the fundamental problem is that costs are too high. All the rest of what you're talking about stems from that simple fact.
No, I disagree. You're confusing problem with symptom. The high prices (and poor overall outcomes) of US healthcare relative to other countries is a *symptom* of the dysfunction in the current system. It is not, by itself the cause.
One of the big issues resulting in high individual pricing is that the healthcare revenue pool is currently not well-aligned with the cost pool. This causes a huge amount of unpaid costs and preventable emergency care costs to be tacked on to those who responsibly have insurance and pay their bills, including business-financed health plans. Again issue->misalignment, symptom->high prices to those that actually pay for healthcare. Alignment of revenue & costs is a key part of the solution. Freeriders be gone.
The other big issue is citizen unwillingness/inability to afford healthcare planning en-masse. Why do people find themselves with crushing medical debt, unprepared, and even uninsured? There's a whole number of reasons this happens, and only a few are individually controllable.
Carrying insurance, which insulates you from catastrophic or severe expenses is good. It is something everyone should have. Carrying a health plan that insulates you from every expense and makes every decision cost-neutral, on the other hand, is a terrible idea. It guarantees that you will pay more for your healthcare than you would have without it.
It may be a terrible idea to you, and I bet to many alert people with time to micromanage their healthcare, plan ahead, and have a stash of free cash for emergencies and "wellness" care. This is not the profile of the average US citizen, this is not even your 30th percentile citizen. I'm happy for you and you seem to have succeeded so far. However I disagree your stategy is widely applicable, or that it's a good idea to export it to those who are known to be ill-prepared to execute it.
Partial self-insurance is not a workable/sound idea for a population who, for various reasons, is unable to save even for their own retirement. 75% of US people nearing retirement have <$30K saved. Are you recommending these seniors, unable to save for a patently certain event like retirement, to go with the emergencies-only plan? If not, then you're just advocating for a variation of the freerider program we had prior to ACA...a "freerider-light"?
if you start talking about cost-effective medicine people freak out like it means cutting corners and getting shoddy care. But because I pay out of pocket, I get to make reasoned choices about the health care options in front of me...
Again, you may be good at negotiating, and it may provide you with instant savings. The skill and inclination to execute this isn't common, and it's not a strategy that will succeed for your average (especially below-average) population. There is an enormous, built-in imbalance of power in healthcare, and the patient is ALWAYS in the weakest (pun intended) position to negotiate. Why hang your hat in the weakest of all pegs?
"...get to make reasoned choices about the health care options in front of me"....really now? This must be close to verbatim what I read on a notice years ago...Human Resources smooth talk for higher premiums, higher co-pays, and higher out-of-pocket limits. But hey, they're doing us all a favor, we should all feel good 'cause now we're all empowered and motivated, and have skin-in-the-game, and I guess the HR people can sleep at night. I'll tell you, a decreasing amount of people actually find these statements convincing. Not because they're not achievable by some (i.e. there's a bit of truth in every good lie), but because by now everyone is aware they're impractical for most.
I do agree there are costs to be saved, but I have little faith in these savings being realized by grassroots haggling (or pulling bootstraps for that matter).
You talk about regular checkups. The costs to deliver these are tiny compared to non-preventive care. Yet, a surprisingly large proportion of patients don't take advantage of annual wellness checkups even when included in their "subscription plan". I assert that the rate of preventive care will always be hopelessly worse with self-payers. Given the documented cost-benefit of catching conditions early, again another area your suggestions, as successful as they may prove to you, just don't scale and don't improve the overall system.
Unless people start paying for their own health care, this cycle will never end and eventually the country will be basically a "company town" where we all work for the health care industry.
Really? The cycle will *never* end? Well, signs already point to this not being the case, but no one can rule out we'll go a few more years of escalating HC costs.
That being said, you paint an impossible unraveling. We will NEVER become a "company town" where we all work to pay for HC. The people will install some form of "single-payer" long before we're anywhere near your prediction. Not a chance.
My prediction is that we'll be taking another run at a public option again in ~10 years time. No "company town".