I recently had some blood tests ordered by a doctor. She sent me across the street to the "lab" to have blood drawn and sent off. But before they took the blood, I was curious how much the tests were going to cost me. Here is a slightly paraphrased version of the inane conversation I had:
Me: "Will my insurance cover this?"
Phlebotomist/Receptionist: "I don't know."
Me: "Umm.... Could you check please?"
Phlebotomist/Receptionist: "Well, I won't know if it's covered until I send it off to the insurance company."
Me: "Okay. Could you call them and ask?"
Me: (trying to get an upper bound) "Uhh.... Okay. How much would they cost out of pocket?"
Phlebotomist/Receptionist: "I don't know. We'll see when the insurance company gets back to me."
Me: "So you're saying that I might have to pay an infinite amount of money out of pocket for these blood tests?"
Phlebotomist/Receptionist: "Well, no, some of it is probably covered."
I eventually got her to go through her papers and find the actual cost of the blood tests so I could determine an upper bound on what I'd have to pay.
The moral of the story is that it's extremely unclear how much medical procedures cost in America (and even more unclear what your insurance company is going to cover, which you often don't know until after you've already had the procedure done and incurred the liability for the expense). The fact that it takes so much trouble and effort to figure out how much you've paid for healthcare is one of the reasons why healthcare sucks so much in this country. If it were easy to see how much things cost before you had them done, with a comparison chart for how much that same test/procedure costs in other practices, hospitals, states, and even countries, then maybe we'd be a bit more adamant about demanding cheaper health care. This data, in addition to the comparative outcomes data that Orszag is pushing, seem to be prerequisites for any meaningful reforms.
Addendum: The receptionist, after prodding, said the maximum I would possibly pay was about $228, which was the cost of the tests. I just got the statements from my insurance company. The tests came to over $700, of which I had to pay about $100 or so. Basically, the incentive here is for the lab to maximize what they can get from the insurance company. The end result is that the lab company makes a fortune, the doctor who prescribes the tests probably also gets paid a lot, the consumer (me) has to pay way more than necessary, and the cost to the health care system as a whole is ginormous.