[mindslight]

As soon as we can defeat the medical provider, drug, and "insurance" lobbies. Given that legislation in the US only gets passed when it empowers some lobby, good luck.

The main source of our dysfunction is this "HMO" fallacy that a 10kft-view insurance company can somehow create the intelligence to administer effective care. Rather, what we've gotten is more opaqueness, more market inefficiency, onerous and arbitrary approval/denials for arbitrary procedures, and every incentive for doctors to kick the can down the road as each visit is a billable event.

To me, the obvious market based solution is based around making medical providers provide straightforward prices or rate schedules, like every other industry, as a requirement of forming a binding contract to bill against. Regulate that prices are all the same no matter who is paying, and regulate that every medical insurance plan must pay any provider. The sheer majority of care happens very slowly - not the emergency "car crash" example some healthy person with little experience with the medical system will inevitably throw out as an argument.

Regulate the insurance industry such that coverage must be purely in financial terms. If an insurance company wants to set some cutoff on what they think a given serrvice should cost, they can do so in a transparent manner that can be easily checked against all provider quotes. Otherwise the default dynamic is to reimburse some percentage of all expenses.

Emergency service costs get limited statutorily, similar to how the state regulates towing rates (when the police call to get a car towed, etc). Due to lobbying, these costs generally end up higher the open market, so there is no problem with constraining the market.

Public health insurance plans continue to exist in the new framework, for those of limited means and those without access to insurance. Ideally we work towards unbundling insurance from employment over time, but that's not a necessary component.

Of course I realize this is all a pipe dream given the aforementioned lobbies, despite the little bit of recent noise towards price "transparency". I'm not opposed to single payer (basically using two of the lobbies to kill the third), but the rot in our system goes far beyond the mere billing nonsense that makes much of the news and I don't think single payer would be enough to reform the deeper problem of providing effective care.

[SQueeeeeL]

I like how this comment acknowledges acute horrific care incidents that essentially makes market based solutions horribly preditatory, but continue describing it anyway as if it's an afterthought

[mindslight]

If you had bothered to read my entire comment instead of jumping on one sentence in isolation, you would have gotten to the part where I addressed that in terms of statutorily limiting emergency prices.

When your car is towed involuntarily, the cost can certainly be described as predatory. And yet it's still probably within a factor of two of what you could negotiate on the open market for a planned tow. That's much better than the blowups on medical prices. And the "huge bill" thing is fixed by wider access to insurance, both private and public plans, as well as making it so that insurance companies can't easily cancel or deny coverage. Furthermore, there can be a public payment plan as a backstop for everyone, such that if you do fall through the cracks and get stuck with a huge bill, you're still only expected to pay a certain percentage of your income per year.

For the issue described in the article, single payer would only change the billing bureaucracy from that of health "insurance" companies to the government. The same incentive for hospitals to play the minimum staffing blame game will be there. Only the market dynamic of patients choosing to go elsewhere can raise the standard of care to favor places that employ more than the legally minimum staff. That requires removing barriers to patient choice.

If you're hangry, you can walk into any random grocery store or restaurant and still expect sane prices, because the sheer majority of their business is done less urgently.