It's time for transparent pricing in medicine
No, price lists won't fix the system. But it's a first step - and it's politically possible.
No surprise, Sunday’s article about 10 possible fixes for American healthcare sparked lots of reader suggestions, from minor to radical. I may run a second list with your ideas (or host a chat to discuss the issue).
But I was struck by how many of you pushed one seemingly simple change: requiring open pricing for medical procedures, services, and drugs whenever possible. This suggestion came up more than any other, even restricting drug advertising.
I agree. Open pricing may seem like a small change, but in fact it would have major philosophical and practical benefits.
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(I’m committed to transparent pricing for Unreported Truths! Click to see!)
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Our $5 trillion system encourages consumers, aka patients, to think of care as free — while setting up a maze of hidden financial incentives and honeypots that providers and administrators spend huge amounts of time navigating and fighting over.
Pretending medicine isn’t about money hasn’t made medicine less about money. It has just distorted the system in deeply destructive ways.
Even if doctors do not let financial incentives drive treatment decisions for individual patients (and some clearly do), profit drives every structural decision in American medicine, from where hospitals open satellite clinics to the drugs pharmacy benefits managers push to how quickly patients are discharged.
The list is endless.
Yet at the most crucial point of contact, we simply hide the price of treatments. Among other distortions, this fiction encourages patients to overconsume medical services. We implicitly assume we do not need to discourage people from seeking out healthcare. We imagine most healthy people will not go to doctors if they do not have to, so we do not have to regulate access to care.
But in the United States in 2026, that assumption no longer seems to hold.
We have an ever-increasing number of chronic conditions, often driven by unhealthy lifestyle choices, as well "sort-of" diseases with a strong psychosocial component. Drug company advertising fuels patient demand for the costliest possible treatments for all these conditions. (To a lesser extent, so does hospital and physician group advertising.) Under the circumstances, even completely healthy people may feel almost compelled to use the system, if only because they pay so much into it and get nothing back.
Meanwhile, the lack of open pricing discourages competition on price (obviously). This cartel-like behavior is particularly harmful because many procedures, particularly imaging and blood testing, have very low marginal costs. And routine imaging doesn’t always require expensive new equipment. Cheaper, older machines can deliver more than adequate results.1
In other words, independent providers may have more flexibility on price than patients (or even they) realize, especially for cash payors where insurance overhead isn’t a major cost.
As one reader wrote:
An absolutely crucial fact--that almost no one with conventional insurance even realizes--is that most day-to-day, routine medical tests, procedures, and drugs are very inexpensive. That's especially so in markets like Las Vegas, where I live, where there are many cash-pay customers. A chest X-ray is $23; a standard MRI is about $125; I had a CT scan 2 weeks ago that cost $103…
Of course, there are any number of conditions, medical emergencies, and specialized drugs that are astronomically expensive--that's why we all need some form of catastrophic insurance. But for the day-to-day, routine stuff, the less any 3rd party (insurance company, employer's benefits manager, government, hospital corporation) is involved, the better off everyone is.
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It’ll save you money in the long run once we fix medicine!
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And so we should require transparent pricing for a broad array of routine services — in doctors’ offices, in outpatient and urgent care facilities, in testing labs, even in hospitals where possible. Doing so will encourage price competition. It may also convince some people to start paying for routine services themselves and switch to higher-deductible insurance plans.
Most importantly, it will encourage people to think of routine medical care as simply another service — and help restore their agency over not just health, but the healthcare they consume.
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Another reader put the problem — and the solution — in a larger context:
The core problem in American healthcare is not simply cost. It is complexity, and more importantly, the velocity of complexity.
Rules, reimbursement structures, compliance requirements, coding systems, network rules, and incentive structures change so rapidly that only very large institutions can realistically keep up. Hospitals, insurers, private equity groups, pharmaceutical companies, and large regulatory/compliance infrastructures adapt because they have armies of administrators and lawyers. Independent physicians and patients cannot.
That instability itself becomes a mechanism of control.
Direct physician-patient relationships, transparent pricing, and simple market feedback become harder and harder to sustain because the system is constantly shifting underneath everyone. The result is opacity. And opacity is where fraud, waste, abuse, and rent-seeking thrive.
The public can understand simple ideas:
* transparent pricing,
* aligned incentives,
* direct accountability,
* same rules for everyone,
* and reducing unnecessary intermediaries.
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Implementing four out of those five suggestions would require massive structural changes that are essentially politically impossible in the current system.
But transparent pricing? That’s hard to argue against. That’s at least theoretically possible.
And maybe moving towards it will eventually help drive the rest.
As one reader wrote: I broke my foot and my insurance was billed almost $6K for the no contrast CT scan. I think the surgery with everything - anesthesia, doctor, titanium screws, etc. - was about $8K total and used techniques not available 10-15 years ago. CTs have been around since 1971 - over half a century. Utter BS.
The passage of ObamaCare eliminated what Obama called “trash insurance” AKA catastrophic insurance. The availability of inexpensive catastrophic health insurance coupled with pre-tax health savings accounts, would drive transparency, patient control and reduce over utilization.
Alex, Your point is correct but incomplete. It would not matter if the pricing were transparent as long as the consumer does not have to pay it -- and that is the current state of how things work. It is the decoupling of the consumer from the fiscal decisions that is the problem -- not whether the price is posted.
Let us say I twist my ankle. I go to urgent care and they say "This is a strain, not even a sprain. Elevate it and ice it and you will be fine in a couple days. BUT, there is a 0.01% chance that this could be something worse. We could rule that out with an MRI -- would you like one?" If the cost to the consumer is nil, it does not matter whether the posted price is $103 or $10,300...they will be inclined to say "sure". And THAT is the primary failing of the system today -- not transparency but responsibility for first dollar expenditure.
The proper fix will be a return to catastrophic insurance (yes, some amazing medicine is really quite expensive and that is OK), a broadly constituted Health Savings Account available to anyone and everyone where funds can be set aside for health related expenses, and a return to a practice model best exemplified today by Direct Primary Care -- where the overhead and complexity you note just does not exist.
That would put the patient at the center of making decisions about where and when to spend health care dollars, would ensure continuity of care at the base level, and would still protect for the catastrophes that might occur. Transparency is surely part of the solution. But making the patient have to make choices based on that transparency, as they do with virtually ALL other decisions, is what fixes it.