I love what you say, but how does one realistically implement this today? I can’t exactly call up a hospital and say “cut the bullshit. I need a single price for procedure x”. They’ll just laugh and hang up the phone. (I’ve tried- most recently for a vasectomy). As you say, the industry is fat and happy and has no reason to bend to my will no matter how much sense it makes in the long run.

My point is that we have a whole bunch of policy nerds hand waving this complexity away and saying “enjoy your hsa- go forth and price compare as the invisible hand of the free market will provide!” Unless there is force from above, there certainly is no way the masses can navigate the system and force change themselves.

And the truth is that stuff does happen that’s not anticipated. My wife’s surgery was supposed to be routine. I would have had no idea ahead of time that there would be a lingering internal infection afterward. Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”.

If a tradesman screwed up a plumbing job, he would be called back to fix it at no cost. Instead I’m (or in this case my insurance) is stuck with >$100k of bills from the ICU to bring her back from the brink. I consulted with several malpractice attorneys who basically said unless the surgeon was drunk and slurring his words while operating, there is no case. The standard of care is so low.