What I don't get is why the insurance companies don't ask the hospitals to seek alternatives. I know they often refuse to cover expensive treatments. I guess this is a case where they'd rather pay more than deal with bad press.
Last I checked it wasn't so much "bad press" as "massive lawsuits" -- from what I can vaguely recall, hospitals et al being sued because they used "usually good enough" instead of "best", even when there's like a 1% effectiveness difference and the former costs a slim fraction of the latter, has resulted in fairly major legal kurfluffles. It's one of the reasons hospitals and whatnot default to the most effective (which generally means most expensive, as well) treatment in the US, even when they very often don't need to. You often have to
request generic prescriptions and whatnot, ferex. Basically, the alternatives have some hurdles to be reached, and can be risky for the medical side of it to actually administer. If you have two medical options, one with 99.1% effectiveness with .1% the cost, and the other with 99.2%... and you give the former, and the person dies? Even if they would have died with the latter, shit is about to go down. And to be fair, the difference in lives between those two would be a hundred people per 100,000 population -- for a country the size of the US, as an example, that's... not exactly trivial.
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... as for the paying stuff, it's just... weird. I meet a lot of people that actually
want to pay for whatever, but they have trouble understanding how much stuff costs (I have fairly regular trouble with my grandparents regarding that, actually, because they have the occasional issue recognizing that prices have changed and/or what goes in to what they're asking for -- they want to pay what they think the service or item is worth, but don't quite know what that amount
is) or can't really (/don't think they can) afford to pay for X, and so on and so forth. Most folks I meet are pretty down with paying for what things are (what they understand as) worth. The amount of folks I run in to that actually want something for nothing has largely trended towards slim, for me (the closest exception I've noticed would probably be regarding music, and even then people often want to support their favorite bands).
Most of their balking seems to come from either (lack of) capability or wanting to spend their money well* and running into that lack of understanding.
It does seem that that changes when you get to higher order stuff -- corporations, politicians, etc. -- but... honestly, a lot of that seems more like (highly) perverse incentives than anything. The politician can't raise taxes because much of their constituency is already on the edge (do remember that the median wealth/income for a US citizen is not exactly impressive, and there's a pretty significant portion doing substantially worse than that), or would have to make pretty significant non-trivial exchanges to cover for it (at least in the short run, which is often a daunting prospect, even if the 5-10 year outlook would be a net gain). The business runs into problems with increasing expenses because that cuts into investor interest, even if it would otherwise be better for the health of the company, and so on, and so forth. Still... it often looks like there's not really an ideological opposition against consummate payment and whatnot, stuff just... gets in the way. They don't want shit for free, they just have pretty strong incentive to act like they do.
*Or at least things they'd prefer to be spending it on -- see the healthy young adult that doesn't want to spend for healthcare because they haven't been to the doctor in the last half decade and are highly likely to not need to for the next, either, but are having trouble keeping a house and transportation. Yes, there's very good reasons they should be contributing anyway, but it's understandable why they'd be resistant, and it doesn't boil down to wanting something for nothing. It's more not understanding that that's what they're asking for.