I'm personally I the camp of, why the hell can I not know how much stuff costs up front, why can I not tell them no I dont an unnecessary x-ray, and why am I not told cost owed by me until after the procedure only to find out it's just an absurd amount of money
Private insurance blows cause we're all basically required to have it but it's worse than a tax because we barely ever know how much we owe.
There's plenty cash-only doctors and clinics out there. There's also companies that handle healthcare for their employees via personal accounts (they put more cash in your account each year, and you spend or don't as you see fit). People on such plans do a lot more shopping around.
And as the other poster said, you always have the right to refuse treatment, up to your death if you like (unless it is some kind of involuntary commitment where you are put there because you are supposedly dangerous). Many terminally ill people choose to go this way.
Pre-authorization sounds good, but unfortunately a lot of the time it isn't possible. For example, when I was in the ER they gave me a few choices on how they could do stiches on a big cut... But there is definitely no way I could compare the costs! I just ended up paying a $500 bill a few months later.
Lack of pricing information is ridiculous in the US.
You can’t base a system on the “free market” then prevent consumers from having pricing information.
It certainly wouldn’t fix everything in the US, but it would be a huge help.
To be honest, I’m not sure why hospitals in the US haven’t taken the lead on this. If I had a choice between two hospital of similar quality, but one provided price transparency and maybe even a price guarantee (your procedure will cost $X, guaranteed), I would certainly go to that hospital.
Price transparency is a tremendously difficult problem because healthcare is a multi-layered bureaucracy.
Even then though, making prices transparent wouldn’t address the primary scenario that results in personal bankruptcy, which is emergency care. You can’t exactly shop around for the cheapest ER facility if you’re bleeding from a gunshot wound.
Information asymmetries are a huge problem in "market solutions" and there's a huge one here: doctors have 8+ years of medical training and most patients....don't. It's going to be very hard for many people to second-guess a doctor's recommendation or estimate the expected value of decisions.
In a non-emergency situation, you can certainly try to read up on your own, but the medical literature is not always easy to interpret. A friend of mine asked for advice after he was diagnosed with Parkinson's Disease. Despite having a PhD in neuroscience and working as a researcher in a PD Center of Excellence, I had a really hard time making a recommendation. (Neuro conditions are particularly hard, but this is also possibly the best-case match with my experience).
I had a good friend who worked in a leadership role at a major health system in CA.
He readily admitted that the hospital has a very poor grasp on their own costs. At a high-level, they just charge as much as they can - sometimes they lose money, sometimes they make a 90% profit. They pool it all together (usually by line of business) and hope it all works out as a profit.
That’s why specialized, stand alone clinics (e.g. MRI clinic) have some of the best prices. They know exactly what things cost and can make sure prices reflect it.
It's so ridiculous. I had Kaiser for a period, because I was under the impression the bundle of insurer and healthcare provider would avoid these issues. It worked that way for a bit, but then I got some X-Rays. Paid up front, and then a few months later got an additional bill.
> I was under the impression the bundle of insurer and healthcare provider would avoid these issues.
It gets worse, bundling those two is the epitome of conflict of interests when you find yourself the victim of the hospital's negligence and expect your insurer to act in your best interest.
Private insurance blows cause we're all basically required to have it but it's worse than a tax because we barely ever know how much we owe.