The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering.
In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much.
The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket.
Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.
In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much.
The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket.
Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.