Because it's sort of like hotels. There's a "rack rate" which is a high price that nobody pays, and a price floor is whatever Medicare pays. (With Hotels, GSA is the "normal" price floor, and cheaper rates are usually wholesale) If you price cheaper than Medicare, you get sued for fraud unless you charge that low cost to Medicare.
Everyone else has a bewildering discount scheme. The doctor literally has no idea what you pay.
In other cases you have HMOs, where primary care doctors get a monthly nut to take care of you and don't get a fee for service in most cases.
Great example. Ever checkout without an idea of what your hotel bill is going to be?
> The doctor literally has no idea what you pay.
But if it matters to me, then it should matter to my physician. Most of them will come up with a reasonable response if I tell them "doc, I checked at the pharmacist but I couldn't afford those drugs you prescribed, what else can we do?" Most of them empathize with their patients and come up with an alternate treatment plan if one exists.
I don't think it's good enough to say "well gee discounts and providers and algorithms -- math is hard let's surprise you" because somehow they can figure it out at bill-generation time. At the very least, hospitals/physician's offices could produce a "given your insurance + the nature of your chief complaint, this visit will cost $x, these common diagnostics cost $y/z/w."
Everyone else has a bewildering discount scheme. The doctor literally has no idea what you pay.
In other cases you have HMOs, where primary care doctors get a monthly nut to take care of you and don't get a fee for service in most cases.