There absolutely must be, IMO. Emergency care is what insurance _should_ be for - the stuff you can't plan for, must have, and can't comparison shop for. IIRC, emergency healthcare spending accounts for around 2% of our annual totals. I just don't think we can justify our full medical pricing system on the basis of emergency care needs alone.
For everything else, though, I'd be much happier if I could just have a price list up front and shop for the provider of my choice. I did it with Lasik, and it was easily the best medical experience I've ever had, not just in terms of "knowing what I'll pay", but the outfit I had it done by was actually competing to win my business. I felt like a customer they wanted to win, not just an account number that they were going to throw at my insurance company.
By means of analogy, we carry car insurance in the case of accidents, but we don't expect car insurance to pay to refill our gas tank (even though gasoline has a lower price elasticity of demand than heathcare!) or pay for oil changes. Food has a lower price elasticity of demand than healthcare, too, but it's still cheap and we don't carry grocery insurance. Insurance makes sense to cover the unforeseen and unexpected. Why do we obfuscate prices and billing practices for routine, elective, and foreseeable care?
"Don't have insurance cover routine care" is obviously insane if pricing were to remain unchanged, but I absolutely think the fundamental problem with the affordability of healthcare in the US isn't the availability (or lack thereof) of insurance, but the way we've completely separated services from prices. Hiding the prices doesn't mean they don't exist and don't get charged - they just eliminate the forces that would otherwise exert downwards price pressure. If we could get pricing transparency on everything, and then see providers start competing on uninsured pricing, I think that could open the door to "actual insurance" plans (at far lower cost than exists today), while actually reducing prices for everything else across the board.
People with chronic diseases aren't subject to an emergency, but they're far more expensive to provide medical services for than otherwise healthy people because they need so much more medical care. Same with people with cancer: cancer is not an emergency in the sense you're describing, but no amount of comparison shopping is going to make cancer treatment affordable for one person. What does make it affordable is that a huge pool of people are paying for it.
setting aside the american/healthcare market with the inflated prices for the sake of the argument, wouldn't be more cost effective, for planned expenses, to go with savings or a loan?
I completely agree emergency care is one thing insurance is for, but I think more generally it's "catastrophic costs" which often includes ongoing things. A lot of issues require follow up costs (I've heard insurances are switching from itemized costs to a fixed cost for the whole procedure. Similarly, I see a lot more "continuity of care" in healthcare).
As an example, let's say someone had vision loss for a couple minutes. An emergency room visit finds them to be ok in the immediate term, but it was because of a blockage in the heart causing a minor stroke. Which means there's a lot of follow up, with large costs. How do you best incentivize this? It's not "emergency care," there is time to research cost, but putting the cost burden on the patient is more than they can handle (hence insurance). Insurance tries to use cost signals like co-pays. An ongoing cost like dialysis will be optimized around convenience if you don't expose the cost, but exposing the cost may bankrupt them.
I think tying healthcare to employment and pushing it as a benefit is the worst offender for the skewing of the market--masking the cost of routine care. Fixing that alone would make me much happier (I also think it would be an economic benefit because of people tied to their jobs and the drag on starting a small business).
Example if you have a baby and ask for an itemized list you might see something like $49 for chest to chest time with baby... they're fucking charging you to hold your damn baby.
Or $35 for a single ibuprofin for pain. Seriously? 100x markup? I can get a bottle of 100 ibuprofin's for < $10.
Some things should just be free because it's a hospitality industry right? I mean you go into a restaurant and ask for extra napkins they just give them to you. They don't charge $2/napkin. Or at the very least - at cost.
Contracts prohibit them from raising prices on some items, so they shift price increases to other items sometimes in the ridiculous ways you list.
If I had to guess, it's a reference to the joke about turning in your expense report, after being told they won't reimburse you for the umbrella you lost, and so you overstaet expenses enough to cover the umbrella's cost. But that never made sense to me, since they demand receipts anyway...
On the one hand, you do really want people to be relatively insensitive to the cost of medical care they actually need. When you need it, you get it. On the other hand, that price insensitivity, applied indiscriminately, leads to the massive ballooning costs we've all seen. I don't think there's a way to have full price insensitivity and to keep prices in check - which means that we either just spend whatever our doctors ask (I'm not interested in that), or we start making people more price-sensitive to allow those downward pricing pressures to be exerted.
Fundamentally, you don't get away with increased price sensitivity without someone yelling about death panels. Prices are how we allocate scarce resources, which means they determine who doesn't get things. We can either pretend prices don't exist (and get the status quo), or we can acknowledge that they do and that sometimes, people can't or won't pay those prices. Neither is emotionally attractive, but I think being realistic about the existence of prices and allowing consumers to actually exert some market pressures is preferable than just being held hostage to whatever the insurers demand we pay this year, just so that we don't have to think about costs at the point of service.
