>someone who chooses a treatment with a $500k/QALY is probably suffering from the same sense of urgency/price insensitivity as the guy bleeding out on the street. Just because that person has some time to shop around, doesn't mean that they aren't getting price gouged. When someones health/life is on the line they are not going to act rationally.

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.