Writing good rules to prevent this stuff is hard. Insurers have to create networks so they can negotiate fair rates with doctors and hospitals. These rates oft

Writing good rules to prevent this stuff is hard. Insurers have to create networks so they can negotiate fair rates with doctors and hospitals. These rates often end up being more than medicare would have paid, but not wildly more. Sounds pretty fair. But what to do if the patient goes to an out-of-network doctor? Insurance might say "we won't pay unless it was an emergency," but then the patient gets stuck with a $30k bill. He'll get angry, tell the media, write his Congressman, etc. Somehow the blame will always fall on the insurer (who had no way to prevent this from happening) and not the doctor (who was engaged in price gouging.) Or maybe the insurer can say "we'll only pay the same rate we would have paid an in-network provider." No problem, says the doctor-- we have the patient's signature on this huge contract that says we can bill them for the remainder. Now the patient gets a $29.5k bill instead of a $30k bill. Still no good. I'd love to say "just socialize medicine and be done with it", but this worries me too. The US already runs two 100% socialized healthcare systems: the VA for veterans, and IHS for Native Americans. Both are absolute nightmares where people sometimes wait years to see a barely-competent doctor. Many IHS doctors only work there because no private hospital would hire them[1]. I'm not sure what a good solution looks like. [1] https://www.pbs.org/wgbh/frontline/article/u-s-indian-health-service-gave-troubled-doctors-second-chance-patients-paid-price/ https://www.pbs.org/wgbh/frontline/article/u-s-indian-health...