What is the “micro scale” you’re referring to where healthcare prices are a non-issue? Medical bankruptcies are a pretty conspicuous problem in the United States.
I'm sick, I need to go to the doctor. In the USA, good luck figuring out how the price of anything in any way should affect the choices one makes at that moment.
Is there a difference between going to the CareNow clinic near my house or the Code3ER near my house? I have no idea. Should I go to a hospital instead? Is that cheaper or more expensive? I have no idea. Once I get there, are things going to cost me more or less depending on which arbitrary doctor I end up with? I have no idea. If they order further tests or a consult with someone else or some medicine I've never heard of, do I have the ability there to ask questions about price? No, I've tried. Doctors genuinely seem to have no idea whatsoever what things cost, by and large.
So at that scale, not the big picture but the individual scale, prices don't matter because if they did, I'd just stay home and hope I live through whatever ails me. Which is often what I do, in fact.
I hope forcing publication of prices makes a difference. I'm suspicious that companies will find a way to do so that protects their profits, but hey, I'm hopeful.
As for the physicians and pricing - I have some sympathy there. First, I'm happy that they are not making medical decisions based on overall price but instead based on risk. This seems to be the best way to treat me the patient and not me the line item.
That said, they also have to deal with liability (especially in an ER) so they have to treat any POSSIBLE thing that you might have before you leave since people often arrive with zero medical history and they have to rule out side effect things that may not be an issue. Further, the fact that their physicians often deal with advanced specialities and/or emergency medicine means you're paying for a specialty for something that could be simple. I try to stay out of ERs unless I'm worried about my life and instead use urgent care / clinic visits when my GP is not available. Their billing seems to be much more consistent, anyway, and there's less risk a physician won't be covered by your insurance just happening to stop by.
They are there but you more than likely don’t know anyone personally that has done it. Most people have insurance via group plans and don’t get that sick, it is the outliers that have huge problems. That is what makes the problem so hard to get people fired up about.
