Great article and I am going to read your book.
I wish I could just put money in an no-limit HSA and then “shop” for medical care. Maybe I’d have some very high deductible plan for freak things. But I can’t do that. I am not offered a high deductible plan (which might be a good thing), but still there is no choice.
There is no transparency in cost of procedures nor can an individual consumer get the insurance negotiated rate or even know what that is. If you go out of network, who knows what it will cost.
In addition to everything you mentioned, the IRS needs to reform the rules around FSAs and HSAs. ALL medical expenses should be tax deductible, period. Why should there be so many strings attached? Limits, required spending in a year, % of medical spending to your AGI — you shouldn’t need to guess how much you’ll need or get an accountant to make sure you’ve met the requirements to deduct medical expenses.