Reminds me of this really good article. TLDR: Man tried to call a number of hospitals to find out how much childbirth is going to cost him and received no answers.
https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...
It's inescapable, in that providing a description of the problem that is precise enough to generate a perfectly accurate estimate is very close to actually just being the solution. As you do the work, the estimated time to do the work approaches the time already spent doing it.
But a lot of customers want essentially the same thing--probably a glorified CRUD app with pretty management dashboards, and a workflow that exactly parallels the all-paper workflow first designed in 1965. If you do that sort of thing often enough, eventually you get a feel for how much it costs, even with the variation across customers.
Medicine has a great advantage over software in that decades of hyper-detailed hospital billing--set up in an effort to maximize the yield of patient cash-ectomies in the face of insurer pushback--can now be subjected to statistical analysis. All those diagnosis and billing codes can be plugged back in to the billing databases to discover the median cost for the care to treat a particular ailment. It isn't so hard to then say that I am willing to pay the median actual cost, plus an X% margin for the hospital, even if the actual cost is less, provided that the hospital also eats the difference if the cost is actually more. On average, if everyone did this, the hospital still makes enough money to stay in business.
Some diagnoses in particular, such as the one every woman on the planet is likely to get an average of 2 times during her lifetime, probably while between the ages of 16 and 50, are particularly amenable to cost averaging. If you can't quote the cost of a hospital childbirth to a patient with months of lead time, including the possibility of emergency surgery, you deserve what happens to you when every actuary can crank out an answer using a pocket calculator within 15 minutes of being asked to do so. You know how much it costs. You just don't want to say, because that takes away your leverage to charge more.
But ethically, the care provider should probably not have that leverage, because if they haggle, people can die. If you cure a disease that affects 3 people in 100000, we can talk about the size of your bonus. But if you (the hospital) are on your 3rd laparoscopic gallbladder removal in the same week, and still don't know how much it costs, I want the power to set the price taken away from you.
The hospital can totally give a realistic, projected price: It can know what the probability of a complicated birth will be, and it is also able to amortize that over all the uncomplicated births.
There's no sane public-policy reason it should be structured like a reverse slot machine: you pull the lever, get a fixed prize, then find out how much you'll pay for it.
Unforeseen complications are not exclusive to the healthcare industry. Imagine if you were trying to build a house, but had no idea how much it would cost. "Realistically, no construction company will give out a price; they don't know what unexpected complications may arise."
Something needs to happen here. Either healthcare is socialized (my strong preference), or the industry needs to implement some type of price transparency.
Not to mention, your analogy to construction works is a good one - but perhaps not in the way you intended. Plenty of construction projects run into complications and experience cost overruns. The only situation in which I can see hospitals giving out prices is in the same context as construction projects. Non-binding estimates that are projections based on prior assumptions, which will change if unexpected situations occur.
In fact the best analogy I've come across is with car mechanics. Fixing a person is like fixing a car. The shop can charge a set rate for labor, and will provide an invoice for parts. In that sense, price is perfect transparent. But even the best mechanics can't predict with certainty what it'll take to fix a car without seeing it first. Who knows when they'll pop open the hood expecting to do a standard operation only to find that the car is messed up way harder than was originally predicted.
As the GP noted, if you don't even know the order of magnitude to expect, the cost will always be a concern. The upper bound on the price is in the trillions, after all.
> If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an uncomplicated birth in order to subsidize those that do experience complications.
This function is currently performed by insurance companies; a frequent criticism is that insurance should limit itself to true emergency situations, but when any routine operation can balloon in price unexpectedly, it's not irrational to want its purchase mediated through the insurance provider.
Prices negotiated with insurance companies are negotiated under conditions very different from an uninsured patient. For example, risk of non-payment is drastically higher among the uninsured. This had to be offset by charging a higher rate so those losses are made up on patients that do pay. If you offer to pay for medical procedures in cash and immediately then you can usually negotiate the price down to a fraction of the list cost.
They can?
Vox's reporting over the past couple years has suggested quite the opposite—that past prices are not easy to find, and that even when they are, your price can drastically vary from someone else's even for the same service. That's why they started this "submit your emergency room bills" project.
That's not quite enough scope control for all services.
It says "Additional charges are made if you require critical care. If your baby requires transitional or specialist care, this is free if they are entitled to NHS care and is chargeable if they are not."
It's a little harder to do that with humans since they aren't going to pause an operation, keep the incision open, and tell the spouse "We found an unexpected tumor, so let's wait an hour while we generate a new quote and you can decide if you want to pay it".
But that should be part of the quote "Unexpected events can cause us to exceed the quote", and then they should have to document why it was unexpected.