For almost all non-emergency care you can get a good cost estimate up front though. Even for much "emergency" care it wouldn't be hard to provide an estimate and then stick withing a certain % of that. Stuff like stitches, pulling fish hooks out of people and all sorts of other "routine" things that are uncommon individually but are common from the perspective of the emergency room can also be estimated accurately. Chronic illnesses and long term care are what's really expensive.