Patients have time to shop for most healthcare services. Only a small fraction of healthcare spending is for emergencies. The highest cost stuff is mostly elective procedures. If you need a colonoscopy or hip replacement then you have time to shop around.
Socialized healthcare has its advantages and is probably more cost effective on average. But we also see affluent Canadians coming to the USA as medical tourists and paying cash for MRI scans in order to avoid the queues back home.
> Patients have time to shop for most healthcare services.
Patients have the time but rarely have the actual ability to shop around outside asking "is this provider in my coverage plan?" They demand me to sign a document stating I'm willing and able to pay while often never being able to actually tell me what the procedure will actually cost. Often, they won't even know that same day the procedure is done, it'll be weeks before I'm actually invoiced. And don't even get me started when you've chosen the surgeon in your plan, the facility in your plan but it turns out the anesthesiologist they scheduled wasn't in your plan. Oops. That's an expensive mistake you made, should have shopped around!
My knee kept locking up and I'd experience tremendous pain. Only once every few weeks though, so I had time to "shop around". I called up several places and tried to get an estimate of what it would cost ahead of actually seeing the doctor. Nobody would actually offer that, they could only make an appointment to see the doctor. No idea what the doctor would actually want to do during that appointment, so who knows what things will cost. Will they want x-rays? Will they want an MRI? Can they do the MRI there? Won't know until you commit to paying!
And out of the few dozen choices of kinesiologists around me which were covered by my insurance few had any appointments available within the next several weeks. Many weren't seeing new patients. So really it was deal with my knee randomly causing me immense pain for several more months or take whoever had the first appointment. And this is in one of the top five largest metro areas in the country, not some small town in the middle of nowhere.
Shopping for which hospital to do the delivery of my children, the estimates for our costs after insurance had a massive amount of uncertainty to the point of being useless. Could be $4k, could be $20k, who knows. Imagine going to a burger joint and the menu says a burger could be anywhere from $1 to $50, we'll invoice you in a month. Go down the street, menu says it could be $3 to $48, we'll invoice you in a few weeks. What an ability to shop around! Free market at work!
> avoid the queues back home.
I already mentioned, most kinesiologists around me were fully booked for months. Very few had anything within several weeks. That's queueing.
I tried to book an appointment with a new dermatologist a few months ago. Once again, in this very large metro area. For dermatologists in my area covered by my insurance, the earliest appointment was six months out. It took several months to get a family member's hip replacement scheduled. We have queues in this country as well.
Getting medical imaging is generally pretty quick and easy though, and places like MRI imaging centers just want to keep moving people through so if they have an empty spot in an afternoon having someone in the machine constantly is important. It's also generally the easiest thing to automate in healthcare; mostly just a matter of getting enough machines and lightly trained techs to rotate people through. Radiologists are often off-site contractors getting paid for every scan they review.
It's unreasonable for you to expect a cost estimate on knee pain. You can ask the provider organization how much they charge for a regular office visit, and then check your coinsurance or copay amount. During the initial office visit the doctor is likely to recommend follow-up tests, imaging scans, medications, and/or physical therapy; you can then ask for price estimates on those additional services.
The No Surprises Act does give patients some protection against high charges for out-of-network services.
> It's unreasonable for you to expect a cost estimate on knee pain
Ok, but then it goes back to this idea of queueing and the "free market". Ok, so it'll take me a few weeks to go to the first doctor just to get his paid estimate. If I don't like whatever estimate he gives (which once again he probably won't directly) what am I to do? Start calling around, make another appointment with someone else several weeks later and pay yet another appointment fee? Hope his prices are better? Rinse and repeat to get a few quotes?
And so continuing the burger example, you call ahead to book a time well in advance and pay $2 just to be able to look at the menu. What a free market.
One of my kids had to get tubes in his ears. I didn't actually get a good faith estimate of cost until that morning in the hospital despite calling several times. I had to schedule, wait weeks, show up early in the morning, and refuse to sign for the financial liability until I got an actual estimate. Free markets at work here guys, totally not a broken system, easily just shop around. And yeah, sure, I could have gone to see a different audiologist and then gone through scheduling it all again and waiting another few months and a couple hundred dollars. After all its just my kid's speech development, no big deal delaying that another month or two (or three).
At least it's good to see this No Surprises Bill solved at least that one example of the healthcare industry screwing people over. Thanks for sharing that.
Socialized healthcare has its advantages and is probably more cost effective on average. But we also see affluent Canadians coming to the USA as medical tourists and paying cash for MRI scans in order to avoid the queues back home.