Not only that but a lot of the time you have no reasonable way to know what a medical service will cost you until it's already done. You can't even reason about

Not only that but a lot of the time you have no reasonable way to know what a medical service will cost you until it's already done. You can't even reason about shopping around for a better price much of the time. Insurance coverage rules are so complicated and astoundingly open to evaluation by your provider after the fact that consumer choice is basically nullified. There's effectively no downward price pressure at all for this reason. Insurers and medical providers have built a feedback loop of ever increasing prices that consumers have virtually no power to stop except by risking their own health. Contrast that with a typically optional and not insured procedure like laser eye surgery where prices have fallen over time and are clearly advertised. Consumers can shop around and know ahead of time what the price will be thus prices fell. Without that option there's nothing free about the market for consumers.