Nobel Laureate Kenneth Arrow argued that healthcare doesn't fit into traditional market based thinking and I agree. http://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf
What you say is correct only if you have transparency in pricing and some type of quality measurement. ONe of the things Obamacare did do was to improve hospital practices such that there are far fewer infections in surgical wards and as well as fewer mistakes in Rx dosing. There is no transparency in pricing at all. I tried to get the prices of a lumbar spine MRI and no provider would tell me how much they charge. the only control on pricing right now is through insurance negotiations and if you go to an in plan facility or have Medicare you can get a preferred price. What if you are on your own and you can't get pricing information. this is exactly what will happen if you have an HSA or some other high deductible policy.
As to quality, how do you define it? How do you know the hernia surgeon was the best one? How do you know about surgical infections in the hospital? etc. To make this argument that market forces will take care of this is specious at best and certainly not a recipe for good healthcare.
Although I agree that the health care market does not currently fit a traditional market, I do not think that this is inherent.
The problem with health care is that insurance has become a middle man for almost every procedure imaginable, which is what we have come to expect. So, those whom are receiving the care never really know how much it cost or the quality. Those whom do know these answers are not the ones making the decision on whom to use or what to get (usually).
The market has become distorted.
How do you fix this, let people negotiate the fees themselves. Prices will come down. People will stop buying and, of course, die, initially, but the net effect will be to equalize the market and bring pricing down. This sounds draconian, but like any other market, it will work.
I am not sure I would be prepared to go this far though.
Instead, maybe only have insurance for terminal illnesses and deceases, much like car insurance. We don't expect car insurance to cover oil changes and basic checks, so why should we expect health insurance to cover cost associated with the common cold, or a broken bone, etc.?
Now, insofar as getting pricing for procedures, I am sure the lack thereof set prices is partially due to insurance coming into the market as well. Hospitals and complex heath care centers most likely invest in MRI or Gamma Knife Radiation machines (or whatever) without really knowing how much they need to charge per screening to produce a profit. They just know what their overall revenues will be from insurance payments and allocates a certain percentage to advancements in care.
Once again, take away insurance as a middle man and they will quickly figure this out.
For simpler procedures, not like the ones you listed, you can get pricing fairly easily.
I did go about two years with out coverage. In that time, I broke my hand in two places and (thankfully) only needed a cast. The x-ray initially cost $120, but I got it lowered to $80 since I was paying out of pocket. The cast was $450, but was lowered to $280 for the same reason. I doubt they felt bad for me, but more likely since they were being paid on the spot (cash in hand without any paper work) that was a cut to their business admin cost for my service.
Should I have had insurance? Not sure. I know the cost of insurance during those two years would have added up to a lot more then $360, and any money I had at that time went to marketing my business. I think I made the right choice to go uninsured for two years, especially now that my business is doing well.
