Why health care price transparency isn't working for patients — and 3 ways to fix it

Open enrollment is underway, and millions of Americans will once again pick a health plan without any real idea what their care will cost. Every year someone tries to name the culprit. The usual suspects are doctors' salaries and hospital profits. Both make good headlines. Neither explains much of the bill.

Physician pay has been estimated at roughly 8% to 10% of national health spending. The median hospital operating margin in 2025 was about 1.3%, and many small hospitals lost money while caring for patients who cannot pay. You could cut every doctor's pay and every hospital's margin in half and still not fix what patients feel when the bill arrives.

As physicians, we see a process broken in three places. Patients have no reason to shop. They cannot read what they are charged. And their own records do not travel with them.

The bill nobody can read

Hospitals now post their negotiated prices. When we analyzed those files for common interventional radiology procedures, commercial prices for the same procedure varied up to eightfold from one state to another. Same procedure, same training, very different prices.

The uninsured face yet another price that almost no one can see in advance. Hospitals must stabilize emergencies regardless of ability to pay, but that does not cover months of cancer treatment.

Then the bill arrives, often listing undiscounted charges that no one actually pays, and patients reasonably conclude their doctor took home a fortune. The reality: In 2026, Medicare pays about $92 for a typical office visit, and that one payment has to cover not just the physician's time but the nurse, the documentation, the medical records, the rent and the office equipment behind it. Medicare pays the physician about $232 for placing a tunneled dialysis catheter, including 10 days of follow-up care. And doctors are paid by the codes attached to a procedure, not by how complex the patient was or how long it took.

No reason to shop

When a commercially insured patient is referred for a scheduled scan or procedure, they usually cannot see the price beforehand, their copay is often the same wherever they go, and if they choose a facility that costs their plan thousands less, they keep none of the difference. Not shopping is the rational choice.

When the price reaches the patient, patients respond. After the California Public Employees' Retirement System (CalPERS) set a reference price for hip and knee replacements, the share of members choosing lower-priced hospitals rose from 48% to 63%, and hospitals above the reference price cut their prices by about a third.

Design matters. Maine requires small-group insurers to share savings with enrollees who choose a lower-cost provider. In 2023, about 1 in 2,600 eligible enrollees used it, and they received about $51 each. A refund patients must discover on their own, after the decision is made, does almost nothing.

A better process

Make the order portable. A doctor cannot review prices with every patient while ordering a test, and the patient cares about the cost more than anyone else in the room. Every order should carry its procedure codes and a QR code. Scan it, and see what nearby hospitals and imaging centers charge for that exact order, using the price files they already post. Doctors can still recommend the centers whose work they trust. The patient makes the final choice.

Share the savings. When a patient chooses a facility priced below the plan's reference price, a meaningful share of the difference should go into an account the patient owns, available tax-free for future medical costs or withdrawable as taxable income. Health savings accounts work much like this, but only with high-deductible plans. States could offer a version for any commercial plan and exempt it from state income tax; Congress could do the same federally.

Let records travel with the patient. Shopping only works if care can move without losing history. Today a patient who switches imaging centers often has to request a CD of their own scans, and the radiologist reading the new study may never see the old one. That is how a nodule stable for 10 years becomes a new workup. Portability does not mean every note ever written. It means a snapshot: major diagnoses, past surgeries, recent labs and the actual images. Many of the largest health systems already use the same records platform, and modern data standards make exchange far easier than it was. Facilities that will not share should say so up front, so no patient is quietly held hostage by a business model built on friction. This is not a call for government access to medical records. It is a call to let patients carry their own, securely.

Why this matters

None of this requires new mandates on how doctors practice or a new agency to set prices. It puts prices in front of the person making the choice, rewards good choices and removes friction from records. Plans save money, patients keep some of it, and higher-priced facilities face real pressure to explain or lower their prices.

The details are worth debating: how large the patient's share should be, which services qualify and how to protect patients who have only one option nearby. States can test them. But the core problem is not mysterious. We built a system where the person choosing care cannot see the price, has no reason to compare and cannot bring their own history along. Until that changes, price transparency will remain a website nobody visits.

Pouyan Golshani, MD, is an interventional radiologist and the founder of GigHz, a health data analytics company.