Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care.

PS: I agree with you, it should generally be affordable without insurance.

Funny you say this. A friend just went through this. Not even the insurance company could say. The calls to everyone got so ridiculous that I had to construct lawyerly questions so that people couldn't default to weaselly answers. The provider billing staff seemed to feel put upon that they were being asked to coordinate w/the insurer to figure out patient out of pocket cost would be. And in the end they still couldn't figure it out.

Exactly this! I thought having my friend appeal to the provider's interest in being paid might spur them to figure it out. Surprise! It didn't. Even when explicitly mentioning that the point of asking for this information was to ensure that (s)he had the $$ to pay them, the provider('s billing team) still balked at being asked to figure out out of pocket cost(s). When (s)he threatened to cancel the procedure, they just said "Fine."

(s)He tried w/another provider, who was a little more diligent in trying to figure things out, but the best that they could do was figure out that the insurance company would approve the procedure, and what some of the involved parties were billing. Mind you, (s)he was actually dealing with the hospital where the procedure was to be performed. But of course, since all of the people involved are not hospital staff, they "can't" figure out everything.

It's all ridiculous and the result of bad policy and planning.

On a separate note, I once noticed a billing error. When I called the insurance company to ask if they had any standards/definition for what constitutes delivery of a particular service/procedure, the rep said, "No. We just look at the amount charged and pay if it makes sense."

The customers from which the providers drive revenue are the ones who can afford to go to the doctor. The ones who can't (even if they pay for insurance) are ones providers wouldn't be getting revenue by serving.

“If you have to ask, you can't afford it.”

Or, more to the point, medical procedures often have an unbounded upper limit on potential billed costs, without the opportunity to stop work and inform the customer and get new instructions when it is realized that the original estimate will be exceeded, and even getting a reasonable idea of the statistical distribution of charges for a particular procedure under costly comparable conditions by the same provider wouldn't be easy.

Now, providers could adopt a flat fee structure and eat the risk of long-tail costs, but that creates a lot of risk (and some perverse incentives) for providers.

Unless we're discussing medical care as a luxury good-- and if that's the way that we really want to approach this, okay, let's just be honest about that-- this is incorrect. In my experience, med professionals have made assumptions about what I could and couldn't afford based on their mental databases of flawed correlations. Things they thought I probably couldn't pay for, not only could I have if necessary, but didn't need to because my insurance was willing to cover it any way.

I'm not going to address the rest of what you've written because, quite frankly, I have a difficult time believing that you are being serious, for a number of reasons. If I'm mistaken, then I thank you for sharing an interesting thought pattern and apologize in advance.

Agreed.