Setting prices by supply-and-demand and having insurance "pay for whatever is needed regardless of the cost" are incompatible. Insurance blocks the pricing cost signal back to the patient. Insurance also prevents better doctors that provide better service from charging more because the patients will pay for it.
An example: about 20 years ago I had just a major medical plan and I was at urgent care for a problem. After diagnosing the likely problem and prescribing the solution, they were about to run some tests "just in case." When I told them I would be paying for the tests due to the major medical plan, they explained that the tests didn't have any benefit, so we didn't run them.
I don't know of a real solution to these problems.
A partial solution is exposing some of the cost to the insured to create an incentive to save (like what I had when I was paying for the tests). At my company, we fully pay for a high-deductible plan AND a give company-funded contribution to a Health Savings Account that mostly covers the per-person out-of-pocket max. If the employee does not spend the HSA money (which is their money in their account), it can be used for retirement savings... so they have an incentive to save. But once someone hits the out-of-pocket max, there is no more incentive to save.
Patients must be incentivized to understand their care and question care that is unnecessary and wasteful. The partial solution you mention is the way to go, and if every employer adopted it, it will change the culture, and will at that point become a full solution.
Capitalist structures have a long history of pushing ownership of problems to the powerless individual, then exploiting information asymmetries (and actively obfuscating the truth that would allow for better informed decisions) for profit.
Suggesting that the average person should be able to make medical decisions and override their health care provider’s recommendation is ridiculous.
> Suggesting that the average person should be able to make medical decisions and override their health care provider’s recommendation is ridiculous.
The situation is similar to taking your out-of-warranty car to a dealer for repairs. Sometimes, you may suspect they’re not being completely honest with you. What do you do in that case? You get a second opinion before agreeing to a costly repair.
Sure, and that’s possible (at significant added cost) in a portion of cases. But not all - you might be on an operating table or in the middle of a psychiatric event, etc etc, where time does not permit second opinions, and if the system is set up to “gotcha” as a baseline, then only the most minor, time insensitive, situations will receive fair pricing.
> if the system is set up to “gotcha” as a baseline
This is what we have to change. When physicians and hospitals know that patients are scrutinizing care plans they will find a new fairer baseline. That cultural change will subsume older practices.
I'm willing to take a risk there because if my car craps out, I'll buy another.
Wish I can say the same about health. If the doctor who has my entire medical history recommends x procedure, yes I'm not going to risk potentially having irreversible damage to my body.
In my example in the grandparent post to yours, it was actually the empathy of the medical provider toward my paying the bill that prevented the unnecessary test.
An example: about 20 years ago I had just a major medical plan and I was at urgent care for a problem. After diagnosing the likely problem and prescribing the solution, they were about to run some tests "just in case." When I told them I would be paying for the tests due to the major medical plan, they explained that the tests didn't have any benefit, so we didn't run them.
I don't know of a real solution to these problems.
A partial solution is exposing some of the cost to the insured to create an incentive to save (like what I had when I was paying for the tests). At my company, we fully pay for a high-deductible plan AND a give company-funded contribution to a Health Savings Account that mostly covers the per-person out-of-pocket max. If the employee does not spend the HSA money (which is their money in their account), it can be used for retirement savings... so they have an incentive to save. But once someone hits the out-of-pocket max, there is no more incentive to save.