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This would be true if the people that do pay the prices had no influence on your purchasing decision, but the insurers maintain a massive hold on purchase decis

This would be true if the people that do pay the prices had no influence on your purchasing decision, but the insurers maintain a massive hold on purchase decisions. And in reality, a ton of insured people do pay very directly for their healthcare in deductibles and denied coverage claims. I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. Quite the opposite is most people's experience. You have to justify any visit to a specialist before going, you don't get to choose the specialist, many times the insurer will simply deny a payment request for care already received. On many plans, you have to spend 5 figures per year before they will even cover anything. I would love to have had healthcare in America where I was insulated fully from the costs of care. My experience was that it was rare to see a doctor where I wouldn't end p paying at least three figures despite having fantastic insurance. Meanwhile in Canada, I can recklessly visit three doctors per day for the same issue at no out of pocket cost if I want, and it will still cost my insurer (the province of BC, in my case) less than a single doctor visit 60 miles south of here. From where I sit, the US, which has an unusually high exposure to the real costs of healthcare among peer states, also has the highest cost of healthcare. That sort of goes directly against what you are saying

timr 1y ago
> From where I sit, the US, which has an unusually high exposure to the real costs of healthcare among peer states, also has the highest cost of healthcare. That sort of goes directly against what you are saying The US has the highest cost of healthcare primarily because nobody knows what healthcare costs. Even your doctor has no idea -- try asking sometime! I routinely point out to my primary care doctor that the medicine/test/whatever they're recommending is expensive and low-quality, and he looks at me like I'm an alien. Statistically, I am. You're not wrong that you can get caught in a circle of hell after you get the bill, and that insurers are an opaque barrier to purchase decisions, but that's just saying the same thing a different way -- you have no ability to shop for what should be a commodity service. > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. ...and that's one of the few good things about our system, though I agree that the US implementation is maximally stupid. You should have to evaluate the cost and benefit of going to a (rare, expensive) specialist! While I agree that insurance companies suck, it's telling that the debate around this issue has devolved to indignation that someone should be acting to control costs by limiting the freedom to choose expensive things.
- ceejayoz 1y ago
  > The US has the highest cost of healthcare primarily because nobody knows what healthcare costs. This requires explaining how places like the UK - where the cost is far more hidden than it is in the US with high-deductible plans being very common - have substantially lower costs.
  - timr 1y ago
    Well, you're making a a series of logical fallacies (are we talking about the UK, specifically, or an unspecified constellation of "places like" they UK, so that you can avoid the false dichotomy?), but my general rebuttal would be this: "the existence of magical unicorn places with worse price transparency than the US does not make opaque pricing good." I'm honestly not sure what you're trying to argue. The US system is good? Price transparency is bad? UK good, US bad?
    - ceejayoz 1y ago
      The US has better than average price transparency, as a huge proportion of us are on high-deductible plans where you directly pay the entire bill until you hit your deductible. Someone on such a plan knows their pediatrician appointment costs $300, because they have to swipe a card (or get a bill for it). Much of the rest of the developed world doesn't ever even see a dollar amount. Thus, the "knowing costs drops spending" theory doesn't hold up.
      - timr 1y ago
        > Much of the rest of the developed world doesn't ever even see a dollar amount. Well, as long as you're just making stuff up, I don't see how I can possibly argue with you. Actually, I do: "Paying the bill you get, after the fact" is not at all the same thing as "comparison shopping". So if you want to call that system price transparency, then all I can do is shrug and walk away.
        ceejayoz 1y ago
azinman2 1y ago
Many of these things you state as fact do not match my reality. > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. That’s basically my plan. I work for a FAANG, and have a low 2k/year max out of pocket for in-network, which is almost everything I encounter. I just book specialists when I want, and I see them as many times as I need. I can do PT 365 times per year, so as long as I don’t go more than once a day (which would be silly), I consume as much as I want. I recently chose to go to the Mayo Clinic — out of state, no referral, and everything is covered. I keep getting estimates from them of $0 since I hit my max out of pocket. The only thing I’ve been denied for is Botox for TMJ which they say is not medically proven (seems to be the opposite, but I understand why they’re wary). I’ve never had a medication, procedure, or doctor visit denied.
- _DeadFred_ 1y ago
  Yes, the US system works great if your are at the social peak, such as working at a FAANG. Thanks for reminding us of the level of class disparity as we struggle to pay our bills or get our children medical care. When I was a kid, everyone no matter economic level had pretty much the same pediatric doctor group. Now the working class people around me don't really have a pediatrician, but an overworked 'nurse practitioner'.
  - azinman2 1y ago
    From the GP: > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. Quite the opposite is most people's experience. You have to justify any visit to a specialist before going, you don't get to choose the specialist, many times the insurer will simply deny a payment request for care already received. On many plans, you have to spend 5 figures per year before they will even cover anything. These do not apply to me. I cannot be the only one. In fact when I was a 2 person startup things weren’t so terribly different from my current situation as well. No need to accuse me of classism when I’m simply refuting the premise with my own data and lived experience.
- dghlsakjg 1y ago

