What you say about insurance companies is very true. In the end, it's negotiating with providers that will bring down costs. I own an HSA policy for myself and my child ($1350/year), so I am insured against only a big loss instead of being insulated from the true cost (as I used to be with employer insurance). Since I pay my own medical bills and would likely only hit the 5K deductible if we had a hospitalization, you'd better believe I'm cost-conscious and discuss the cost/benefit with my doc about everything. I also know, for example, about the cheapest ways to get medical testing should it be needed. As it is, no one cares how much an MRI costs because no one sees a bill.

"I'm cost-conscious and discuss the cost/benefit with my doc about everything."

How much does your doctor charge to see you to discuss costs?

I one asked a doctor what a lab test would cost but she said "I don't know the cost. I just order the tests."

Yes - part of the problem is people with good health insurance are insulated from the true cost of the coverage as they have no incentive to find out how much doctor visits, lab tess, etc. cost. Thus, there has been a push toward high deductible plans to encourage people to become better health care "consumers". The problem is if you're like me, there's no way you can join one of these plans. My husband's a type I diabetic and I'm on a medication that costs about $15K a year. If employers are removed from the equation and we're pushed into individual health insurance, we're screwed.

Serenity:

MRIs are not driving the cost of healthcare insurance. Popular fantasy amongst 90% of the population. It is simpler than MRIs.

You may be good at finding the cheapest wat to get medical testing, but are you a health care professional? You say that in the case of a hospitalization you would discuss the cost/benefit with you doc about everything...good luck with that. If you or your child was hospitilized you would see you doc for about 5 minutes once/day and s/he would be busy directing your care, not explaining to you exactly why those lab tests that cost $500 are needed. Are you going to over ride the doc and say, no, I don't think I need those? If the test cost $750 at the hospital but only $350 at the clinic down the street are you going to get up out of your bed and walk down there? Suppose you decide that for you the cost does not outway the benefit so you don't have them down and the outcome is not good? Are you going to be happy that you saved the $500 or are you going to live (or die) with that regret? Suppose it is your child and not you? When my children are hospitalized I want the best care the doctor I trust perscribes and I would rather trust the doc than myself when it comes to those decisions, and I am (probably) more medically sophisticated than you. I'm not going to compromise their care just because it might cost me some dollars.

All insurance is based on the assumption that the insurer can invest your money for many years before it has to pay claims for you. Group insurance is supposed to lower the cost on the assumpiton that the majority of the insured are not going to make major claims at the same time or over many years. This is why insurers can have open enrollment with no restirctions on preconditions. The healthy insureds give a ride to those who are in need medical attention. An individual is going to be covered for prexisting conditions unless willing to pay a very high premium. The premium will go up with the age of the insured and the insurer always has the option to cancel. or raising the premium, leaivng the insured person holding the bag. The ony way to cut insurance premiums is to cut the number of insurers competing for the medical insurance dollar. The greater number of insured n the insured pool, the less the cost. Competiton in the medical insurance industry results in policies with approximately the same benefits, deductible exclusions and premiums for approximately the same cost. There is no true competition in the medical insurance industry and the whip hand is always with the insurer