Unnecessary medical care is harming patients physically and financially (2015)

Anyone going for surgery should strongly consider whether or not being placed under a medically induced coma, cut open poked around in, and sewn back together, along with the possible complications of all of the above, are worth the procedure happening. (That's not to say don't do it, but there's no such thing as risk free surgery).

[0] The piles of forms that they stuff in front of you are filled to the brim with this information. You are normally handed them at an incredibly inconvenient time, and told not to worry about them.

That's fine, but LeifCarrotson presented an anecdote like it was a universal truth of health care in the US. That's bullshit and that's what I have a problem with.

> long waits and impenetrable bureaucracy has been my experience, as well. My wife is currently trying to get treatment and she's had to wait months to see various doctors and specialists. We live in a metro area in the US.

So, is this some effect of your insurance coverage? Does she require referrals for specialists?

The problem? Pre-existing conditions. Let's say you have lifelong degenerative condition that will require constant medical care. What incentive does an insurance company have to take you on? You can try to make discriminating against pre-existing conditions illegal but insurance companies know who their most expensive clients are and will try and find a reason to invalidate them.

Why employer-based insurance works is that it groups people. It's really a form of collective bargaining.

If you insure one person you look at how much that person costs you vs their premiums. If you insure 50,000 employees of a company then you're looking at revenue vs cost of 50,000 vs 0. This is something insurance companies are exceedingly good at. Large numbers even out individual variance (and thus risk).

This idea can go too far. In Australia we have (had? I haven't lived there for 7 years and we have a conservative government so who knows what they'e done to the health system while I've been gone) what's called a "community rating" for private health insurance. Emergency care is largely the government's responsibility (through Medicare). Community rating means insurance companies basically treat everyone the same other than allowed factors (eg # of children).

The downside to this is that elderly people cost more but get charged the same as young people. This makes no sense for young people so they leave the private system and health premiums go up. This has been a decades-long problem.

The solution here is for there to be an alternative for employer health insurance. So someone else needs to come in and negotiate for a group rate. It needs to be small enough so there's no Walmart like situation of all but one company getting squeezed out. It needs to be large enough so the number of plan participants averages out individual variance.

The question then becomes who should that be? In smaller states it should probably be the state. Maybe there should even be more than one supplier? In larger states, maybe it might be split further?

Cover this with state taxes. Decide what this covers. It should at a minimum include basic preventative care, affordable access to a GP (PCP), ER visits, emergency medical care, big-ticket medical items like transplant surgery and cancer treatment and so on.

Then maybe employer health insurance is just for extras like better elective cover.

Americans in particular have a real false dichotomy view of health insurance as in the choice is between a free market and a 100% state-run system where all hospitals and medical professionals are government employees. This is patently false.

The current US system has providers deal with any number of insurance companies with the differences between their various billing systems (eg there are jobs where people simply have to convert between billing codes used by different companies). It's insanity. State-run insurance would grealty simplify this.