timr 1y ago

> From where I sit, the US, which has an unusually high exposure to the real costs of healthcare among peer states, also has the highest cost of healthcare. That sort of goes directly against what you are saying The US has the highest cost of healthcare primarily because nobody knows what healthcare costs. Even your doctor has no idea -- try asking sometime! I routinely point out to my primary care doctor that the medicine/test/whatever they're recommending is expensive and low-quality, and he looks at me like I'm an alien. Statistically, I am. You're not wrong that you can get caught in a circle of hell after you get the bill, and that insurers are an opaque barrier to purchase decisions, but that's just saying the same thing a different way -- you have no ability to shop for what should be a commodity service. > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. ...and that's one of the few good things about our system, though I agree that the US implementation is maximally stupid. You should have to evaluate the cost and benefit of going to a (rare, expensive) specialist! While I agree that insurance companies suck, it's telling that the debate around this issue has devolved to indignation that someone should be acting to control costs by limiting the freedom to choose expensive things.

ceejayoz 1y ago
> The US has the highest cost of healthcare primarily because nobody knows what healthcare costs. This requires explaining how places like the UK - where the cost is far more hidden than it is in the US with high-deductible plans being very common - have substantially lower costs.
- timr 1y ago
  Well, you're making a a series of logical fallacies (are we talking about the UK, specifically, or an unspecified constellation of "places like" they UK, so that you can avoid the false dichotomy?), but my general rebuttal would be this: "the existence of magical unicorn places with worse price transparency than the US does not make opaque pricing good." I'm honestly not sure what you're trying to argue. The US system is good? Price transparency is bad? UK good, US bad?
  - ceejayoz 1y ago
    The US has better than average price transparency, as a huge proportion of us are on high-deductible plans where you directly pay the entire bill until you hit your deductible. Someone on such a plan knows their pediatrician appointment costs $300, because they have to swipe a card (or get a bill for it). Much of the rest of the developed world doesn't ever even see a dollar amount. Thus, the "knowing costs drops spending" theory doesn't hold up.
    - timr 1y ago
      > Much of the rest of the developed world doesn't ever even see a dollar amount. Well, as long as you're just making stuff up, I don't see how I can possibly argue with you. Actually, I do: "Paying the bill you get, after the fact" is not at all the same thing as "comparison shopping". So if you want to call that system price transparency, then all I can do is shrug and walk away.
      - ceejayoz 1y ago

azinman2 1y ago

Many of these things you state as fact do not match my reality. > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. That’s basically my plan. I work for a FAANG, and have a low 2k/year max out of pocket for in-network, which is almost everything I encounter. I just book specialists when I want, and I see them as many times as I need. I can do PT 365 times per year, so as long as I don’t go more than once a day (which would be silly), I consume as much as I want. I recently chose to go to the Mayo Clinic — out of state, no referral, and everything is covered. I keep getting estimates from them of $0 since I hit my max out of pocket. The only thing I’ve been denied for is Botox for TMJ which they say is not medically proven (seems to be the opposite, but I understand why they’re wary). I’ve never had a medication, procedure, or doctor visit denied.

_DeadFred_ 1y ago
Yes, the US system works great if your are at the social peak, such as working at a FAANG. Thanks for reminding us of the level of class disparity as we struggle to pay our bills or get our children medical care. When I was a kid, everyone no matter economic level had pretty much the same pediatric doctor group. Now the working class people around me don't really have a pediatrician, but an overworked 'nurse practitioner'.
- azinman2 1y ago
  From the GP: > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. Quite the opposite is most people's experience. You have to justify any visit to a specialist before going, you don't get to choose the specialist, many times the insurer will simply deny a payment request for care already received. On many plans, you have to spend 5 figures per year before they will even cover anything. These do not apply to me. I cannot be the only one. In fact when I was a 2 person startup things weren’t so terribly different from my current situation as well. No need to accuse me of classism when I’m simply refuting the premise with my own data and lived experience.
dghlsakjg 1y ago