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Firstly, prices only reliably influence decision making if you have skin in the game.
If I am at a bar and paying for my own drinks, I will carefully consider the trade-offs between different options. If some corporation is paying for drinks, different things could happen. Perhaps I am indifferent to the company spending money, then I might use high prices as Bayesian evidence for "is a good drink". Or I like the corporation and do not want them to spend money needlessly, then I might still consider the trade-offs. Or I hate them and want to try my best to bankrupt them through my liver, then I might simply drink the fanciest drinks I can find even if they taste like horse piss to me.
For major surgeries, patients typically do not have skin in the game, their health insurance is paying for them. Price transparency is nice for society, but not crucial for patients.
Secondly, the health insurer and the hospital already have a pre-existing agreement on a price list. What they are negotiating about is which medical procedures (and line items) are indicated.
In a borderline sane medical system (e.g. what we have in Germany), that should be wholly between the health insurer and the clinic. The doctors use whatever procedures they see medically indicated, and then their billing department will settle with the health insurer. Sometimes the health insurer will dispute the charges. If dispute resolution favors the insurer, the hospital will just eat the charges. Running a hospital is a mixed calculation, you can afford to lose money on a few cases if you make some money on average. The patient would only be on the hook if they had lied about having health insurance.
Of course, the US health care system was lovingly hand-crafted by Moloch himself. Take competing health insurers, but then let the employer -- who cares very little about coverage but a whole lot about costs -- pick the health insurance company for their employees. Then pass a lot of regulations forcing Dog Butcher Healthcare to actually cover anything. Let every insurer build their own network based on secretly negotiated prices so that people will have to change their therapist when the change jobs. Sprinkle in some socialized healthcare for the poor. Have juries award excessive malpractice damages to keep everything expensive. Also link in the Molochian university and student loan system for the same reason.
I agree that there are plenty of situations where the patient doesn't really have much skin in the game or where price mostly doesn't matter for whatever reason. I wrote about an example of the former here.
The latter are probably quite routine, too. This is sort of unsurprising in economics. Demand curves slope downward, and everyone to the left of the equilibrium point gets consumer surplus. The further left you go, the more surplus they get. If I'm a customer who would buy an apple for $2, and prices usually vary a bit around $1, but maybe if there's a bad harvest, they're like $1.50, then yeah, for the most part, the price doesn't matter to me. That doesn't really imply that the price doesn't matter in general. So, riffing of what you say:
Price transparency of apples is not crucial for a bunch of people whose willingness to pay isn't somewhat close to what the price actually is. But it's actually pretty important for society and for a bunch of people whose willingness to pay is much closer to the actual price.
Many people are discovering the headline-grabbing version of the problem, too. Imagine if apples usually cost about a dollar. It varied from day to day, but they didn't tell you up front. Some times, incomprehensibly to the individual, they suddenly cost $1k. But they also didn't tell you this until after you'd eaten it (after services were rendered). Everyone knows it's kind of sketch, but no one can bring themselves to just make the grocery stores give people a price up front. This is how a lot of people view the current lack of transparency. Memes abound about how you got a papercut, spun the roulette wheel of the American Medical Industry, and found out later whether it cost you $1 or $100k.
Yup. This cuts out most of the arguments for why patients shouldn't get prices. At the very least, providers can provide an estimate of what procedures (and line items) they're planning to bill. They can look at the pre-existing, agreed upon price list, that they have, and give you the relevant information. Of course there will be cases where 'something happens', and it turns out to not be correct. The classic example is that you're going in for a relatively routine surgery, and there's like a 1% chance they're going to find something that 100x's the price. Well guess what? There's a good chance that the doctor already told the patient that there was something like a 1% chance of finding something that significantly changed the nature of the procedure. That's just good informed consent. That same informed consent should at least include some form of, "...and yeah, if that happens, it'll 100x the price." (Now, that may not meaningfully matter for some insurance cases, but just inform them, people!)
For the most part, providers and insurance know where the line items are that typically get argued over. Sometimes, a pre-auth is actually good to do. Providers can at least tell the patient what their plan is, but it would also be nice if they gave their perspective on whether the planned billing was likely to run into difficulties or not. As the linked article puts it:
Just communicate. If there's likely to be some sort of issues with haggling over line items, inform your patient the best you can.
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Let’s also add EMTALA- hospitals get left on the hook for care for genuinely uninsured patients.
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