In theory, I think it's true that healthcare costs are high because most people aren't paying them, their insurance companies are. And then the insurance compan

In theory, I think it's true that healthcare costs are high because most people aren't paying them, their insurance companies are. And then the insurance companies just turn around and charge more, so they aren't really (enough) incentivized to lower costs either. In practice, the current system screws a lot of people at the bottom. We live in a world where by-and-large, the people with the most clout are also the most likely to have better insurance with lower deductibles. If you work at Google, McKinsey or JP Morgan, you probably have the option to get a low-deductible plan with 80%-100% of premiums covered. Work at Walmart? Your lowest deductible for a family is $3,500 with an annual out-of-pocket maximum of $13,700 [0]. And Walmart actually has better insurance than many low-paying companies, presumably because they are a behemoth with a lot of negotiating leverage. > So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really affect me. Changing people's behavior is important part of reducing costs of the health care industry. Yeah, but there are two big issues here: 1) Sure, it prevents some people from going in when something isn't really an emergency. But it also prevents people from going in when something really is an emergency. I recently heard a story of a poor family whose toddler accidentally drank something poisonous. They knew that they couldn't afford to go to the ER, so they drove to it and waited outside to monitor the kid and see if she started having seizures or other side effects from the poison. She luckily ended up being okay, but that's a horrible decision to have to make. I'm personally very lucky to be in a financial situation where a few thousand dollars is significant to me, but not significant enough to take chances with my child's health. 2) Why is that bill $2K in the first place? I once had some chest pain and went to the ER. They took an EKG, everything was fine and they discharged me. Bill was a few thousand bucks. EKG machines are ubiquitous, not very costly to purchase (given how much they are used) and the test takes less than 10 minutes to administer and look at. In almost any other developing country, they'd be able to do exactly the same set of tests for a few hundred dollars, insurance or not. [0] https://smartguide.walmartone.com/smartpages/Media/Default/LeadershipGuide/Decision-Guide-eComm-English-2018.pdf https://smartguide.walmartone.com/smartpages/Media/Default/L...