[jjulius]

In addition to the other responses, I'd add that I don't believe the "free market" adequately incentivizes insurance companies to "deliver better quality". If it did, I don't know that we would've seen a collective, "Oh, yeah, we get it," response to the recent shooting.

My faith in things is so entirely shot that if I saw a company like the one you suggested, my immediate, heels-dug-in assumption would be, "That's cute, and in five years they'll be just like the rest of them".

[jaredklewis]

Well there is also the fact the calling the US healthcare market a "free market" stretches the term beyond all comprehension.

Due to a weird, historic tax incentive, people get mostly get insurance through their employers. Their interests are not in opposition to, but are still different than those of the people actually being insured. So you have a situation where the people doing the insurance "shopping" aren't the ones using the insurance.

Then on the actual healthcare side, for no coherent reason, almost all prices are hidden from the patient, totally inscrutable, or highly variable. Providers and insurers collude to keep these prices astronomically high so the providers they can overcharge medicare (which is not allowed to negotiate prices) and the insurers can "give" their customers "negotiated prices."

A more normal free market would be something like: people buy their own insurance or pay providers out of pocket. This would incentivize people to make price conscious decisions and evaluate insurers and providers for quality. Providers would need be required to set and publish fixed prices for different procedures and services so the market could actually function, but this seems pretty simple.

[lantry]

As a cherry on top, prices also aren't visible to the doctor, aiui. Doctors also can't really tell in advance if something is going to be covered or not.

[datavirtue]

Doctors seem to me like deer caught in the headlights of an oncoming train that is the medical system. My wife just lost her third primary care doctor because of turnover. When I was a kid we had family doctors we had known and visited at their office for twenty years and one doctor would stop by our house to visit and check in on my brother whom he diagnosed and treated as a cystic fibrosis patient for over a decade. We were just an insignificant middle class (working class) family in Cincinnati.

These days the bedside manner is trash. Though I don't blame the doctors. And they are little more than privileged employees...if that. The real service they provide, and the service people are growing to expect, is to navigate the insurance system to wrangle out some semblance of coverage. Being employees the most you are going to get is a wink and a nod because as employees they cannot speak freely.

[datavirtue]

Systems drive human behavior and determine human performance. Individual exceptionalism doesn't scale. The default of course is ineptitude, which is why it's so important to design systems that yield exceptionalism.

In the case of healthcare I don't think we are capable of building a system this large, prescribing every detail, while getting it right. It's like trying to plan an economy.