@partyof5 It certainly wasn’t the first thing on my mind when my husband, who has a very high tolerance for pain, was in such bad pain he was crawling across the floor…
Many consumer choices in medical insurance have minimal competition.
A. If you have employer coverage, you probably have one or two companies to choose from, unless your employer is very large, like the national government or a large state government. Your employer may see more competition when choosing what to offer, but its choices may not align with your preferences.
B. If you are buying on the individual market, the number of choices varies, but people in some areas have only one or two companies to choose from.
Employers consider not just costs but outcomes and employee satisfaction when choosing plans. And there’s always the nuclear option of changing jobs if you really hate the insurer. But overall, I agree it makes little sense to tie insurance to employers. Government regulation (oddities in how benefits are taxed) created that mess.
As for having few choices in certain markets, that again was caused by government regulation. Prior to the ACA most areas had multiple insurers competing for clients.
But often none once you got a pre-existing condition.
Employer provide insurance came about after WWII and mostly through unions. Employers wanted a way to offer benefits and the government complied by making the tax laws favorable for such a plan. Now it is flipped that employers have to provide insurance and it’s creating a lot of part time positions.
I worked at a small office where the partners weren’t on the plan (they weren’t employees) so the office manager picked. Well, the firm paid for the employee’s premium and the employee had to pay for spouse and children. The office manager wasn’t married and her children were grown, so she picked a very (very) expensive plan that covered everything she needed covered. The result was that most of the employees, even the lawyers, couldn’t afford the $700+ to cover their spouses and children each month.
My daughter’s company just signed up with something called Direct Path that acts as an intermediary between the employees and their health plan. Sounds interesting (one of their services is to find and compare providers for specific health procedures.) They claim they also resolve billing issues. Anybody know anything about this?
And yet the reason we pay more is NOT that we get more care than people in other countries. It’s that we pay more for the same amount of care.
It’s the Prices, Stupid: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.89
It’s important, imo, not to confuse past practices with current. Eg, I recently had a CT for kidney stones, the lab knew they needed pre-auth and got it, within 5 minutes. Your provider should know, especially post ACA, which covers mire than just insurance purchase. And you can ask.
Some of this is also how a doc writes up your notes. If they’d denied the CT, my lab would’ve called the doc back. And ime, ER has always said, check with your own doc as follow up, versus coming back to the ER.