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> Unfortunately health insurance is easily misused. We started relying on it to pay for all health care, rather than to actually mitigate the risk of a sudden m

> Unfortunately health insurance is easily misused. We started relying on it to pay for all health care, rather than to actually mitigate the risk of a sudden medical bill. The result has been a rapid and continual increase in the price of health care over the last 70–80 years caused directly by the fact that nobody pays for the services they use, but instead pays into insurance plans that then pay for the care. I don't think it's as simple as that. Empirically, lots of countries have health insurance systems whose incentive structure could be described in the same way, yet the US is an extreme outlier in healthcare costs. Something else must be going on.

twoodfin 3y ago
I don’t think any other national system offers the same un-rationed, low-wait access to - top-skill, top-paid specialists - world-class research hospitals with near-luxury-level amenities - cutting edge pharmaceuticals, including absurdly expensive novel biologics that is enjoyed by, say, a junior Microsoft developer and her family in Seattle. One example of how this plays out as GP described is childbirth: There’s something like a 5X cost disparity for a typical birth process between a perfectly competent regional hospital and an elite research institution. But the typical well-insured US mother-to-be doesn’t spend a moment thinking about that difference vs., say, the reported quality of the food. Obviously, this is not every American’s experience with the system, but for the portion of outlier costs that aren’t related to outlier US population health trends (e.g. obesity), it’s an important part of the story.
- zrail 3y ago
  > But the typical well-insured US mother-to-be doesn’t spend a moment thinking about that difference vs., say, the reported quality of the food. Your definition of "typical" apparently is very different from my own, or we are thinking about "well insured" very differently. Every pregnant person that I've ever talked to, if they have a choice at all, has weighed the projected cost heavily in their decision on where to give birth. The typical person in the US has a deductible that runs well past several thousand dollars and then they have to pay a coinsurance amount, which could be up to 25% of the cost, up to absurdly high out of pocket maxes.
  - ryandrake 3y ago
    Also, his definition of "low-wait" is different than others'. Last time I tried to get a new-patient appointment with a doctor, every doctor in my area had a 4-8 month waiting list. And yes, the cost weighs highly in mind every time we make a decision about whether we need to go to the doctor or not. Not knowing if this trip to the doctor is going to be the one that bankrupts us (cancer diagnosis?), I tend to simply not go unless a limb is falling off. My wife on the other hand came from a country with socialized health care, and can't shake the habit of just going to the doctor whenever she feels ill or injured. Then I have to be the bad guy with the "honey I know you feel sick but do you feel that sick? We're looking at a minimum bill of many hundreds of dollars out of pocket every time you go."

twoodfin 3y ago

I don’t think any other national system offers the same un-rationed, low-wait access to - top-skill, top-paid specialists - world-class research hospitals with near-luxury-level amenities - cutting edge pharmaceuticals, including absurdly expensive novel biologics that is enjoyed by, say, a junior Microsoft developer and her family in Seattle. One example of how this plays out as GP described is childbirth: There’s something like a 5X cost disparity for a typical birth process between a perfectly competent regional hospital and an elite research institution. But the typical well-insured US mother-to-be doesn’t spend a moment thinking about that difference vs., say, the reported quality of the food. Obviously, this is not every American’s experience with the system, but for the portion of outlier costs that aren’t related to outlier US population health trends (e.g. obesity), it’s an important part of the story.

zrail 3y ago
> But the typical well-insured US mother-to-be doesn’t spend a moment thinking about that difference vs., say, the reported quality of the food. Your definition of "typical" apparently is very different from my own, or we are thinking about "well insured" very differently. Every pregnant person that I've ever talked to, if they have a choice at all, has weighed the projected cost heavily in their decision on where to give birth. The typical person in the US has a deductible that runs well past several thousand dollars and then they have to pay a coinsurance amount, which could be up to 25% of the cost, up to absurdly high out of pocket maxes.
- ryandrake 3y ago
  Also, his definition of "low-wait" is different than others'. Last time I tried to get a new-patient appointment with a doctor, every doctor in my area had a 4-8 month waiting list. And yes, the cost weighs highly in mind every time we make a decision about whether we need to go to the doctor or not. Not knowing if this trip to the doctor is going to be the one that bankrupts us (cancer diagnosis?), I tend to simply not go unless a limb is falling off. My wife on the other hand came from a country with socialized health care, and can't shake the habit of just going to the doctor whenever she feels ill or injured. Then I have to be the bad guy with the "honey I know you feel sick but do you feel that sick? We're looking at a minimum bill of many hundreds of dollars out of pocket every time you go."