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You don't even necessarily have the option to shop for service in the USA. Earlier this year my family had a medical emergency that resulted in us being billed a truly staggering amount of money for services that were technically elective, somewhat unproven, and not necessarily even recommended by the standard of care, and for which the actual sticker price varies wildly from hospital to hospital. But, when an emergency happens, you don't get to shop for hospitals, and you more-or-less unthinkingly do what the care team recommends, because there's simply no opportunity to stop and do any sort of cost/benefit analysis. As luck would have it, we ended up at a hospital that both tends toward the more liberal end of the spectrum in terms of what they do, and tends toward the more expensive end of the price range. Fortunately our financial hit won't be too bad, because we have decent employer-provided insurance, and that cushions the blow quite a bit. If there's a silver lining, it's that we hit our out of pocket expense limit in the first part of the year, so we basically get everything for free for the rest of the year. But that whole situation is also a big part of the problem. We're nominally in the driver's seat, but, in practice, we really aren't in charge. Because we don't have access to a lot of the information necessary to make informed decisions, but also because we've been insulated from some of the major factors that might motivate an informed decision. Social criticism in the USA tends to revolve around the "theater" metaphor. We have security theater, we have hygiene theater. I would characterize the underlying principle of the USA's health care system as agency theater. |