Indeed. Vets can do operations for less than a tenth the price doctors can, so prices could presumably go a long way down given the right market incentives.
But getting the right incentives in place is the hard thing. I don't think there is a really good way to run health care, all the obvious solutins have big holes, e.g.:
- buyer paying for health care as they need it doesn't work because someone might not have any health problems for years then they are suddenly hit by a crippling bill
- insurance doesn't work because once people have a pre-existing condition, they can't buy insurance any more.
- big state-run bureaucracies have all the problems you'd expect with big state-run bureaucracies.
(Published price lists with limits on 'negotiated discounts'? Antitrust actions splitting up larger operators? Tax favoritism for processes that make true costs clear, rather than for processes which hide costs through multiple levels of indirection?)
If there's essentially only one payer, and even the terms of every transaction outside that one payer are dictated by national legislation, then the 'fig leaf' that the providers are nominally independent isn't worth much.
This isn't complicated: the price list for medical procedures bears no relationship either to the cost of those services or the money changing hands between providers and insurers.
I'm only questioning your claim that collusion among insurance companies does much of anything besides push us closer to monopsony pricing.
If employer-sponsored health insurance wasn't the primary vehicle for medical expenses in the US, maybe you could get an actual price list for hospital services even in the face of aggressive negotiation. But it is, and so you can't, and any conversation about health expenses that tries to dodge that point is disingenuous. That's my point.
Collusion is problematic because, the insurance companies [legal] duty is to increase their profits. Their interest in reducing costs is to reduce their cost of doing business not the patient's cost for services.
However when the insurance companies collude to deny coverage for tuberculosis, it is problematic from the standpoint of my self interest because your untreated tuberculosis will kill me. There is a difference between healthcare and insurance.
It's all well and good to tell people to fund HSAs or buy health discount cards or get savvier about spending and buy generic meds. But a trip to the emergency room or a serious illness is simply going to max out your deductable, no matter how cost-conscious you are.
The core problem is that medical services are priced by colluding hospital chains and insurance companies, and those prices are both (a) deliberately decoupled from the actual economics of providing health care and (b) a fig leaf covering the way hospitals and insurers actually resolve invoices.
Unless/until you can extract the insurers from medical pricing, no amount of free market cheerleading is going to fix the problem. We don't have a free market to fall back on.