The only real competition in our system is among insurance companies, medical people and employers. Notice, the patient isnt really in that mix?
As a general rule, you get the insurance your employer offers (if they offer).
Generally, employers are not looking at providing the best health care for their employees, they are looking out for their bottom line and own self interests.
Hospitals, doctors and insurance companies negotiate pricing amongst themselves.
The patient is pretty much left out of the mix.
Now, you do have the option of not using the employer offered insurance and instead paying for your own choice of insurance out of your own pocket. But even if you choose to do that, the employer doesnt credit you the money they would have spent on insurance for you. You just lose that and spend more to get your own insurance. Moreover, if you have an ongoing condition such a diabetes, you may not be able to get that covered if you go to private insurance. (pre existing condition)
So you dont REALLY have much of a choice there. Hence, there is no real competition.
And, if your employer doesnt offer insurance, which usually is the case for lower paid jobs, and you cant afford to buy insurance on that lower income salary, then you can get health care if you are in a life threatening situation. But if you cant pay the bills, you face alot of other issues, like your credit being destroyed or losing what little assets you might have.
I knew a bankruptcy attorney once. He was a good friend. He once told me that most of the bankruptcies he did involved medical bills and that they were usually the trigger for a BK.
You've mentioned tort reform on a few notes. Clearly malpractice insurance plays a part in all this. Doctors order all kinds of tests that are really not necessary, but they are covering their backside.
Like I have said before (in another thread) -- I got a cortizone injection in my elbow. 1 doctor visit, medicine was $15, the rest of the bill (after insurance discounts) was $285. Seems high to me. Insurance didnt pay because it was a "surgical procedure" so it went to my deductible.
Anytime it costs an insured person $285 for an injection of $15 worth of medicine, there are problems in the system. Plain and simple.