Regardless of what you do people who are bleeding out in the middle of a street or who are delirious from fever won't be acting with price sensitivity.
Even a large percentage of ER visits would likely see people acting with price sensitivity -- This is why in some places of the country you see Emergency Rooms advertising about how low their current wait time is. The wait time isn't really relevant to true emergencies (you get seen right away), but people without true emergencies don't want to wait. Financial cost is irrelevant (someone else is paying), but the cost to their time is relevant, and so people select emergency rooms (and urgent care clinics) where they will have to wait less. Hospitals are acting on the one thing that the patient cares about (sitting in a waiting room), since the other (price) doesn't matter.
For the really expensive things, like end of life care, governments with universal healthcare systems are the ones that act with price sensitivity and ration this care and refuse in some cases to pay for the most expensive treatments. For example, the UK has the National Institute for Health and Clinical Excellence (NICE), which set a maximum of about $47,000 per quality-adjusted year gained. What we refuse to do in the US is allow patients to make a choice like that (instead, we mandate that insurance cover far more in health care expenses, driving up the cost of that insurance). As a comparison, the US sets it supposedly to about $50,000 per QALY, but in practice it tends to be far more, with some regulation-required treatments requiring as much as $500,000 per quality adjusted year (some heart pumps, and kidney dialysis being another very expensive example).
Does the ACA address QALY? Seems like it might make sense to tie health insurance coverage to that metric. I would be more than happy to pay for coverage that covered the low end of the spectrum if it would mean lower premiums.
What insurance lets you do is decide in advance what you think is reasonable, assuming no government rules about what must be covered (just like the UK does for its entire population).
Nobody (at least before preexisting conditions were not required to be covered) was buying insurance that would cover a $500k/QALY right when they needed it. Instead, they previously bought insurance that the government decided had to cover a $500k/QALY for certain treatments and weren't allowed to make any other decision.
And what if they choose the insurance that didn't cover a $500k/year heart pump and realize in a panic at the last minute that they actually did want to be able to be treated at that high level of expenditure, but can no longer afford it? They're in no worse condition than somebody in the UK who would never be given the option.
And my point was that such situations account for a very small percentage of situations in health care. Most situations and most medical care expenditures aren't of the type claimed by OP. In other words, it's really not a prime example and many of the highest costs are things that people could decide on. For example, the UK will probably not offer treatments that cost more than about $50,000/quality-adjusted year. It would be possible to offer insurance in the US for substantially less if insurance companies could sell a policy that would stick to that, and many people would take probably buy them (many people choose not to even buy insurance currently).
And I think that you are wrong, particularly when you consider this based on dollars billed by emergency rooms, not patients seen by emergency rooms.
The statistics are that all emergency care expenditures totaled accounts for about 2% of all medical expenditures, or in any case no more than 10% depending on who is reporting and calculating [1]. And, not all emergency room visits are emergencies by far [2] and many patients are swayed by things like advertisements for emergency rooms.
Sources:
1) http://www.politifact.com/truth-o-meter/statements/2013/oct/...
2) My ER doctor wife
Who is talking about all medical expenditures? I am talking only about emergency room visits.
1) Ads for emergency rooms function as ads for hospitals in general. People in need of non-critical care will naturally be influenced by ads that depict a high quality of care for emergencies. The existence of ads for emergency rooms therefore tell us little.
2) "Real" emergencies will almost certainly be more expensive than "non"-emergencies. They are going to charge more to sew your hand back on than to give your kid some coughdrops.
3) "Non"-emergencies, as perceived by a doctor, are not the same as "non"-emergencies, as perceived by patients. The mother frantically driving her kid with a broken arm to the hospital is going to consider the situation far more urgent than a doctor would. In these cases, people are not going to act with price sensitivity, even though they could, strictly speaking.
I said "my point is that [those situations] don't make up the majority of situations in healthcare" and you said "And I think that you are wrong, particularly when you consider this based on dollars billed by emergency rooms". I don't get the point of looking at a percentage of emergency-related dollars billed in emergency room visits. My point is that if less than ten percent of all medical expenditures are related to the type of emergencies where (to quote OP) you are "bleeding out in the middle of a street or who are delirious from fever [and] won't be acting with price sensitivity.", then that type of situation is not a primary driver of medical costs in the US, nor is it the most important factor to consider when deciding how our medical system should be run. A huge portion of health care expenditures are of the type where a person would act on price.
In short: Non-emergency care doesn't necessarily mean care where you can flexibly and easily choose your care provider.
How long she should suffer before getting treatment definitely doesn't have anything to do with your disposable income. Some people might agree with you that poor adults deserve whatever the market gives them (I won't) but how are you going to hold people's kids responsible for having parents who are too price-sensitive to get them timely medical treatment?
I know this is a straw man for your argument but try and make it somewhat realistic. And no need to appeal to emotion by making it about a child.
If that's true, why are we using this tiny loss-rate percentage in healthcare—when other industries handle double or triple the loss rate without any drama—as a primary argument for making dramatic changes to healthcare, or alternatively, as an argument against changes that would fix a whole bunch of other things, but not that, because they don't go far enough? Do we really need to solve that?
It seems to me that we can actually just ignore the problem of emergency room situations—including non-payment—when discussing improvements to healthcare regulation in the US because it really doesn't matter. And since it doesn't matter, people should stop bringing it up as if it did.
My $0.02 (assuming the percentage I've heard is accurate).
"Not everybody can afford cell phones. What's the point in offering them on a free market place for the 1% who can afford them?"
Initially introducing price sensitivity into the healthcare space would only touch marginal areas - maybe surgeries that could be scheduled and small things where it's quite interesting to see whether CVS or Walgreens is the more inexpensive choice, or whether the physical is cheaper at an urgent care clinic or my primary care doctor who offers a monthly low membership fee. But, eventually, open competition by those who master processes and methodologies will create a price pressure (combined with public reviews/vetting) that will permeate the entire industry. Those who optimize by leaving patients happier (less cost more care) will draw more attention, money, expand). So, if you can picture such a model, even the person hit by a car in an accident could benefit from faster and higher quality EMR as and end point of a whole long list of improvements triggered initially by something as mundane as transparency in pricing. Still, funny, we accept that for most parts of our lives as a given.