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I would be over the moon thrilled if doctors were as transparent as auto mechanics. They tell you what they're planning on doing, they give you a (usually pretty good) estimated price, and then if they get in there and find something that's going to change their plan/cost, they tell you, give a revised estimate, and get your approval before proceeding.
No one is asking for doctors to be clairvoyant. Just that they do basic communication of what they know, when they know, to whatever extent possible.
Obviously, there could be cases where a patient is under anesthesia, they find something genuinely unexpected, whatever. I think a simple rule for this is to just follow normal informed consent principles. If you'd be comfortable proceeding without getting specific informed consent for the medical costs/benefits, then you probably don't need to give them a price, either. But to use an example based on what one of the doctors here said before, he said that they might know that a surgery typically costs $X, but 1% of the time there's a thing that makes it cost $[Stupid]x[X]. Simple: you know this, so just communicate it to the patient. Sure, it's probably not going to change much in that particular case, but at least they've gotten a heads up that there's about a 1% chance that they'll wake up on the hook for their entire OOPM. [EDIT: I'm pretty sure this is concordant with medical informed consent procedures. If you know there's a 1% chance that there will be a major shift in what you're going to do in a surgery, I'm pretty sure you're kinda supposed to tell the patient, "Hey, so this is a small chance, but it is known to be about a 1% chance."]
It's honestly just basic human decency in business practice.
If you know the rate of the complication and the cost change then a simple financial insurance product could normalize that cost.
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