If people paid out of pocket for more of the costs and there was no such thing as a $10 co-pay then you would see the premiums seriously deflate.
*We* are. In addition to our $700/month insurance premium, we shell out maybe $600 in medical expenses out of pocket. We paid maybe $15,000 out of pocket last year, and only stayed afloat thanks to the charity of family and friends. Now, we're a special case because our son is a special-needs kid, but the majority of our medical-related expenses
insurance won't pay (non-covered stuff), or they'll pay 50% of the cost and we cough up the other 50%. Which is why I'm a bit jaded when the UAW throws an absolute fit that GM wants to raise their copay to $10 or $20 or whatever...
If I made a bit less per month, we'd qualify for Medicaid and SSI. As is, we don't (Medicaid and SSI are essentially fiction if you make enough to pay taxes...we learned that the hard way.)
The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...
Exactly. Been there, done that.
Also, once you've been treated for a particular disease, you often can't get insurance that will cover future episodes of that disease. Example, my son's heart condition. If insurance companies weren't required by NC law to cover preexisting conditions when you join a group health plan, the only people able to get insurance would be those who are healthy enough to not need it. Can't get an individual plan.
Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?
We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.
We're in that boat right now. After paying for the roof over our heads, food, electricity, and water, we spend practically all our disposable income paying for our son's medical care. Our vehicles are 19 and 13 years old, and the newer one (a Plymouth) is currently broken; I am fixing it myself b/c I can't afford to pay someone to do so. I haven't bought a new pair of glasses in ten years, though I badly need a pair. My wife needs some dental work, but we can't afford it, and the dentist wants payment up front. I've got a couple spots that probably put me at elevated risk of skin cancer, but I can't get them removed right now because I can't afford the deductible. I don't even have a primary care physician right now (haven't had one for ~3 years) because I can't afford the out-of-pocket costs; have to pay for my son's specialists instead. Good thing I'm pretty healthy.
If I took a job as a janitor instead, I'd qualify for Medicaid in 6 months, my son would qualify for SSI (he already does, except we're above the income limits), and we'd have free care for most of our needs, and access to all the doctors we have now...and I know one college-educated man who has done just that, for precisely that reason. But if we did, we couldn't afford some stuff that Medicaid won't cover, like nutritional formula (our son can't eat), and we'd go bankrupt and/or lose the house in the six months before Medicaid would kick in...and we'd have no insurance during that six-month period, either.
I understand the free-market-based arguments perfectly. I also know that the British NHS has problems with institutional coverups of medical malpractice (wouldn't want to make the government look bad, you know), and there is a strong tendency for doctors in a government-run system to develop the Doctor-Is-God complex. I don't
know what the ideal solution to the current problem is. But the current approach IS in trouble.