This story on gene therapy gives us something of a clue to something very important about the US health care industry:

Gene therapy has eradicated cancer from two dying men using genetically modified versions of their own cells.
…

Of the 17 patients with advanced skin cancer who
underwent gene therapy, the treatment worked only on Mr Origer and
"Thomas M", aged 39, clearing the disease from liver, lymph node and
lung.

But scientists believe they can improve the response and adapt it to fight other cancers, notably breast, colon and lung.

The
success using the patients’ genetically modified white blood cells is
reported today in the journal Science by a team at the US National
Cancer Institute led by Dr Steven Rosenberg, a pioneer in the field.

Yes, the US spends vastly more on health care than any other nation, both in total numbers and as a proportion of their national income. Part of that is that they are indeed a richer nation: the demand for different things changes as income changes so it’s no great surprise that richer people want to spend more on healthcare.

It’s also true that the structure of the industry there makes it more expensive.

This story about gene therapy though shows another reason why their costs are so high: they essentially subsidize almost all of the medical research going on. Either directly (NCI is taxpayer funded I think) or indirectly via the higher prices they pay for treatments once invented. (Just in case you think this is some ferociously right wing analysis it originally comes from Owen Barder, not known to be a ferocious righty.)

For example, drug prices are higher in the USA than they are almost anywhere else. In fact, the drug companies make their money back on the development of a drug in the US market: when they come to deal with the NHS and similar systems their prices are much closer to marginal costs than they are over there. This is a huge subsidy from the US consumer to the rest of the world: it might or might not be a good deal for them but it’s a great one for the rest of us.

Any reform of that US medical system is also going to have a great impact upon that subsidy. Fewer new treatments at higher prices for the rest of us.