I don’t think that’s true. I think you’re misunderstanding the way some people perceive fairness.

There are some people who feel very strongly that it’s unfair to give out benefits such that the people who worked hard and took care of themselves are no better off than people who did not work hard.

For example, regarding student loan forgiveness, I have heard people say: “I struggled for years to pay off my student loans, but now the government is going to just cancel everyone else’s debt? That’s like punishing me for being responsible and rewarding people who didn’t sacrifice for putting the problem off.” And I can see how someone would feel that way. It would be more fair to track down everyone who had student loans and refund the full amount for all of them, including people who had already paid them off.

I’ve also heard friends who are legal immigrants oppose amnesty for illegal immigrants because they feel it’s like punishing everyone who went through all the trouble of the legal process.

I don’t think you can actually prove they are right or wrong in their argument. This is exactly like the parable of the prodigal son, so it’s an ancient human dilemma that giving grace and generosity to people who are in need tends to make people who are one notch up the ladder feel bitter that when they needed help they didn’t get it, and that their hard work is somehow invalidated by the fact that others got something for free when they had to work for it.

Finally, there’s always a question of who pays for things, and some people just feel that - while they’d prefer some government benefit in theory - they aren’t willing to pay any more in taxes in order to get it.

Considering the US has a track record of relatively high total taxation (when you add up all the local, state, and federal entities), while receiving generally poor public services, there are plenty of people who feel the answer is to stop “wasting money” on the problem and expect the government to become more efficient or better at providing services before they’d support any more taxes.

A lot of people feel that broad welcome in a policy means fewer resources to share with more people. If you're in an advantaged position, it may make sense to oppose such broad social care measures.

There is some merit to that argument, because we have artificially constrained the supply of doctors in order to sustain their high salaries. Perverse is a polite word for the situation.

There is no country in the world that does not have an 'artificially constrained supply of doctors.'

Yet most of those countries have cheaper/better/cheaper and better health outcomes.

'The supply of doctors is constrained' is largely a red herring.

Not disagreeing necessarily, but I’m not sure the 1:1 comparison works with “most of those countries”. For example, the US is burdened by a disproportionate amount of R&D which helps to lower costs in other countries. It’s a complex problem and overly simplified comparisons don’t often offer a real fix

> For example, the US is burdened by a disproportionate amount of R&D which helps to lower costs in other countries.

This doesn't explain the disproportionate costs of decades-old medications and procedures still using decades-old methods.

You can maybe justify high drug costs based on that, but drug costs are a small fraction of overall medical costs.

To an extent, it does. Particularly when other countries have cost control regulations, the companies are incentivized to make up those R&D costs elsewhere. Today’s drug profits are funding tomorrow’s novel medicine.

Note in not saying this is ethically fair or optimal, just that it’s a consequence of the particular system

Again, drugs are a only a small part of overall health costs. They only make up 14% of healthcare spending[1] in the US. For contrast, they make up ~15% of healthcare spending in Canada, and ~16% of healthcare spending in the UK.

Your theory does not explain why the other 86% is so bloated.

[1] https://www.drugcostfacts.org/us-healthcare-spending

All my comments were deliberately couched to specifically not pretend there is a simple answer to healthcare cost bloat in the US. It is merely a testament to a single factor that increases costs while also inhibiting naive comparisons. The US healthcare system is awfully complex to even scratch the surface about causal factors in a forum post.

Beyond that, you may be conflating prescription costs with drug research, which is not the same. The fact that prescription costs take up roughly the same percentage of total healthcare costs seems to support my point. An equal percentage of a bigger pie would indicate they are inflated.

My personal stance is that the US optimized for access and quality at the expense of cost. As the saying goes, you can only have two. R&D spending is a large part of this. The US contributes over 40% of the worlds medical R&D, effectively subsidizing other nations. It’s not a bad thing and it doesn’t explain away all healthcare costs but it does create systemic ramifications. It’s been awhile since I’ve viewed the numbers, but the US had the highest health access and quality scores for a country of comparable size. Off the top of my head, I think the next closest was Russia. Again, the point being simple comparisons are harder than one may think when dealing with complex systems.

I’m only reiterating this because your responses make me think I’m not stating my central claim clearly enough: there is not “a reason” healthcare in the US is expensive. There are multiple, sometimes covariant reasons. Only one of those is drug prices. And if you don’t think pharmaceutical companies impact those other healthcare costs, you may not have a sound understanding of the healthcare system.

Related to your comment about the difficulties in comparison, you underscored my other point. People flippantly say “but look at country X’s costs” without understanding the nuances that make such comparisons worthless.

The point in my opinion is lost, because in those countries you might be referring to, the doctors earn a fraction of what they do in the US.

Well, if it comes to making a choice between better health outcomes, weighed against doctors only making six figures a year (and medical schools only charging five figures per year), I think the choice for most of us would be pretty simple.

This only "makes sense" if such a person believes that their personal advantage is more important than other people. It makes no sense whatsoever from a Rawlsian perspective.