They are solvable, but with regulation, and they will sometimes get an edge case here or there wrong, which will inevitably result in a low-effort, sensationalist news article which will decry the situation, degrade people's support of the systems, and damage the institution.
Maybe I've misunderstood you but how can there be no way to achieve what almost every other country has achieved?
In Singapore, for example, Medisave only covers drugs that the government has deemed cost-effective. Need a high-cost experimental medication? Not permitted. Denmark has notably bad cancer survival rates, much a consequence of long wait times for screenings and treatments. The US, by comparison, has some of the highest cancer survival rates in the developed world, arguably because Americans can (and do) spend on tests and screenings at far higher rates than other countries. IIRC, Americans get medical imaging scans at a rate roughly 100-1000% higher than patients in other first-world nations. Most of those scans don't find anything, and if you're a government bean counter deciding how to allocate this year's medical budget, they're going to be high on the list to cut or ration - but when they find something, those early warnings and immediate access to aggressive (and expensive) treatment make a significant difference.
I bet there's a lot of people who would take this. And it would both save money and make a pretty big difference in the lives of people who still have a lot of life left to live.
Well the price list should be up front, but that's the case regardless of whether you're paying for all of the care or just some of it.
> Emergency care is what insurance _should_ be for - the stuff you can't plan for, must have, and can't comparison shop for.
Wouldn't that discourage preventative care?
Agreed.
> Wouldn't that discourage preventative care?
At the margin, yes. OTOH, paying less in insurance premiums and known/lower costs for services would leave more money for elective care (or whatever else you wanted to spend it on), which would apply pressure in the other direction. Most routine preventative care doesn't have to cost particularly much. Additionally, there's no reason why we couldn't have pooled cost systems for routine care like our existing insurance plans today for those that prefer to amortize their costs, but IMO, they should be separate from emergency care. Emergency care insurance isn't practically optional.
In my experience hospitals and surgery centers can't or won't tell you what something will cost up front.
We went through this during a very stressful time when my SO found a lump in her breast, and it took the kindness of a nurse that worked between the doctors and the billing department to give us a possible list to get a ballpark of what to expect. She called us after hours to tell us because she didn't want to get in trouble with her manager.
Once we had that information, we called several hospitals for quotes and ended up being offered 40-70% discounts. It went from thousands to hundreds to ultimately having some of the tests comped... all because we had a little information and asked the right questions about the process.
This is a disgrace and not how you treat people's health.
However, a hospital could provide a list of prices that are commonly billed. What a list of prices would do is give you a sense if one hospital costs a lot more than another in general. If you knew you might change which hospital you go to and.. you know markets etc.
Of course it didn't cover every possible contingency... That's what an "estimate" means by definition. But that doesn't mean that it's impossible or even unreasonable to provide a baseline price, along with some of the more common events that can modify that price.
This way, all the money going into the system is actually spent on healthcare, instead of having profit extracted from it. You also get rid of the stress of money from the already bad situations of major disease, and the complex bureaucracy that insurance brings with it.
Edit: tone and some extra details.
Almost no countries have such a model. The closest one is the UK. But the U.K. still rations care aggressively to control costs. (The government uses formulas to decide whether the benefit from a treatment is worth the cost.) In Germany, where the government subsidizes multi-payer insurance, more than 2/3 of hospitals are private. Even in Sweden, which had a system like you’re describing until 1995, more than a quarter of hospitals are private.
I forget what the primary care costs, although I think it is more than urgent care; I can't get an appointment with my primary care without a couple months of lead time, so it's pretty much moot.
Unless you know the average outcomes and standard deviations choosing procedures based on cost is suboptimal.
I've never met a pre-op individual that knew how to properly choose LASIK procedures. They all use price signaling and word of mouth from post-ops.
The same is true for me in medical areas where I do not have expertise.
I think that reducing procedure selection to cost and expecting competition to fix it is an error.
In non-emergency situations where you can do advance planning MRIs are cheap. It all started around 15 years ago when some college professor set up a company a2zimaging I think it was called that sold idle MRI capacity to anyone. I believe he eventually shut it down but there's now several other companies willing to do a full MRI for anywhere from $320 to $1500. Google "cheap mri" and choose one.
If you are brought into a hospital after a car accident and use their scanner without making arrangements, you can end up paying $10-$20k for the exact same scan.
Clearly that doesn’t work for emergency services. But is there room to distinguish emergency from non-emergency services? I had surgery for a deviated septum. I don’t know what it cost, but if I had an incentive I could’ve price shopped for it. There are a lot of non-emergency procedures (colonoscopies, hip replacements, knee surgery, etc.) that could be subject to competition.
Also, the comparison to Singapore’s health outcomes is a bit odd:
> The result is not only 77% less spending than the United States but also, as Bloomberg Businessweek reports, one of the healthiest populations in the world.
Fun fact: Life expectancy for Asians in the US is 86 years (almost 90 in New Jersey!), quite a bit longer than the 82 years in Singapore.