I remember going to a medical financing conference, probably in the late 80’s. There was some sort of legislation pending, have no recollection of what it was. But there was a session, attended mostly by physicians, assailing unions for destroying healthcare. While I certainly didn’t agree with that conclusion, the point was that growth of 1st dollar coverage and the demise of annual deductibles and 20% co-pays greatly reduced consumers motivation to carefully consider their use of medical services. $10 they could always afford. 20% not so much.
(Ironically, it was the physicians who were the greatest beneficiary of that particular shift. But they got it all and more taken away from them with they began accepting risk with capitated payments. But that’s a whole different story. Confirming your conclusion that the problem is extraordinarily complex. Indeed it is. And irreparably broken.)
