But I think you missed the point.

I agree that most folks aren’t going to "go shopping” for the cheapest thoracic surgeon. OTOH, it would be nice to know, especially if one has an HDHP (High Deductible Plan), how much that surgery is going to cost. Granted, it’s not likely that all of the associated costs will (or even can) be known ahead of time, but let’s not allow the perfect to become the enemy of the good.

As far as the stitches go, I can speak to that authoritatively (if sheepishly): a few months ago, while making a salad, I accomplished a rather robust chiffonade of my index finger (yes, I know, that wasn't technically a part of the recipe). My wife and I decided, based on a quick examination, that a trip to the ER was warranted.

At which point, I’ll stop, and step into “transparency mode:” this was, indeed, an “emergency,” but it was unlikely that I’d die (at least quickly) or become seriously disabled. Rather, it was one of those common situations that required a decision of where. Being a Sunday evening, my two choices were the local Urgent Care, or the local ER. The UC facility is not in my plan’s network, while the hospital is. Score one for choice. Had they both been in-network, an additional decision would have been made.

Back to the story:

After examining my finger, the resident offered two treatment modalities: stitches, or SuperGlue (don’t laugh: the product was originally developed for this exact application). Here’s a perfect example of how transparency would have worked for me: in addition to the other (non-economic) factors, I would have had additional information available to help me choose.

Most folks, however, do not use their digits as cooking ingredients, and so transparency is generally taken to mean that consumers can (and will) use this information as a factor in deciding how to budget for healthcare.

It is this idea, that we can (and should) be more aware of what health care really costs, that is at the heart of transparency.

Is everyone going to want to know the price of that shot, or mammogram, or prescription? Well, no. But then again, no one is forcing folks to use the information. But denying it to those who will is just plain wrong.

Although I think we're talking at cross-purposes.

You say that shopping for routine care  "would do little to produce any significant health care cost savings," and that the "real costs of health care are for those procedures we don't have the luxury of shopping around for."

This is simply not true. Most of the cost of health care is, in fact, for such items. The small, routine claims are those which are most expensive to adjudicate. And, of course, rx costs (which are generally not purchases made in an emergency) are a substantial piece of the pie, as well.

As to the UC/ER dilemna, I did, indeed, have a choice: in-network (lower OOP) or out (higher OOP). So my decision in that case was cost-driven.

I went back and re-read my initial response, and can find no instance where I said that cost was the only, or even most important, factor as regards the stitches/glue decision. Of course the others that you mentioned would have been at the top of the list. But that does not mean that cost wouldn't have been one factor. Indeed, all things being equal (though they seldom are), I probably would have chosen the glue for the simple reason that it did not require a shot (for anaesthesia). I hate shots.

Again, I don't think that cost is, or should be, the sole criteria when shopping for health care. But it seems to me that it is a valid consideration, one which is currently difficult to pre-determine.

Marc:

I'm not ignoring you; working on a major post for IB (my blog), which is eating up my time. I do appreciate your comments, and have some thoughts on them.

I'll try to get to this this evening.

Thanks for your patience!