In a life or death scenario, you certainly aren't shopping hospitals. And so they can gouge you hundreds of $$ for even simple things like ice packs and Tylenol. Our system is a scam. One hour in the ER should not cost $5000
FWIW, I live in an area where there is ONE healthcare option (Racketeering/monopoly). I (as an independent consultant) pay $1640/mo for a $5,000 family deductible. So basically, I pay over $19,000/year for the PRIVILEGE of paying another $5,000 and that's assuming I only go to the doctors "they allow" me to go to. (it was $800/mo for a $1500 family deductible prior to ACA). Obama can EABOD.
The only people who like the ACA are the people who don't have to pay for it.
Edit: Also I was in an MVA in July, the Emergency Dept. didn't accept my insurance at all - so who gets the bill? I do. The MVA wasn't my fault, but that bill is still my responsibility.
That's another crazy part of our system. Medical coverage is baked into your health insurance, your auto insurance, your property insurance, workman's comp insurance. A medicare for all plan, should require comensurate decreases in all of those policy areas.
Everyone working or non-working gets some kind of base coverage --to which they can buy a ala carte additional coverage/perqs. At the base level people who behave healthy (but not necessarily healthy) get breaks (premium perqs) for trying to be healthy in terms of diet and activity (activity monitors, etc.)
In addition to some base coverage, people can opt in to more premium coverage with shorter wait times, additional non-essential care, opt out of lifestyle monitoring, etc.
That way the system can be streamlined to be efficient in handling 80-90% of cases and then have the second, premium system available for those who want or need less ordinary medicine.
If you can keep 80-90% of your pop healthy efficiently and then you get the rest to pay extra for their added needs, I think that could make the economy more effective, overall.
Healthcare products are complicated. Getting the price right is a very hard problem. Markets, generally speaking, have proven to be a fairly effective way of settling on price. This is basic economics.
It would be interesting to see if there was regulation for open pricing, billing standards and others. If that doesn't happen, Medicare for all is definitely a good option.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Using life expectancy as a basket proxy for average effectiveness of care, Canada is 12th, the U.K. 20th, and the United States 31st. It's broadly accepted that on average, medical outcomes are generally better for pretty much every indicator (infant mortality, length of hospital stay, etc.) in countries with effective universal health care, at much less the price.
If you introduce any pay structure into healthcare you are saying that those with money can reserve scarce resources ahead of those without.
You are saying rich people are more important than the poor and the poor should die more quickly to get them out of the way.
If you live in a society that takes that view, how long before you become the poor?
You pay your local hospital $x per month based on income... something like 4-6% of your income if you earn > $30k.
The hospital might get some gov't subsidies based on # of insured patients it carries.
When you travel your hospital covers the bills at other hospitals. Since each hospital = insurer they will work/negotiate with other hospitals for faired deals than they would w/ insurance companies.
This also will do away with some of the billing requirements and could streamline that process a bit.
A good startup might be creating the billing systems that manage all of this, and centralizes everything between different hospitals.
No HMOs, Networks, etc... Hospitals could choose what extras they might cover like infertility/etc... as a bonus so patients might pick a different local hospital that has better coverage..
The boon for the hospital: Monthly recurring income from all it's patients - past, present, and future.