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pietvo, if I'm a bit slow responding to you, it's because I'm making something of an effort to choose my words (not succeeding as well as I've hoped, as my last post seems too emphatic to me now).
Insurance isn't evil per se, but the US seems to be at the point where the insurance companies dictate who gets what treatment. That makes me very uncomfortable. Why can they do that? Well, if an insurance company denies coverage, in many (most?) cases the cost is prohibitive enough to cause the patient to forgo treatment--and that's even setting aside the deductible barrier. Costs are too high, and a focus solely on insurance doesn't address them, and even increases the role of the insurance provider as the deciding authority.
Why are costs too high? You brought up one possible cause which I've had my eye on, but Elfwreck put a finger on what's probably a bigger cause, namely that demand is through the roof, putting great stress on the market. Why is demand so high? Well, it's difficult to avoid the conclusion that the American way of life is highly unhealthy, but another possible factor is that Americans would seemingly rather solve their problems with a pill that by correcting their behavior (of course this is a broad statement; but before you jump on me, stop and think how many people you know that would blame anything or anyone than themselves if given half an excuse; I won't presume to guess at the rest of the world, but it's an all too common trait of Americans). The problem of doctors prescribing unnecessary treatments has an equal effect.
That all feeds into another major contributing factor to costs: the fact that the pharmaceutical industry has the United States over a barrel. What I understand of the new law is that it presented to big pharma everything that it wanted, on a silver platter.
Of course, many costs are artificial. It's been in the news over here how hospitals charge insurance companies one rate and uninsured patients a higher rate for the same treatment--price discrimination. It's not illegal, but it ought to be. Here, again, I think we run into the fact that almost all hospitals in the US are now run by big for-profit corporations. I don't believe that most doctors, because of conscience, would price-discriminate, but the only conscience a US corporation is expected to have in this brave new world is "shareholder value". Take a hospital that is oriented on "shareholder value", let it talk to an insurance company that is oriented on "shareholder value", and I don't think a reasonable man would say that the end result is oriented on the patient's best interests. And the NYT ran an article recently on the trend of doctors to stop private practice and join hospitals.
I was going to write something about who pays, but that's quite enough. Again, the focus on insurance is wrong because the issue is cost. Insurance has it's place, but to expand insurance without controlling costs is asking for trouble. Sorry for being a broken record--don't get me started on the Wall Street bailout!
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