I gotta say that this “skin in the game/shop for a car repair” approach is brutal on the ground, in the real world, when you have a health situation/emergency. How do you really know that the 30% less knee surgery is actually a great idea and not a sloppy job with no follow up — ? Yelp? The dozens of Dr. comparison and review sites that may or may not have legitimate reviews? Online research takes hours and with current resources is often completely useless. It is incredibly stressful, if not impossible, to do that when you have a child lying in your arms with a broken leg.
I agree with Shane and others that getting costs in advance is nearly impossible. And coding, I also agree, is the go-to excuse, as in “I can’t tell you the cost, it depends on how it is coded.” I have had a 10 minute Dr. visit with the same Dr. cost $60 or $350, the $350 visit due to each body part a question was asked about being coded as a different item (!).
In the real world of the thrifty and award winning HMO I belong to the reimbursement rates for things like massage and acupuncture are so low ($25 and less) that good providers will not agree to the terms, so I have to out of the network if I want good care for those things. I am not at all convinced that bidding to get costs down would result in good care. I like the general drift of some of your ideas but without a meticulously designed infrastructure none of it would work. I’d like to see a working model for reputable cost estimates and medical reviews as a start.