Life expectancy rise in rich countries slows down: took 30 years to prove

> You can't exactly shop around

The vast bulk of health care is by appointment, not a dash in the ambulance.

Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead".

This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).

You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two.

It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.

Even for non-emergency, the short amount of time before a health issue turn serious means that it's already hard for you to take second opinion.

Even more fun is when your doctor refers you to a specialist that's in-network, but your insurance comes up with a bunch of reasons to deny it.

How did we collectively decide that it's okay for insurance companies to overrule medical professionals?

AFAIK the overruling is done by a "medical professional" as well, albeit one that's on the insurance company's payroll.

A large portion of healthcare could be free market. Insurance should be for unlikely events not every single thing deemed "medical". My home and auto insurance don't cover regular costs for maintenance. Why must health insurance cover a checkup with the doctor?

> This is my main argument against private healthcare: there's no real choice involved.

Is your argument that there is choice involved in public healthcare? Or simply that it's not even a question?

other than normal doctor’s office visits, i have no idea what i’m going to pay when i get a small procedure done.

a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped.

and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars.

you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.

Legally speaking the insurance company isn't overruling medical professionals. They're simply refusing to pay. Patients still have the option of paying for treatments out of pocket. (I do understand that for poor patients this is a distinction without a difference, I'm just clarifying the legal issue.)

Some states have recently passed laws which limit the authority of health plans to conduct medical reviews or deny payment for services that providers deem medically necessary. This will reduce hassles and expenses for some patients, but it will also accelerate the inflation of insurance premiums paid by everyone else.

> i have no idea what i’m going to pay when i get a small procedure done.

All you gotta do is ask.

There are many options for cancer treatment, with different prices, efficacy, misery, etc.

> Nobody chooses healthcare

Yeah, they do. Root canal vs implant vs dentures, for example. Ozempic vs diet+exercise, for another.

That "medical professional" has literally 90 seconds to review your case and say yes/no. They've never met you. They don't know your doctor. All they have are some notes on the case, a billing code, and a quota to reach every day. They get bonuses based on how much money they save the insurance company.

All of that cost savings makes US healthcare cost double what it does anywhere else in the world.

They don't know. Nobody does until the bill is processed. There are a thousand factors that might affect your coverage. This is the nightmare I'm living through right now. Even if you have the code and doctor and patient the help desk at the insurance company can't say for sure if they will cover it or not. That comes down to the discretion of the claims adjuster. You won't know if something is going to cost $100 or $10,000 until after it is done.

and then wait 3 weeks for them to get back to you, as they contact your insurance and work out what they can get away with billing

> They don't know

It works every time I asked.

The provider or the insurance company? The provider can give you the cash price, but that's a made up number with no relation to reality. The Insurance company can give you what the standard discount would be on that procedure, but they can't say if they'll cover it, give only that discount, give nothing, or anything in between.

I think you're a little confused about causality. All healthcare systems, including fully socialized ones, perform similar types of case review to ration care and hold down costs. US healthcare costs might be high now but would be even higher if the payers (including the Medicare / Medicaid government payers) paid every claim that came in without denying those that fail to mean plan coverage rules.

If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.

Price controls always result in shortages.

The provider. And yes, I negotiate.

Yes, exactly. Since demand for healthcare services is essentially unlimited, creating artificial shortages is one way to ration care and hold down public spending. The US government already creates healthcare shortages in other ways, such as constraining the number of residency slots to limit Medicare spending. (I don't support this, but it is somewhat effective from a fiscal policy perspective.)

The prices you're getting are fake, whether you know it or not. Because you're not the one paying.

This is why it's sometimes cheaper to have no insurance than insurance.

if you ask the provider you will eventually get burned. they can only give you the cash price as a backstop.

if you ask the insurance company you’ll never get an answer. providers are usually more helpful about what “should be covered”, but that’s not guaranteed.

seems like prior authorization is the only way to really make sure charges are covered but takes forever. but even then, if your insurance covers $x and they bill $y, you might get a balance bill in the mail.

point is, the market is heavily skewed against the consumer.