[elmuchoprez]

One of the problems with healthcare in the US that for a long time, lots of people had insurance that would cover everything. So people would go to the emergency room over a stomach ache or schedule a doctors appointment because of a runny nose. Why not? So long as they paid the premiums, there was no incremental cost for going to the doctor. And while you're there, get some tests. Hell, get all the tests! Why not, you're not paying for them. And since the doctor knows you're not paying for them, they can bill whatever they want for them.

The net effect is that you have a bunch of people consuming excessive and over priced medical services. This means lines get longer and overall costs, especially for the uninsured, go through the roof.

On that note, I think the high deductible health plans make a lot of sense. I'm covered if something really expensive happens to me, but I still have to front the first $1300 and then another $1500 or something at a 20% co-pay. So my total exposure is only $2800, which won't break the bank if I get into a serious accident. But it's enough to make me think twice about going to the doc over trivial issues.

Some people would argue that you shouldn't have to think about cost with a doctor - if you think you need to see a doctor, then see a doctor. But that really can, and has, gotten out of control if you completely disconnect people from the price of healthcare the way US insurance has for a long time.

[mjn]

I used to have that view, but from what I've read more recently, the cost of doctors' visits is basically negligible in the overall U.S. healthcare picture. Almost all the money is going into major medical expenses: hospital visits, surgery, end-of-life care, nursing-home care, and chronic conditions with expensive medication. So either doubling or halving the number of times people go to the doctor for colds, by changing incentives on that front, just doesn't seem like it'll move the needle on healthcare costs.

If anything, some of the actuaries seem to think people aren't going to the doctor enough: my dad's corporate health insurance plan recently changed their policies to incentivize going to the doctor more often, by giving you a discount for various kinds of visits: you get a discount if you have an annual physical, and another discount if you have less-frequent major workups / lab tests done.

[crusso]

hospital visits, surgery, end-of-life care, nursing-home care, and chronic conditions with expensive medication

Any list of major costs in the medical system that doesn't include legal expenses is highly suspect.

[mjn]

Depending on which estimate you believe, legal expenses (including direct and indirect) account for about 1-3% of overall US healthcare costs. Not nothing, but not in the range of what we're spending on, say, end-of-life hospital care (10-20%).

[crusso]

Okay, fair enough. I remember reading about substantially higher percentages in the past, but googling just now turned up a best guess of 2.4%. I couldn't find any details on how they calculated the indirect nature of defensive medicine, but what they did have didn't seem to be very comprehensive.

[npsimons]

This really doesn't make any sense to me; do you have any sources for this? Everything I've heard about problems with healthcare in the U.S. falls in line with the OP, along with:

1) People go to the emergency room precisely because they don't have insurance, and what's more, they wait until the last moment (ie, when it's most expensive to treat) [1].

2) If people were really getting so many tests done and going as early as possible, surely the U.S. would be far ahead of most other countries in terms of preventative medicine [2].

[1] - http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_roo...

[2] - http://www.commonwealthfund.org/~/media/Files/Publications/I...