Earlier quoted context omitted.
With employer based insurance and lack of price transparency there is almost nothing the patient can do to reduce costs. You can’t get any upfront pricing, it’s hard to evaluate whether a test is needed, you can’t change insurance. You are giving the patient responsibility for something they have almost no chance to understand.
On top of that, it's impossible to shop around for some of the biggest purchases. Broke your leg, now what? Start calling local hospitals to see who offers the best price? It's impossible to be an educated consumer with healthcare. Impossible.
Any responsible citizen would have received insurance approval and checked out hospitals before breaking his leg. Same applies to car accidents :)