The arm story sounds interesting

1) The surgery is elective, almost no one feels compelled to buy it.

2) Insurance doesn’t pay for most of it. The patient pays and decides what price he/she can or is willing to pay.

3) Related to (2) Competition. Many who want major cosmetic overhauls realize they can get equally good work done for less overseas. I have relatives who visited Canada a decade ago for cosmetic work and saved roughly 50%. Today they might go to Brazil or India or ….

The costs of purely cosmetic dental work may show the same curve. Or not. Here in AZ you can go to Mexico for dentistry and be home the same day. You wouldn’t do it for a $100 routine exam, but for $10,000 of cosmetics maybe you would.

My (safe) options to limit my family’s consumption of medical care are nonexistent at this point. We already do the generic drug thing (where possible with the cancer). We don’t go to the doctor for sniffles. We’re not trying to leech off of society…and I don’t expect other people to pick up my tab. But it would be nice to be able to find a catastrophic plan for people who have already had two catastrophes–neither of which was our fault. There just aren’t any good options for us in the current “system.”

I agree with what Warren has written about consumption. The closer the relationship of the consumer to the price, the more cost efficient the product or service is going to be.

And you are correct. Gravity alone didn’t break my arm. There were 2 disproportionate masses and an inconveniently placed fulcrum.

http://www.kpbs.org/news/2009/jun/19/more-primary-care-doctors-switching-concierge-care/

My point was more that neither I nor many of my colleagues had realized that our group consisted of exactly just us – I realize that may sound pretty dumb, but I think lots of people don’t really think about what their “group” is composed of, and what exactly contributes to costs going up.

I also had assumed that insurance premiums going up was inevitable, like the turn of the seasons. It honestly hadn’t occurred to me that little things like opting for brand name drugs to generic, or making those just-to-be-on-the-safe-side trips to the pediatrician, could actually have a concrete effect on my own premiums.

Many of us know better than this on our home insurance – making claims puts your personal premiums up, so we think twice about replacing a windshield with one small chip in it, or making a claim for the kid’s bike stolen off the front porch. But I also know that my HO insurance premiums are tied to events across my whole state – when a hurricane hits the Gulf Coast, my central-TX premium is likely to go up.

If people knew more about how their own specific behaviors affect the costs of their insurance, and precisely how that is spread across what consitutes their group that might (like pricing for individual procedures) help people make better choices about what to consume. Maybe.

BTW I also agree with your general ideas on how to start fixing things.

To your point about people not feeling responsible for their health, I’ve worked in various pharmacies over the years, and I was always amazed:
1) at HOW MANY medicare/medicaid patients there are
2) how few of the medicaid/medicare patients speak English
3) how irate these freeloaders get when they have to pay anything, even the smallest amount, for their medication.
I remember one lady, who reeked of cigarettes, berating me for 10+ minutes for a $4 charge on 3 months of meds b/c SHE felt that medicare should have picked up the entire bill. Sure, she probably spent $200/month on smokes, but Obama forbid she should have to pay $1 a month to stay alive.

I patiently explain to them that no one is going to charge them $200 a month for insurance to cover their treatments that cost $300 a month. It’s equivalent to trying to buy insurance on a car *after* you wreck it.

People don’t view health insurance as insurance, for whatever reason. The larger picture is that people don’t appear to feel responsible for, or personally in control of, their personal health. Insurance is something you buy to cover rare events that cannot be realistically saved for as an individual. Not something you buy to cover reasonable and expected expenses on a recurring basis.

You get the same problem with people focusing on their doctor Copay. Insurance costs $200+ a month and their worried about whether they pay $25 or $50 for a cold two or three times a year.

So when I paid $10 for a co-pay I was going to Walgreens and buying $25 meds. But when I have to pay for it myself I can get a 6 month supply for $33. BUT, I have to dodge around the stupid government laws in order to do it as if there was a black market for Triglyceride medicine where pre-pubescent teenagers would get all hopped up and crash their cars.