What would you propose as an alternative? Healthcare costs are already high. Imposing step therapy requirements to try cheaper treatments first is one of the few ways that insurers have to control costs. And the cheaper treatments do work well for many patients (or they recover on there own just due to time).

Look at any nation that doesn’t have these unbelievably, ridiculously, insanely high costs. This isn’t an unsolved problem, nor is it a sensible one.

What’s with the stupid “here’s the cost” bill you get, followed by the insurance company just, like, deciding things are a different price? What’s with the unreasonably stupid “out of network” medical charges? What’s with the fact that you can walk into a pharmacy and request a discount, but they can’t tell you about it once the transaction has been rung up?

There are SO MANY stupid rules in this system, I literally cannot imagine a system with more low-hanging fruit.

Many of the nations with lower healthcare costs also have step therapy requirements, or simply don't make the most expensive treatments available at all. That is literally one of the cost control mechanisms they use.

Ok, that’s fine? We still don’t have an easy time accessing the cheap and simple stuff here. I have to keep going in to get a doctor to approve a non-controlled substance I’ve been taking for a decade. It has no habit-forming effects. It has no use as a precursor. It has no use recreationally. It’s a worthless, ongoing expense.

Why are you defending this awful, awful system? Have you had even one good experience? Not “well, that wasn’t awful”, but truly one GOOD experience?

Hospitals here don’t even follow up to see if your medical care was effective.

Hell, I’d even take Australia’s approach, where basic stuff is free and you pay for additional coverage.