Apparently they do this so that people aren't surprised at the magnitude of the bill. Last September I got a covid test at the same place as I had symptoms and was just about to travel. They didn't provide an estimate at that time, but looking at my insurance statement, I see they billed $394.35. The negotiated rate meant that the provider was paid $184.98.

Looking back at my past estimates, I see that in 2015 the estimate for the MRI ordered by an ENT that was diagnosing hearing loss was $11,427. In Canada, apparently a private MRI would cost $1,000 or less [1]. I bet the fact that they are available for free for those willing to wait a bit longer helps keep the cost down. If I was given the choice of paying $500 or waiting a few more months for free, I would have definitely taken the free option because I had already delayed care on this for over 10 years.

1. https://www.olympiabenefits.com/blog/how-much-does-a-private...

My wife works with people that are undergoing cancer treatment. One of them is single and lacks FU money in her bank account. She needs to carefully manage the 20 weeks of unpaid leave available to her (and a couple weeks of paid sick leave and vacation) so that she doesn't lose her job. While COBRA could provide continuation of benefits at her current level, that is quite expensive. The Affordable Care Act would give her a path to affordable insurance, but her recent salary would seem to put her out of the running for a full subsidy. Switching insurance in the midst of treatment could mean switching providers. Surely switching providers from one of the best in the area (which is open to Medicare) to someone else while in the midst of cancer treatment is not ideal.

Per the Canada MRI pricing, a private option can be an empowering alternative. A high-quality public option is needed to keep the private options in check and to provide a base level of care for those that are not lucky enough to be able to afford private insurance and private care. Even then, surely there are horror stories.

Indeed, transparent pricing is a plainly obvious requirement of a free market, which is why lots of business "innovations" are ways to hide pricing. Where it breaks down in my mind is that we have a hard time assigning a market value to human morbidity and mortality.

I have my own story of US healthcare which may be enlightening. It happened to a friend of mine. Let's say this friend is not particularly well to do and lived with his 2 brothers, but they don't always get along that well. At some point, they got into an argument that escalated into an altercation where one brother broke a poolstick over my buddy's head. He had a concussion and laceration needing stiches, so he went to the ER. He was unable to remember his name or which ER treated him, and as a result, was never billed for the care provided and learned the key to universal healthcare in the US - he just gives a fake name at the ER now.