I am pretty sure the providers and insurers know exactly what everyone is charging. It’s the patients that are being kept in the dark.

When I needed a similar non-emergency procedure (cervical, rather than lumbar, MRI), my neurosurgeon, at a large, university-affiliated hospital, referred me to the in-house radiology department.

Within a day or two, I received a phone call from some department at my health insurance provider telling me "Hey, we see that you are going to get an MRI; did you know that you can get the exact same procedure at providers A, B, and C, for a lot lower cost?" They did this even though the hospital's radiology department was in-network.

In this case, the cost difference was similar to what's noted here - about $4,000 vs $450. Since the insurance company was paying most of it, aside from my copay / share of cost, they were motivated to provide me a little transparency.

To be honest, as a patient, I would have preferred to get the MRI at the hospital; their facility was nicer, cleaner, more modern, and there was better data integration for getting the results to my neurosurgeon and keeping them as part of my holistic medical record. Nonetheless, I went to the cheaper provider.

Like any opaque market, bigger players will have more info, but I doubt anyone will share information as its collusion (maybe illegal) and also advantages either your negotiating opponent or your competitors...

Exactly. Small payers are actually pretty hungry for this data. Generally, big payers are more privy to market rates (by paying for datasets, owning clearinghouses, etc).

Yeah, actually I can attest that a lot of our hospital clients have no idea what the hospital next door is charging / getting paid by insurance. So, a lot of price setting is guessing. It's often not cost-based. And often, negotiations will arbitrarily shift high prices over to one service type, eg Blue Cross will say: "Fine, if you want to get paid that much for knee replacements, we get a lower rate for bariatric surgery." So you'll find weird price discrepancies within the same provider.

I realized over the past few years that there is no "natural" price for anything. It's 100% set by competition.

Economic research confirms this. Mergers result in higher prices due to less competition.

What we need is way, way, WAY more competition in healthcare. 10x as many providers, 10x as many clinics, with prices posted on the wall. When they start losing business, they'll notice.

I think you're right. The issue with these services is that they're extremely local. Really, only cities will likely really have much competition. That relies on there being separately owned facilities. And even then there is the issue that 2-3 providers never really compete even if they're not colluding...

I honestly think that free market healthcare is doomed to failure. The information a-symmetry, the size of hospitals compared to populations, localization, the degree of specialization, strategic nature of services, and the social externalities are just too great to ever really have a market. But that's just me on my soap box.

Hopefully transparent pricing will do some good at least. I wonder if requiring insurers to share savings in cash would further encourage people to shop around (eg going to the place 4h away to get a 2k MRI instead of a 4k MRI means you get say half the saving [1k] back from your insurer)...

There will never be 10x as many providers due to the AMA and lobbying. Existing interests don't want to see lower prices and competition.

If this was possible, I'd agree with you. But the reality is that the best we can hope for is single payer.

I was arguing with a doctor friend recently about the AMA. He's on team New York Times, "knows" the Koch brothers are Satan incarnate, "knows" Trump owes Russian oligarchs money, etc.

It just didn't register that the AMA is the sixth-biggest spending organization on DC lobbying [1], right behind Blue Cross Blue Shield (an insurer) and the American Hospital Association.

People worry about the NRA and all kinds of other stuff. They should really get mad about how outrageously the medical industry lobbies (as do the realtors), and how much they've managed to extract from ordinary Americans. It's an utter coup of PR that people aren't rioting in the streets about this. Everything about the medical industry -- licensing, high physician salaries, etc. is rigged to be good for insiders.

[1] https://www.opensecrets.org/federal-lobbying/top-spenders

Sidecar Health's website publishes exactly what their insurance pays for a procedure/doctor-visit/Rx -> https://app.sidecarhealth.com/previewCoverage