A long time ago, when I was poor and underinsured, I had a medical situation that required imaging. The doctor’s office said they had the machines on prem, but they couldn’t give me any kind of price break. So he sent me to a specialist. Signing in to the specialist, they told me that the cash up front discount was 75%, and that even a hint of having to deal with insurance companies was going to mean a higher effective out of pocket.

Practically any US medical practice is going to have huge staffing overhead for the people who maintain the accurate billing records and wrangle with insurance companies.

I can directly compare with the French system: Doctor has a receptionist, you pay him cash right there on the spot, and he’s very limited in what he can do. E.g. he has to send you to the pharmacy to buy your shots, but he’ll administer them. When it’s all done, you fill out a crapload of forms, staple all the receipts to the stack, and your employer (via insurance) returns somewhere between 60-80% of it.

I have long maintained that moderate reimbursement for outpatient care would be a huge improvement for the US. At the same time, there’s a fairly large entrenched interest that wouldn’t like this at all.