[JimboOmega]

Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more.

Consider the example the OP gives is a patient who they're paying thousands of dollars a day for, rather than hundreds. They're paying several people to work for days just to figure out how the rules work. It's only marginally working for them.

And let's not forget that they are also fighting profiteering on the other side; is it inherently wrong that your insurance might not pay for a new brand-name medicine that costs 100x as much as a generic with only the barest minimum difference they could sneak past the FDA and get a patent for?

I have Kaiser. Kaiser is a special beast, but one thing it does do pretty well is talk to itself. Combining providers and insurance under one roof provides a lot of upside in knowing what will be covered (though it has the downside that you really don't have options if Kaiser isn't getting the job done).

I recently had the experience of setting up a procedure done by an entirely private (accepts no insurance) practice, because Kaiser wasn't coming through for me. I was shocked how easy it was.

In one phone call, I was able to set up a consult, and even a tentative date, for a fairly complicated (day-long) surgery. Craziest of all? I got a price estimate. (It was 5 figures, but I expected that)

That was something I thought just wasn't possible in the medical world. There's so many variables, they haven't seen my X-Rays, etc, etc, etc. But still they did that. Entirely for profit, though.

I'm not saying for profit is the answer to everything or anything - someone less fortunate than me wouldn't even be able to consider going outside of Kaiser. Just that there aren't any easy solutions. I'm surprised by the system almost every time I interact with it.

[baobrain]

> Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more.

There is something like this for the wealthy [0]. Obviously, concierge medical services are very expensive, and morally questionable imo.

[0] https://www.nytimes.com/2017/06/03/business/economy/high-end...

[JimboOmega]

Let's not forget that most people get insurance through their employers, which really limits the choices.

Paying up front for medical services - especially in today's "Chargemaster" world where nobody has a clue what anything really costs - requires you to be REALLY rich. A straightforward appendectomy for me required an overnight hospital stay which was billed at a $17K (the surgery, etc, was more).

Funny thing about that link. It has a chart of "The average number of days to get a non-emergency doctor’s appointment". Los Angeles is pretty flat around 23 days. Guess what time limits the state of California places on that legally? (hint, it's less: http://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCare...)

[riverstones]

The American medical establishment is the ONLY one I am aware of that should you want a service, you go into the arrangement rarely, if ever, knowing how much you might pay on the other side.

I refuse to p(l)ay. My wife is medical and we have insurance, but I go to the indigent clinic for any infections I may get and buy a $4 prescription. This same experience with a doctor in a nice area would be lots more, even with insurance. Sure, you can tell these bastards you want no tests, etc., but some won't treat you without them, and most are not needed. Think I have strep? That's one test that's cheap. That and flu a/b. Any others are ridiculously pricey.

I spoke to one of the indigent doctors and asked him how he stays in business making $25, $25 there. He says he's not in it for the money. I believe him. He told me that in everyday doctors' offices, the doctors are convinced by the pharmaceutical sales reps to push product. They can win cruises, cars, etc., based on much drugs they push out the door in RX, so the desire to make money trumps being minimalistic in care. Give me only what's needed for the time being. I don't want long-term drugs and refuse to take them. I will only take antibiotics if I need them and only antibiotics. I will never take meds for high blood pressure, cholesterol, etc. Look at the numbers. The threshholds for these numbers have been lowered in the last decade or two to push RXs.

Like I mentioned in another post, the Americans doctors are the Ferengi of medicine. I refuse to pay more than $25 to see the doctor. I've even had stitches for $25. Try getting that price going to a non-indigent clinic. And, the Mexican and Indian doctors at the clinic have been doctors for over 20 years each. I've never been misdiagnosed.

To those who are sick of paying out the nose, look for the cheaper clinics that serve immigrants. They prefer cash, don't need insurance, and actually treat you like a human being.

[ci5er]

> and morally questionable imo.

Why?

And what do you think of medical tourism?

I can get a flight to/from Taiwan from (say) SFO for ~USD$450. I can get a fairly complicated dental procedure done for (uninsured, out-of-pocket), USD$400. (The same thing can be done w/ Panama, fwiw, but I understand Han culture and communication better than Latinx)

Is that wrong?

Q2: Why should people be denied treatment that they can (and are willing to) pay for? Because not 100% of the people are able to? If so - where does that reasoning go? Rich people shouldn't buy a Tesla because poor people can't afford a Tesla? Rich people buying Teslas ultimately drive the price down, right? Then more and more people can buy them, right? If immortality cost $1M/year (not much money, actually) - more and more people would get it and sooner-or-later it would be $10K/year (this happened with fax machines in the 80s). Then $5K/year -- or whatever. I believe that rich people subsidize R&D (for selfish reasons) that benefit us all in the future.

Do you disagree? If so - why?