What health care costs

While not the worst systemic problem with the broken US health care system, the lack of coherent pricing is probably the one I find the most personally maddening. The participation of private insurers as middlemen, while it has served to make health care affordable relative to an entirely individually paid system, has made the entire process of getting necessary care byzantine and unintelligible, requiring a huge amount of effort for anyone who tries to have the foresight to predict their costs. It’s like trying to understand the inner workings of a Macintosh computer, except where Steve Jobs puts out products good enough to make it rarely all that important to understand what they’re doing behind the scenes, with health care costs we’re often talking about the difference between solvency and declaring bankruptcy, between comfortably sending your kids to college and saddling them with financial aid debt for years after they graduate because you needed to have chemo.

To use an example that has some relevance to me, I’m overdue to get a routine blood test but I have no idea what it’s going to cost me out of pocket. If it counts as an “office visit,” it’ll be $40 plus probably whatever the full cost of the test is ($50? $100? $500?), since I have a deductible of almost $3000. On the other hand, if it counts as “preventive care,” it’s free. I have zero desire to call my insurance company before every single procedure to hash out the minutia of exactly how they are going to categorize the care I receive. Just by itself, the fact that the French and Swedes never have to even think about this is a huge point in favor of their systems.

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