I've always viewed it as an arms race to see who can get away with what between providers, insurers, and patients (and before ACA, employers to a degree).
The true cost of service at this point includes having staff and systems (with their own support staff) to negotiate and calculate the cost on both the insurer and the provider side.
So, in a way, if you have one particularly tough to deal with insurer, that cost gets distributed among all patients, and their insurers as well. In addition, the basic cost of any visit now includes some of that administrative overhead.
In the oil change analogy, if you had to walk into the shop, and there was a base price of $50 to cover the administrative costs, you had to wait until you saw a mechanic to decide if you really needed an oil change, and they charged $50, and then you paid the $20 dollars for the oil change, you can bet by now someone would have started marketing a per-visit copay style insurance for cars too.
None of this is to say I disagree with you, just that it's even worse than I think we all think it is.
The true cost of service at this point includes having staff and systems (with their own support staff) to negotiate and calculate the cost on both the insurer and the provider side.
So, in a way, if you have one particularly tough to deal with insurer, that cost gets distributed among all patients, and their insurers as well. In addition, the basic cost of any visit now includes some of that administrative overhead.
In the oil change analogy, if you had to walk into the shop, and there was a base price of $50 to cover the administrative costs, you had to wait until you saw a mechanic to decide if you really needed an oil change, and they charged $50, and then you paid the $20 dollars for the oil change, you can bet by now someone would have started marketing a per-visit copay style insurance for cars too.
None of this is to say I disagree with you, just that it's even worse than I think we all think it is.