re: What in the hell is wrong with medical billing?

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Ok, now i see where you are going with this. Yes, i think it would lower prices in the long term. Would it ever be allowed, though? With EMTALA, i don’t see hospitals being allowed to do this. Also, would they allow this for Medicare and Medicaid patients? What happens when the patients don’t pay? Will you be allowed to refuse to see them again until they do?

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The Dutch system requires payment (or a payment plan or IOU set up) before an outpatient visit or test is performed. No pay, no service. For inpatient and ER visits they require a down payment (it was the equivalent to $100 when I lived there) before they will even give you the paperwork to sign in. If the costs of your visit was more that the downpayment the downpayment was applied to the amount that you owed. Obviously most people cannot afford a ER visit or multiday hospital stay so require patients to sign an IOU which is to be paid within 30 days of the patient's insurance company issues its reimbursement. People whose income falls below have to prove it to the insurance companies (which is basically the same as proving you qualify for medicaid in the USA) a certain threshold are issued a second card with their insurance card and this card allows hospital fees and the cost for the doctor's visit and medications to be sent directly to the insurance companies. Granted insurance companies in the Netherlands are all public-private partnerships so technically it meets the definition of single payer. However, a similar system could easily be implemented without the government involvement.

ETA: A lot of US laws would need to be changed and no I do not think anything like my proposed system would ever come to pass. The government and corporations have the power under the current system and they like it that way.