| As you're sipping eggnog or savoring Thanksgiving leftovers, take a minute to sit back, relax and imagine a world where you never have to worry about paying for health care. It's a fantasy world where none of the the byzantine, baffling, sometimes ruinous financing of US medical care exists — no insurance premiums, deductibles, copays, out-of-pocket limits, surprise bills, ambulance fees, payment plans, health savings accounts, coverage denials, coverage appeals, insulin costs, patient assistance charities, crowdfunding a,nd medical bankruptcies. Nice dream, right? Then, back in the real world, you break your leg in one of the scores of countries with universal health insurance. You're taken to an emergency room, where you receive X-rays. You're seen by a doctor or nurse practitioner who confirms the diagnosis. You get a stabilizing boot and some crutches. And off you go, without so much as a parking fee. That's when reality comes crashing in. You thought you lived in the country with the finest health care in the world. You don't. You live in the country with the world's most expensive health care. A country where, 12 years after an enormous legislative effort to extend affordable coverage to the entire population, 8% still lack health insurance. Where half of adults are worried about medical costs that sometimes force them to delay or forgo care. Where life expectancy ranks 40th among all nations — that's just better than Ecuador but behind Turkey, for those of you scoring at home — and newborn mortality ranks 33rd worldwide. The only category in which the US hold the undisputed lead is in measures of health spending — gross, per capita, and as a percentage of GDP. But wait a minute, what about innovation? Didn't the US free market give birth to the best Covid shots? That's only partially true. The US company Pfizer harnessed technology developed by Germany's BioNTech, which received 375 million euros from the German government. And BioNTech, in turn, got key tech help from a US government-funded researcher. Moderna also leaned heavily on US government funding and collaborated with the National Institutes of Health on developing its immunization. The UK's National Health Service has been starved of funding and is under pressure from workers demanding higher pay. But it was the first country to roll out Pfizer's shots and its researchers were first to identify an effective treatment for hospitalized Covid patients: dexamethasone, a cheap, generic steroid. Health companies love to take public research dollars. But when it comes time to get paid, they love the free market. Health-care companies flock to the US mainly because we spend so much. The American health-care system is an enormous $4.1-trillion red, white and blue whale that every shark wants to take a bite from. Insurers, hospitals, drugmakers, drug benefit managers, device makers, distributors, pharmacies, doctors, nurses, executives and shareholders are all vying to get their share. If that sounds to you like the world's finest health-care system, you're living in a dream world. — John Lauerman | 
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