[ngriffiths]

> It’s not hard to understand why people hate health insurers. When you interact with the U.S. health care system, the providers — the hospital staff, the doctor, the nurses, the technicians — all just take care of you.

> Your interaction with the health insurer, on the other hand, feels like a struggle against an enemy who wants to destroy you.

Exactly, the big factor driving healthcare costs is that people like expensive providers. They like the fancy plan that covers their doctor, that doesn't limit them to a community hospital. Any choice that involves retaining even the slightest market leverage is a deal breaker for many people. I think all the clever stuff we do to optimize costs and increase transparency is worth doing and helpful, but like, it will still be expensive. We want that!

Meanwhile it is not really better to go to an expensive doctor, in terms of health outcomes. So the public health problem is to stop people (and employers) from voluntarily wasting their money on healthcare, so we can use it for better stuff.

[gopher_space]

> They like the fancy plan that covers their doctor

The fancy plan.

[ngriffiths]

Yeah, because it covers all the doctors. It is literally the same as saying you will pay any price. It is a luxury good.