[dtnewman]

I think what this misses is that insurers handle the hassle of dealing with negotiated rates.

As an example, if you go to the ER and get a strep test, you might be billed $500, and insurance will pay $7 (as ridiculous as this sounds). If you go at this on your own, they'll probably bill you $100 and tell you they are giving you an 80% discount. With lots of phone calls, you can maybe get them down to $50.

This is all obviously crazy. But it makes it such that you really do want insurance if you can afford it. More so, even if you are a billionaire and can afford to self insure, it still makes sense to have health insurance (whereas property or life insurance probably don't make sense for you).

Also, don't forget that insurance premiums are often tax deductible for wealthy people, so the actual amount paid is less.

[lostapathy]

Dental insurance is even worse. My dental insurance has ridiculously low limits, but it gets you access to the "real" negotiated rates rather than whatever silliness "retail price" is.

I tried going without when I switched jobs to an employer that doesn't offer it, but one cleaning as a "cash payer" cost more than the annual premiums to buy insurance privately.

[crazygringo]

> but one cleaning as a "cash payer" cost more than the annual premiums to buy insurance privately.

This is my situation too. It's baffling to me. It's not really "insurance" at all, it's more like a yearly Groupon.

It's 0% about actual insurance, 100% about negotiated rates.

[Taikonerd]

Executive order 14221 (passed in 2021, [0]) was supposed to provide transparency about what the actual negotiated rates were. The idea was that it would be a lot harder for hospitals to engage in price discrimination when they had to publish what everyone was paying.

The actual effect has been... mixed. IIUC, the hospitals mostly haven't complied with the order, or they're maliciously complying while trying to keep their real rates secret.

[0]: https://www.cms.gov/priorities/key-initiatives/hospital-pric...