Health insurers make an order of magnitude less than providers, and our providers charge 3-5x more than European providers, but somehow insurance is "the core of the rot"?
OP said the "health insurance scheme we've cooked up" is the core of the rot - not insurers' on their own, but rather the whole regulatory environment ("we") that enshrines the dynamics of HMOs, imaginary prices, and whatnot.
I agree with a lot of what you are saying. Trying to demonstrate some common ground - my (somewhat shallow) reading of the Anthem Anesthesia issue aligns much more with your analysis than the pop narrative.
But how exactly is the denial of care suppose to function as a price feedback mechanism to form a working market between providers and insurers? Is an MRI provider supposed to be thinking that if they lower their prices by 10%, the insurance companies will increase the number of approved MRIs to make up for it? And this still ignores that prices are not the same as profit margins, which is a huge hand wave here. Also if those denied MRIs were truly unnecessary, then how would paying for them merely because they cost a little less make sense?
Which is the crux of where my original comment was coming from. The responsibility of deciding necessary medical care needs to be laid at one decision maker (eg the treating doctor serving the patient per their code of professional ethics while fundamentally still working for the insurance company), rather than this split-brain blame game between the patient-facing doctor having little downside to saying yes, and the back office "doctor" at an insurance company having little downside to saying no. An insurance company shouldn't really even have its own opinion on something decided by a medical professional they're already contracting with, especially when that opinion has been created purely based on formulaic paperwork processing. At most they should be able to refer the patient to a different provider to perform the service, or withhold some payment for the service per their contract with the provider (but invisible to the patient).
This is obviously not the only reform we need to get any sort of price signals and sane division of responsibility in this industry. Because yes, provider costs are the main problem and they've been marching ever upwards. But every one of these terrible dynamics that has been allowed to fester is in need of its own reform, especially if you aren't advocating for the blanket approach of single payer.
