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> I think millions of US citizens would subscribe. And why would millions of US citizens be interested in such a service? If they have insurance, insurance pay

> I think millions of US citizens would subscribe. And why would millions of US citizens be interested in such a service? If they have insurance, insurance pays most of the costs. And this is the reason medical costs are on an upward spiral in the US: consumers are not incentivized to shop around.

wnolens 3y ago
Many many people have high deductible plans, or need to use out of network providers. We cannot shop around as it is.
hathawsh 3y ago
A lot of US citizens have moved to "high deductible" health insurance plans, which means they pay for most medical procedures up to some yearly maximum (such as $10k.) The advantage is the monthly premium is significantly less. Those people are very incentivized to shop around.
- chatmasta 3y ago
  This is pretty much the default option for your average person who doesn't have employer-provided healthcare. And the "significantly less" monthly premium is still in the range of hundreds of dollars. It's outrageous.
  - zargon 3y ago
    It's also the default for very very many employer plans. If you do have a lower deductible option, it is even more hundreds of dollars on top.
EatingWithForks 3y ago
I think the reason medical costs are on an upward spiral is not consumers not shopping around. It's that it's extremely hard to get a price for healthcare, that hospitals are being bought up by investment companies uninterested in improving outcomes but very interested in jacking up the price of service, and that it is perfectly legal to have the only cure for debilitating, potentially fatal illnesses like hepatitis C cost $24,000.
- breadwinner 3y ago
  You should take a look at the prices of medical procedures not covered by insurance, such as plastic surgery. The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. When consumers spend out of pocket, they are very much interested in seeing the price before they do the procedure, and hospitals can't and don't hide the price.
  - ipython 3y ago
    I’d love to see the shopping around that you can do when you need urgent medical care. “Hold please 911, I need to first get three competing quotes for ambulance service”
    - NoZebra120vClip 3y ago
      You jest, surely, but keep in mind that one of the most financially significant decisions to be made is going to be the hospital which the ambulance transports you to. Some insurance plans charge a premium for mileage when it's not the "closest available", and you can imagine the damage if the chosen facility is "out of network" or not otherwise covered.
    - mindslight 3y ago
      Spoken like someone who has never sat waiting in an "emergency" room for hours. The sheer majority of medical services happen non-urgently.
      - ipython 3y ago
        I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are obligated to stabilize any patient that walks through the door, regardless of ability to pay. So you end up with people misusing the ER for chronic non urgent care. I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)
Timon3 3y ago
Why don't people in other countries have to "shop around" to keep healthcare prices at acceptable levels?
- qwytw 3y ago
  Because prices are more or less regulated and controlled. e.g. the Swiss healthcare system is privatized to a much higher degree than the US one (no Medicare/Medicaid equivalents) but 'basic' insurance plan prices and deductibles are fixed so prices still remain reasonable.
  - Timon3 3y ago
    So logically it would seem that the US should introduce regulation instead of forcing its people to shop around, right?
    - qwytw 3y ago
      You can have both? Regulated minimum insurance coverage, maximum premiums/deductibles and transparent prices and an option to shop around for non emergency cases. You still want providers competing either on price and service quality (I don't see any issues with that as). The problem with fully public systems in Europe nowadays is that you end up with two tiers. There is public option with poor service and several month long queues for poor people. People with higher incomes can get reasonably priced private insurance which lets them skip the queue, shop around for "better" doctors/service etc.. In this case it still ends up being subsidized by the public because higher income = better than average health and the government still ends up paying the bill for high cost treatment for serious diseases or emergencies. A well regulated fully private system with income based subsidies just seems like the more fair and efficient option and it should be better at handling supply issues. The main issue US seems to have is massive inefficiency and IMHO both regulation and increased competition is the best (and most feasibly) way to solve this.

wnolens 3y ago

Many many people have high deductible plans, or need to use out of network providers. We cannot shop around as it is.

hathawsh 3y ago

A lot of US citizens have moved to "high deductible" health insurance plans, which means they pay for most medical procedures up to some yearly maximum (such as $10k.) The advantage is the monthly premium is significantly less. Those people are very incentivized to shop around.

chatmasta 3y ago
This is pretty much the default option for your average person who doesn't have employer-provided healthcare. And the "significantly less" monthly premium is still in the range of hundreds of dollars. It's outrageous.
- zargon 3y ago
  It's also the default for very very many employer plans. If you do have a lower deductible option, it is even more hundreds of dollars on top.

EatingWithForks 3y ago

I think the reason medical costs are on an upward spiral is not consumers not shopping around. It's that it's extremely hard to get a price for healthcare, that hospitals are being bought up by investment companies uninterested in improving outcomes but very interested in jacking up the price of service, and that it is perfectly legal to have the only cure for debilitating, potentially fatal illnesses like hepatitis C cost $24,000.

breadwinner 3y ago
You should take a look at the prices of medical procedures not covered by insurance, such as plastic surgery. The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. When consumers spend out of pocket, they are very much interested in seeing the price before they do the procedure, and hospitals can't and don't hide the price.
- ipython 3y ago
  I’d love to see the shopping around that you can do when you need urgent medical care. “Hold please 911, I need to first get three competing quotes for ambulance service”
  - NoZebra120vClip 3y ago
    You jest, surely, but keep in mind that one of the most financially significant decisions to be made is going to be the hospital which the ambulance transports you to. Some insurance plans charge a premium for mileage when it's not the "closest available", and you can imagine the damage if the chosen facility is "out of network" or not otherwise covered.
  - mindslight 3y ago
    Spoken like someone who has never sat waiting in an "emergency" room for hours. The sheer majority of medical services happen non-urgently.
    - ipython 3y ago
      I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are obligated to stabilize any patient that walks through the door, regardless of ability to pay. So you end up with people misusing the ER for chronic non urgent care. I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)

Timon3 3y ago

Why don't people in other countries have to "shop around" to keep healthcare prices at acceptable levels?

qwytw 3y ago
Because prices are more or less regulated and controlled. e.g. the Swiss healthcare system is privatized to a much higher degree than the US one (no Medicare/Medicaid equivalents) but 'basic' insurance plan prices and deductibles are fixed so prices still remain reasonable.
- Timon3 3y ago
  So logically it would seem that the US should introduce regulation instead of forcing its people to shop around, right?
  - qwytw 3y ago
    You can have both? Regulated minimum insurance coverage, maximum premiums/deductibles and transparent prices and an option to shop around for non emergency cases. You still want providers competing either on price and service quality (I don't see any issues with that as). The problem with fully public systems in Europe nowadays is that you end up with two tiers. There is public option with poor service and several month long queues for poor people. People with higher incomes can get reasonably priced private insurance which lets them skip the queue, shop around for "better" doctors/service etc.. In this case it still ends up being subsidized by the public because higher income = better than average health and the government still ends up paying the bill for high cost treatment for serious diseases or emergencies. A well regulated fully private system with income based subsidies just seems like the more fair and efficient option and it should be better at handling supply issues. The main issue US seems to have is massive inefficiency and IMHO both regulation and increased competition is the best (and most feasibly) way to solve this.