The insurance market is selling insurance to individuals.
The healthcare market is selling healthcare to patients.
Except it's not. The patients receive the healthcare, but they don't pay for it, nor do they choose 100% of it...the insurance companies do. Imagine you're buying a car where your choice of car was limited to "SUV, compact, or limo". You pick the category and then your employer chooses who will provide your car insurance and that insurance company selects your exact car brand. The car manufacturer then determines what options you will have on your vehicle. If you don't want that brand car or those car options, find another job. Should your employer pick a shitty or expensive insurance option, you're fuck-all out of luck. Should the manufacturer pick car options that are ludicrously expensive, both you and the insurance company are fuck-all out of luck. That's roughly analogous to the situation to healthcare.
The patients are paying healthcare providers to act as effective negotiators for them, and backing them with their patronage.
They are in fact not doing this. Patients with insurance pay next to nothing to healthcare providers. The bulk of the money always comes from insurance. Additionally, people don't choose their patronage to healthcare providers based on negotiating ability. They choose it based on doctor familiarity and history (or specialists by reference or reputation), often set from an early age (my primary doctor hasn't changed in decades, nor would I want him to). And again the consumer is rarely even choosing their insurance -- their employer is. And what they pay is completely hidden from the consumer as well...it's just another cost to the company. So they could just as easily offer you a salary 10k lower than you would normally have to account for your additional healthcare expense and not spend any time whatsoever shopping for a better deal, thereby leaving you with the option of shopping for a new job to get affordable healthcare (if you even manage to realize you're being underpaid)
Remember the lie "if you like your insurance/doctor, you can keep it"? ACA forced a change in my insurance, which my current doctor was NOT an "in-network" member of. It's a perfect example of the lack of consumer choice in this market. I wanted my doctor. I could not have him, namely because I am not the one in control of my healthcare choices.
Do you believe it's a sane healthcare system for me to basically have to find a new job to be able to keep my doctor? In the current system, true costs of healthcare are hidden from insurance companies since rates are negotiated. Then true costs of insurance are hidden from the consumer, since employers bundle the cost into your salary. Wanna see what's stagnated middle class salaries for the past decade? Look no farther than healthcare.
So what? Nearly half of all providers are out of my care network. They're excluded from my healthcare options because they cost me three to ten times as much. If the hospitals, doctors, psychiatrists, and pharmacies wanted my business, they should have signed on with CareFirst's BlueChoice PPO network and CVS Caremark's Pharmacy Benefits Manager
You're acting like the "in-network" concept is some kind of insta-win. My new insurance is costing me WAY more than I ever paid in the past with my old insurance (on the order of double or triple). So I challenge that assertion. And I had BlueChoice insurance. It's what I was forced to drop because they didn't cover my doctor. Now I'm on my wife's insurance with UnitedHealthcare, another shitshow. Apparently all their bloodwork has to be done at in-network Labcorp and there's no coordination between healthcare providers and health insurance providers to make this happen. So last time when I went to the doctor for bloodwork, despite the fact the nurse drawing my blood being covered by my insurance, they shipped if off to "their labwork provider of choice", which my insurance promptly refused to cover since it wasn't LabCorp.
To get costs down, you must get the healthcare providers to lower their prices
And your plan for this in the current system is what exactly? You're acting like insurance companies and "in-network" concepts are the solution, whereas I don't see them doing a damn thing about costs.
You can only disconnect competition from the healthcare insurance market by ignoring half of the stuff actually going on
That's only true because you've accepted a system where health insurance pays for 100% of your healthcare and you trust your employers and the associated insurance companies to be "trusted stewards" of cost savings. If insurance actually behaved like insurance and left healthcare in the hands of the consumer (like it should), the disconnect wouldn't seem as weird to you. I've never been in an accident that would require an expensive operation, nor had any expensive chronic illness spring up that would require very expensive drugs. I shouldn't have had to invoke my medical insurance at all over the course of my life, yet I can't even get a routine checkup without going through them unless I'm willing to pay the "no-insurance $1000 rate".
If a hospital is spending $63,000 to provide care and charging $58,000 for that care, it goes out of business. Period.
Yes, and if that same hospital could provide that same care for $48,000, but continued to spend $63,000 because apathy/inertia/laziness/incompetence/take-your-pick, your healthcare and consequently your health insurance will be ludicrously expensive and you'll never know why. Where's the stick/carrot that encourages the healthcare providers to operate efficiently? I don't see one. They're certainly not wanting for patients...our healthcare demand outstrips our supply (and likely always will) and their audiences are captive unless they have remarkable job mobility.