Imagine walking into a doctor’s office or hospital and immediately knowing the cost of care before being treated. As you check in, you see a list of prices for all their most common services — the procedures performed so often that the provider already knows what they cost.
That is what my family experienced during a visit to a doctor’s office and hospital in Mexico. Prices were clearly listed behind the counter, and we were informed of the cash prices for each service before receiving care. Upfront price transparency for routine hospital services is not a radical reform. It is a prerequisite for competition, accountability and consumer choice in healthcare.
This is not about importing another country’s health-care system. It is about adopting a basic consumer expectation: Prices should be known before purchase.
This is already supposed to be how hospitals and health-care providers operate in the United States under executive orders issued in 2019 and 2025. In theory, American hospitals are required to disclose prices under federal transparency rules. In practice, few hospitals make prices accessible to ordinary patients and rarely present them at the point of care.
Having price information before services are rendered empowers Americans to choose lower-priced providers when the needed care is compatible across providers. For many elective surgeries, minor infections, small injuries and imaging services, patients have time to compare options, provided price information is available.
Empowering patients to seek better deals puts pressure on health-care providers to compete on price. Health-care markets fail not because competition is impossible but because a key component, prices, is hidden until after the transaction. When patients can compare prices and switch to the provider that offers the best value, higher-cost hospitals must either justify the prices through patient experience and care or lose business. The result is more affordable and higher-quality options for patients.
Beyond the financial benefits, upfront pricing also reduces surprise bills — a major source of patient dissatisfaction. Knowing the costs of surgeries, treatments or tests in advance can reduce stress and provide patients with information they should have had all along.
Upfront cash prices are especially helpful for uninsured Americans, but they also reveal how much — or how little — insurance actually saves patients for routine care. Cash prices are often lower than insurer-negotiated prices.
Overall, half of the hospitals set cash prices below the median insurance price, and 20 percent set prices at or below the lowest negotiated insurance rate. More than half of hospitals have cash prices for psychotherapy, outpatient visits, consultations, preventive medicine, mammograms, cardiac treatments, joint replacements and various diagnostics and surgeries lower than the median prices that insurance companies have negotiated. Routine obstetric care costs the same or less than the lowest negotiated insurance price in a quarter or more of hospitals.
This should not be too surprising. In competitive markets, prices fall. In the current system, insurers often act as unnecessary middlemen, adding costs while disconnecting patients from the true price of care.
I wish I had known two months ago to ask about the cash price for lower back spinal injections. Around 60 percent of hospitals charge a cash price less than median insurance-negotiated rate, and a fifth to a quarter charge prices at or below the lowest negotiated rate. My experience is not unusual. More than 75 percent of hospitals are not in compliance with transparency laws as of 2023, leaving millions of Americans to undergo scheduled procedures annually without being told the price in advance — even though hospitals know what they will charge and often know their cash price is lower.
Health-care providers are supposed to provide this information, but enforcement is lax. Executive orders are not law and can go only so far. That is why Congress must step in and codify upfront price transparency for routine, shoppable services. Lawmakers should require hospitals to disclose binding prices in a consumer-friendly format, and enforce compliance with meaningful penalties.
Without clear statutory requirements, enforcement remains weak and accountability almost non-existent. Market-enhancing price transparency should not be the goal of one presidential administration or another — it should be an American goal.
Justin Leventhal is a senior policy analyst for the American Consumer Institute. He wrote this for InsideSources.com.
