> There's something horribly wrong with a system in which the doctor cannot readily tell you how much a procedure will cost.
There's a reason for this, and I've written about it in more detail on Hacker News before, but in short:
Medicare reimburses rates below-cost. About 7% below COGS, which means providers lose money per-patient, even before they have to pay doctors, nurses, janitorial staff, building upkeep, etc.
To make up for this, providers inflate the rates they charge to private insurers. They don't expect private insurers to pay the full amount that they bill for, of course, but private insurers usually peg their final reimbursement agreements to multiples of what Medicare pays (e.g. "350% of the Medicare rate)[0]. The provider can't tell you what you'll end up paying, because they literally don't know - it depends on the rate your insurer ultimately agrees to pay, which depends not just on what your provider charges, but also on whether the insurance network has existing payment agreements that apply to your treatment and supersede the rate that they bill.
Private practices that don't accept insurance can always tell you what they'll charge you. Private practices that accept _only_ private insurance actually can sometimes tell you, because they don't have to do the roundabout dance to the same degree[1], so they often have more standardized rates with private insurers. However, standalone private practices are a dying breed - most are part of practice groups, which are themselves owned by hospital networks, so it's very hard to find a doctor who _does_ accept private insurance but is _not_ part of a provider network that accepts Medicare patients[2].
[0] It doesn't help that, in many cases, private insurers are required by law to reimburse more than Medicare does, which perpetuates this whole cycle.
[1] They may still have a back-and-forth billing negotiation, but because they don't have to use privately-insured patients to subsidize the publicly-insured ones, they have a much better idea of where it will end up.
[2] Some hospitals are actually talking about dropping Medicare altogether, because it's so expensive and complicated for them to accept Medicare patients, but even if they ultimately decide to, it will take a long time to actually implement, for a number of reasons which are rather tangential to the topic at hand here.