"Another reason is that healthcare and health insurance is simply too complex and time-consuming for patients to fully understand and to appreciate, especially

"Another reason is that healthcare and health insurance is simply too complex and time-consuming for patients to fully understand and to appreciate, especially with the arcane complexity of health plans as they tend to develop in a free market. " Yet another reason: it's not like most simple commerce transactions with 'satisfaction guaranteed or your money back". If I choose option A over option B when looking at medical procedures, I may live or die. No going back for a refund. Or I may be permanently scarred, brain-damaged, or otherwise harmed for the rest of my life. Or... I might be cured. There's very little ability to 'shop around' and 'compare' options when talking about life-critical situations. It's somewhat similar to housing, in that most people only buy a few houses (at most) over several decades - trying to shop around and compare options only goes so far - once you've made a decision, there's rarely ever a quick 'undo and start over' option.