re: "Americans spend more on health care than anyone". What if it is due to consumer choices?

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What if it is due to consumer choices?

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I tend to think that the pooled nature of group health insurance plans plays some role in this. If you are on a good group plan, it’s easy to spend $20-30 on a name-brand drug vs. $7 on generic, even though in reality the name-brand costs $200 while the generic costs $25. Just drives up the cost for everyone, but nobody notices at the individual level because they don’t see the bill. Even if your insurance doesn’t let you purchase a name brand when a generic is available, there are still cases where you have the option to take a cheaper route. OTC vs. Rx, or even asking the doctor for a different Rx altogether. Same could be said for unnecessary services.

This is why I think high-deductible plans with employer HSA contributions are at least good in principle. When you have to pay full price for everything up front you are much more aware of what those drugs/services actually cost, and you have a larger incentive to go with the lower-cost option. Especially when HSAs roll over each year. But with employer-funded HSAs being part of the high-deductible plans, your actual out of pocket costs don’t change much.

I, for one, have absolutely opted not to fill uneccessary prescriptions and/or had a doctor switch to a cheaper drug since being on a high-deductible plan.

Problem is that while it works great in principle, I’m not sure what impact a subset of employer-funded insurance plans have on the greater (read: Medicare/Medicaid) market. I wonder if taking the same approach to Medicare/Medicaid would be worthwhile.