The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

I believe that "closest/biggest hospital" is a choice in emergency. Or when it's something unimportant. Otherwise people tend to choose a doctor and clinic based on reviews or recommendations, or maybe years of experience. Even with a free healthcare you still have a paid private medicine and a free public one. And they have to compete which leads the price going down, because one side is always zero or close to it. Not like it's in the US where the direction is opposite as you don't have a zero side but only "unbelievable high price" side.

Some big differences: Without the equivalent of AMA lobbying Europe has a lot more primary care doctors per capita than the US. No long history of trying to get everyone healthcare without using taxation resulting in a pile of Rude Goldberg regulations that nobody understands. Regular use of cost-benefit analysis in deciding what procedures or drugs to pay for, now that the FDA has approved aducanumab it's going to be available to people even though it probably doesn't work and is breathtakingly expensive.

Though in this case it is quite obvious that there are some parties making an obscene amount amount of money in healthcare, there are businesses where employees feel underpaid, owners lose money / break even, and customers believe they are overpaying, so no one is happy. Childcare is first example I can think of.

You've also got the Certificate of Need system, introduced in the Nixon years on the theory that if allowed hospitals to compete with each other it would lead to redundant capacity and thus higher costs.

And then there's the Medicaid reimbursement rates, decided by a committee using the labor theory of value rather than something sensible like cost benefit analysis and negotiation. And since it's illegal to charge someone else less than you charge Medicaid these tend to have a cascade effect.

Our healthcare system is a huge sequence of "make it so complicated that there are no obvious deficiencies" legal systems with layers of ad hoc patches its amazing it works as well as it does.

Normally I'm in favor of free markets but if nationalization is what it takes to clean up the current mess of a system we have then so be it.

This is definitely a problem but the problem is not high deductible plans, its price transparency which distorts supply and demand and steers people to high cost emergency room medical care while unfairly shifting costs to those who choose more price transparent plans. And the article's charge calculation is dishonest, ignoring premium savings and insurance discounts in order to get a bigger headline grabbing number.

I had a high deductible plan and got snagged with a similar charge but not as large. Same deal, a walk-in by a family member to an emergency room cost over $2, 000, no treatment, simple 15 minute consult. They classified it as a level 4. I understand this is intended to offset overhead and also to discourage unnecessary walk-ins but really ? I argued with the hospital on the level 4 classification and the fact they never informed my family member how much it would cost them prior to (or even after) treatment. They would not budge and I held out until they threatened to send to collection at which point I gave in because it was easier to pay.Also I figured I saved as much on my high deductible plan and it was a lesson learned both to me and my family.

The article is not being up front with the cost calculation.

First, the family in the article likely saved thousands of dollars from their high deductible plan ( for example at the time I was saving at least $300 a month on my plan v lower deductible plan, a savings of $3600 a year in premium). I didn't see anywhere in the article where the premium savings was calculated and it certainly was not deducted from the headline number.

Second, included in the headline number is the unnegotiated undiscounted retail cost. No insured person pays that number. Buried in the article they note the true discounted cost, the "you pay" number which was negotiated by the insurance company as part of their deal with the hospital and passed on to the insured. Granted the discounted price is still outrageous, but it's much lower than the headline.

Third I believe the article fails to mention those with high deductible plans are able to put away the thousands they save on premiums (and more if they choose) in a health savings plan (similar tax advantages to a 529 for education or a 401k roth and similar investment choices of mutual funds, stocks, bonds, cash, etc. ) which is only available for those with high deductible plans and which can grow over a lifetime (this NOT forfeited each year like the medical savings accounts most people are familiar with).

In addition, most areas, and I would bet even in this rural area, there are private stand alone clinics that would have treated him for around $200 . The mistake is to walk in to a hospital emergency room for non-life or death situations, a problem that most people who are on low deductible plans do all the time, driving up artificial demand and real costs for everyone. Hospital emergency rooms are equipped with the most expensive personnel and equipment, they should not be used for non-life threatening problems.

One of the main problems with the American system ( other than government intervention which has royally misallocated resources, screwed with normal market driven supply and demand, and micromanaged health care production, supply, and delivery) is that no one knows how much it will cost given the complexity of the insurance.

Hospital emergency rooms need a simple menu-like sign at the door giving the out-of-pocket cost for common treatments and encouraging people to call their insurance company first and/or go to other clinics for non life threatening issues. The price transparency law that was passed a few years ago did little as it resulted in long lists of obscurely named procedures, usually in a pdf buried in the website.

And/or they should give a reasonable estimate to high deductibles and charge them a r$1000 or so in order to walk through the door, refunding any difference when they walk out.

In addition the low co-pay plans for emergency visits are obscuring the true cost to the hospital, encouraging unnecessary emergency room visits, and pushing these costs onto cash only and high deductible plans. High deductible plans should be encouraged legislatively, rather than demonized.

Also, instead of fighting the tendency of people to run to hospital emergency rooms, hospitals should run lower overhead, lower cost 24 hour clinics adjacent to the emergency rooms and informing people of cost/benefits of each.

While I appreciate this article pointing out the problem of emergency room costs, high deductible plans, are not the problem but one of the solutions to high medical costs. They can regularize supply and demand and increase price transparency.