Happy New Year!
Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?
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Notes -
I agree that monopolistic competition is bad, which is why it's terrible that I can have one hospital in my city and their ER doesn't take insurance. What is the average person supposed to do in that situation? They can't shop around; they just have to eat whatever medical bill comes their way, on top of whatever they and their employer pay for insurance.
Emergency medicine is a place where the free market system really breaks down, and we need a different solution from what we have now. I don't know if the surprise billing legislation is the best situation, but what else is being proposed?
Why can't the insurer pay the customer directly?
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Surprise billing pops up in two major places- the ED and for consult/pop-in needs.
The later is rarer, less obvious to patients, and harder to fix without big sweeping reform (I NEED EXTRA HANDS IN THIS ROOM RIGHT NOW or "is anyone at work right now who can help answer this question?" are hard problems) attempts at fixing the ED stuff break this process to and discourages those resources from being available. Nobody wants to risk not getting paid so community hospitals have an increasing dearth of specialists and then whole death spiral (for the health system) and poor quality of care things happens.
The issue with the ED is that the structure of American healthcare discourages physician self employment and physician owned practices, so one of the major driving factors here is that private equity groups have bought all of the ED doctors who aren't hospital owned and then start some fuckery with the insurance companies and this is one of the things that shakes out.
Realistically it's still a problem in physician lead healthcare but right now it's those large and connected industries fucking with each other.
Some breakthrough protection would probably help a lot "in case of truly emergent care needs the professional fees need to be covered by insurance but at no more than 110% of the fee schedule for the mean costs of in network professional fees" or something would fix the problem.
I'm sure that would have issues but the point is that the insurance companies aren't interested in fixing the problem they are interested in lobbying so that they don't need to pay for things and someone else gets the blame.
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