Some good thoughts here. I like that, “In Japan, people without employer insurance need to buy coverage from their local government.

Note it says “local government”.

I shudder at the thought of the US Federal government defining the parameters of my health care.

Japan also has a pretty homogeneous society, and does not have massive unchecked immigration of people who then would receive all benefits while paying in 6% of a very low income — i.e., subsidized by me.

US healthcare has big problems, but is actually really good. When I have a medical issue, I can select a doctor who is a true expert, and have confidence that if I need cutting edge treatment, I can find it and go and get it. I don’t have to worry that the government will say, “Sorry, that is not for you”.

The big problems with US healthcare are,

1. Drugs can be patented. Instead, we should only allow processes for creating drugs to be patented.
2. There is no incentive to cure people: the incentive is to keep everyone sick, and dependent on long term, expensive (patented) drugs that treat an illness instead of curing it.
3. The fee-for-service model built into Medicare and the Diagnostic Manual (DSM) has crippled the industry, and created a hugely bureaucratic system at hospitals for recovering fees from insurers — putting all the focus on administrative cost optimization instead of treatment efficacy.
4. The cost of drug trials is so high because trials must pay the entire cost of care of each participant — letting insurers off the hook. That unfairly burdens the drug researchers and inflates the cost of a phase 3 trial to potentially billions of dollars. No wonder we don’t see any drugs for things that affect only a small percent of the population or that cure people with a single dose— every drug must be a blockbuster — i.e., entail long term expensive treatment — to justify the costs of trials.

We should not look to drug companies for medical progress. Most medical progress occurs in university research. We need to get corporate America back out of the university lab, by repealing the Bayh-Dole Act. Universities should not be IP factories, which is what they are becoming. We need to fund university medical research with Federal dollars — that will pay for itself a thousand times over.

Medical costs should be going down — not up. If we look at the cost of computers, the cost per computation has historically gone down. In medicine it goes up because the incentives are broken.