The problem is that there are many ok solutions and most differ in details that could be worked on incrementally after implementation.

But the problem in the US I think is that the society is so divided that it got stuck and certain powers want it exacly divided like that. With a totally polarized 50/50 population nothing important will ever change, everything is a big circus. I hope the best for the US citizens though. If the US continue their democratic downward spiral this all will end up in an even bigger crisis with even more individuals left behind.

The problem is that the big insurers are some of the most profitable companies ever. Just look at the lists of highest paid CEOs. As long as they can afford the most and best lobbyists nothing will ever change.

Is this not a capitalist country? There should be multiple competing solutions for everyone to freely choose from. Nothing like this racketeering situation.

There should be, but this is an example of poorly-targeted regulation where (by design) it makes it easier for large incumbents to hire a team of consultants to manage red tape and smaller, leaner, and perhaps smarter players from appearing in the market due to only the made-up problem of compliance.

Large organizations can look out for themselves, Governments, in an ideal world, should entirely exist to serve the people and should also be comprised of them. The problem with elections is that it, by and large, dissuades competent people who would otherwise be good members of government and attracts among the worst kind of person who is hungry for power which lobbies play on to get their way.

Government prevents actual markets in the USA. The closest you get is elective surgeries. Hell, many states won't let you open a new hospital without getting the permission of existing hospitals. Not very capitalist.

The nature of medical emergencies prevents actual markets. If you have a chest pain, that's not the time to be comparison shopping and reading reviews of different hospitals. It's the time to get to the nearest ER while you can. Markets rely on well-informed buyers, which are just not possible in the circumstances.

That’s bull.

I have a nasty medical condition that necessitates ER trips. I know all three ERs. There’s the good one, the OK one, and the terrible one.

The problem is I don’t get to chose my own insurance. My employer does.

I know exactly which doctors, specialists, and ERs are best for me.

Doesn’t matter. My employer, who is remote and employs nobody else in the state, has determined who I can and can’t see.

And they’ve done it completely blindly.

It’s a messed up system.

But the idea that people won’t avoid bad hospitals, including ERs, is untrue.

And what about people who haven't had a compelling reason to maintain a running comparative opinion of their local ERs, simply because they don't have a chronic condition that keeps sending them back to ERs?

OP's point is valid: it's reasonable to expect someone to look up information before deciding on, say, where to eat that evening. It's farcical to expect someone experiencing acute angina or stroke symptoms to inform themselves about their free-market healthcare options by looking up online reviews or whatever for local ERs.

My experience is people know the “good hospitals” and “bad hospitals”, much like they know “good schools” and “bad schools” or even the “good DMVs” and “bad DMVs”.

The problem is most people have no choice.

For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.

What matters is the institution. And they absolutely do have reputations.

For example, Kaiser Permenante has a reputation so foul it’s known nationwide, despite only operating a few states.

Also, I’ve never had any difficulty getting an ambulance to take me to the ER of my choice (that is, my insurers choice), and I’ve done this many, many times.

Honestly, I appreciate reading about your experiences, and bottom line, I'm happy that you're able to access medical care.

Your experience hints at some of the flaws in US healthcare:

> For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.

Right, and if the ER doctor you happen to draw is out of network for you, RIP your savings and/or credit score. Isn't this a decently common problem, where even an "in-network" institution employs practitioners who are "out of network" for you, so you thought you were covered by your insurance company's rules, only to be surprised days after treatment?

EDIT: this "out-of-network provider at an in-network institution" problem was so common and frustrating that Congress has had to ban the practice, as linked in the article: https://archive.is/50VQv

> take me to the ER of my choice (that is, my insurers choice)

Leaving the choice of ER to one's insurer doesn't sound like my idea of "free market" healthcare. What if they choose your area's "bad" ER? I suppose you can indirectly pre-choose your ER by choosing an insurer which covers the ER of your choice -- that is, unless you get insurance through your employer, in which case I guess you'd have to purchase private coverage for your ER of choice.

Different institutions have different reputations in single-payer publicly funded health systems too, so I'm not so sure if that's the crux of the matter. What upsets me is that those people who are in the most desperate need of healthcare are almost by definition in the worst possible position to make an informed choice. Picture an unconscious victim of an accident, violence, stroke, heart attack, etc. Oh, and it seems generally impossible for even an awake and alert person to "shop around" by comparing price quotes for the healthcare they need, preventing competitive choice.

Then there's the issue that ERs must stabilize and treat anyone who enters, regardless of ability to pay. Someone has to cover the cost of this.

What kind of "market" keeps prices secret from incapacitated consumers? I think MereInterest summed it up perfectly: The nature of medical emergencies prevents actual markets.

The current health care system sucks.

And it doesn’t require a free market to refrain from using “bad places.” I avoid the “bad DMV” like the plague - and that’s a branch of the state government.

Regarding free market health care. It can be done - a good example is Canada.

In Canada, health care is free to patients. The state pays doctors directly. The prices are set by the state, so doctors compete on quality/patient preference.

In America, almost all hospitals are nominally nonprofit (religious, university, etc). In Canada they are often for-profit (there are quite a few public ones too.)

Patients can see whoever they want. Good hospitals get patients, bad ones don’t.

Good hospitals make profits, while bad ones don’t.

That seems like a good system to me.

My Canadian relatives love it. The comparison I made is really just me paraphrasing them.

Dental is pretty much a market. Even employer provided coverage usually has some relatively low annual limit.

Dental expanses are pretty much capped. Unlikely that you have to pay in your life as much as these dental insurances cost over time.