In actuality, it would be: "Each blood test paid by insurance company $A costs $X, Each blood test paid by insurance company $B costs $Y." Etc.

I really think a big part of the problem in healthcare pricing is insurance company policies regarding networks and guaranteed volume. Your auto insurance doesn't demand you use a certain body shop, why should your health insurance?

Here's a practical example that recently came up for me. My wife is a nurse at a few clinics. At one clinic, she's got health insurance and that clinic provides IUDs via their hospital, which she wanted to get. At this clinic, the price billed to her insurance would be $4700.

At another clinic she works at, she could get the same IUD brand and procedure for $600.

When she asked her insurance about it, they said they would pay 100% of $4700 in-network but 60% of $600 out-of-network. Obviously, being selfish, she decided to let the company eat the $4100 they would otherwise save so that she would pay $0 instead of $240.

Because that $4700 isn't the cost the insurance company is paying. The real reason you can't go without insurance in the US is they're negotiating steep discounts - where I live it's supposed to average 80%.

It may well be they paid less than $600 for a procedure that lists at $4100.

And of course the government numbers don't take this into account, so what they've published is pretty much worthless.

I doubt it. That $4700 is what was listed in the insurance packet, then again in the bill along with a few other minor expenses incurred during the procedure, and finally paid for by insurance in a later notice to us. The 100% is because of ACA requirements.

I don't disagree with you that insurance companies negotiate different discounts, though, which is what I was trying to get at in my post regarding pricing.

The gov't lists medicare reimbursement which is basically the insurance price maximum. Some insurers get better than medicare pricing.

You know what is wild though? Federal employees aren't insured by medicare but instead the federal govt pays private insurers to insure them!

If the Feds went to single payer for its employees, things would change quickly.

>That way patients can ask the doctors if the tests are actually needed.

How does this work? If a doctor prescribes a blood test, he's already said it's needed. Put yourself in a doctor's shoes for a minute. You told the patient he needs a blood test. Then he asks you whether it's actually needed.

How can you possibly say "Nah, just kidding. We don't need that one"?

One of the most important questions you can ask of a doctor is "what happens if we do nothing?"

That works for treatment, but not so much for tests. If you don't know what's going on you don't know what happens if you don't do anything.

Doctors order tests to help them choose the right treatments.

If they have absolutely no idea what the possibilities are then they wouldn't be ordering tests anyway.

>Doctors order tests to help them choose the right treatments.

No they don't, except in very rare cases. Doctors order tests to make a diagnosis. The treatment follows from that.

>If they have absolutely no idea what the possibilities are then they wouldn't be ordering tests anyway.

I'm not sure a doctor would have "no idea what the possibilities are" unless you don't have any symptoms. If you don't have any symptoms, why are you at the doctor's office?

> > Doctors order tests to help them choose the right treatments. > No they don't, except in very rare cases. Doctors order tests to make a diagnosis. The treatment follows from that.

What I said didn't contract what you said. If test => diagnosis => treatment then test => treatment.

Without a diagnosis, how could a doctor possibly know the answer to the question "what happens if we do nothing"?

I never said without a diagnosis.

It's pretty rare to arrive at a diagnosis without tests.

Overtesting is more or less a thing in the U.S. Many tests are not harmless, so even a person who carries an infinite amount of money around would do well to question the necessity of tests.

>Overtesting is more or less a thing in the U.S.

I don't believe that. Over the years I've had to fight to get tests that turned out to be important, and I'm suspicious of government studies showing "overtesting" right when the government is in the process of taking over health care.

You can certainly eliminate a lot of testing without affecting mortality rates significantly. But that's because in absolute terms a lot of extra people have to die before mortality rates are affected significantly.

need it != it would be useful

Because a plumber from idaho can make better decisions about whether the hacking cough + bloody sputum requires a chest x-ray than his doctor.

Right.