors in EU working in private facilities or facilities provided by others? In the USA, doctors fees go to paying a large staff. In other countries, are staff paid separately? I am not sure, but I think the numbers may not mean the same in each country.

Aussi

Regarding the high costs of health care in the USA, one area I haven't yet seen mentioned in this thread is the legal expenses doctors and hospitals face due to malpractice legislation. The insurance costs are high, but maybe even higher are the additional testing that is done to build a defense against malpractice into the actual processes practiced.

As with the other costs mentioned, this probably also falls into the "real, but tiny relative to overall expenses" bucket. Estimates of the cost of the medical liability system that include defensive medicine vary, given the difficulty of direct measurement - but they seem to be around $45 billion, give or take a few billion:

https://pmc.ncbi.nlm.nih.gov/articles/PMC4231873/

Again, in absolute terms that's a lot of money. But in relative terms, out of a $4,900 billion annual spend, it's less than a single percentage point.

There's no easy fix. There's no big pot of "waste, fraud and abuse" that can be trimmed without hitting millions of health care workers in their rice bowl. Other countries have lower health care costs because their national governments hold a monopoly (okay, a monopsony) on health care spending and are therefore able to squeeze all of the providers and make them provide medical services for a lot less money than they could if there was competition for their services.

That's why we don't have single-payer here, even at the state level. If the government doesn't squeeze the providers, it's too expensive to convert (which is why all the past efforts, as in Vermont, collapsed over money). If the government does squeeze providers, the political outcry would be through the roof.

Regarding the high costs of health care in the USA, one area I haven't yet seen mentioned in this thread is the legal expenses doctors and hospitals face due to malpractice legislation. The insurance costs are high, but maybe even higher are the additional testing that is done to build a defense against malpractice into the actual processes practiced.

That has been a long running debate in the US. The remedy I usually heard offered on bubblevision, was make it nearly impossible to sue. Same thing for every other sort of liability case: protect the "JCs". Except when Mark Haines was on the desk, because he would say "if there is no proximate cause, there is no recovery", which I interpreted as "if the doc didn't honk up, plaintiff isn't going to win".

This is another issue that the western Europeans must have dealt with in some manner, that still affords the patient some protection from the sort of hacks I have seen in the news.

Meanwhile, laff break, from a metro Detroit area tort lawyer. I see another attorney now has an ad showing the exact same thing

Mike Morse Law Firm - Ambulance Chaser

https://www.youtube.com/watch?v=1HXr7KBsFHA

Steve

The Europeans paid higher taxes.

StevnFool
A European who pays 52.1% in various taxes on every incremental Euro I earn and 23% VAT on most purchases...

legal expenses doctors and hospitals face due to malpractice legislation.

Approx 2.4% to 2.6% of total healthcare costs.

Or about $7500/doctor per year. Includes defensive medical practices (extra tests, etc).

Big payouts are less than 1% of all payouts. Per TX Insurance Board, too small to consider.

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