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What mechanic are you going to? Every mechanic I've seen has standard prices based on hours worked and cost of parts. I mean if I bring in a car without knowing what's wrong with it, yeah the cost of "Make this car work again" is unknown. But with a known problem the cost is fixed and they can tell you the exact price to replace a transmission, change the breaks, swap out a strut, you name it.
They might have fixed prices but things don't always go to plan. Maybe something goes wrong and it takes them four hours to get at some part of the car, instead of one. Maybe they find (once they get in there) that the problem isn't just with part A, but also part B. It isn't typical that the final bill exceeds the estimate, but it isn't unheard of either. Diagnostics and repair are not an exact science and shit goes wrong sometimes.
I'll also chime in here that this is not how most auto shops work. Probably not all of them; who knows what Jim-Bob is doing up in the hills. But most places are "flat rate" shops. They list their labor charge as $X/hr, but the way they figure out the amount of the actual charge is not by setting a stopwatch for when the mechanic starts/finishes the job. The history here is that many mechanics would get paid a direct portion of the shop rate (say, P% of the $X/hr that is billed). A lot of places still do this to incentivize the mechanic to get more stuff done and make the business more money (usually the final pay being determined as the minimum of either their labor charges for the pay period or a different hourly rate for on-the-clock time; e.g., they could get paid $20/hr for on-the-clock time or $45/hr of billable labor).
But obviously, it would be dumb incentives for them to be able to start a job, lollygag, take an extra few hours getting it done, and rack up the money. Instead, what the majority of shops do is just use a "book" (a computer these days, for sure) that estimates how long it would take an average mechanic to do that procedure on that car. That determines how much they quote/bill the customer... and how much the mechanic will get paid for that billable labor. This is extra incentive for the mechanic to work hard. If he can be more productive than the average book rate (e.g., he can get a three hour job done in two and a half, then start another job and rack up more billable labor hours), he can make even more money.
I will admit I have no insight into the inner workings of auto mechanics, as I experience it only from the customer side. I was speculating as to what might happen, but I can say that I have had auto shop bills come in higher than the estimate. So whatever the cause might be, it does happen.
Of course it happens. Most people are mostly okay with it happening sometimes, because they got an estimate, were told what the plan was and what the estimate was based on, were able to make an informed decision, and then were told what happened and why the charge was higher. Often times, we would call people when we ran into something that we saw would increase the price and tell them what was going on and if they had options. Many customers are price conscious, and you had to be communicative. If you were, and you made sense in your communication, they're mostly okay with it.
Contrast with the medical industry. Most consumers aren't nearly as price conscious, probably in part because they hardly feel like it's even an option to be1. (There are other reasons, more cultural, but one would have to get off on a tangent about Robin Hanson's terminology of the sacred/profane.) They just go to the doctor, do what he says, and magically a bill goes through their insurance company... and maybe they have to pay some of it. If they bother to inquire, there's a half decent chance they'll be told that it's impossible to know anyway. Every part of it is completely the opposite of the pro-active, communicative pricing information that even only half-decent auto shops provide. If we could get the median medical provider to have price transparency resembling the 25th percentile auto shop (with similar allowances for some situations to happen sometimes where final bills are higher than the estimate, but with similar communication), I'd be super happy. I think this is pretty possible to do.
1 - Yes, and some patients are in situations where they really really really aren't price conscious at all
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Fine, but don't pretend that an edge case in car repair being the norm in health care makes them equivalent.
I mean, it's not the norm in healthcare. It's uncommon to have the kind of issues @ControlsFreak describes - I've never had it happen, and if I think to my wider social circle I can think of perhaps once that someone I know has run into that. I think it's perfectly fair to compare an edge case in healthcare to an edge case in auto repair.
You've always had them provide a price up front? You've never been hit by a surprise? This seems unlikely, especially because this is one of the most common complaints. We've had multiple laws passed in recent years specifically attempting to go after this problem in response to public dissatisfaction, but they've been kind of half-measures (the surprise billing law about out-of-network providers at in-network facilities/emergency care and the price transparency law that only resulted in some incomprehensible websites).
This comes up a lot on reddit, because a lot of people are frustrated with how often it keeps constantly going on. A lot of those times, you have doctors showing up claiming that folks just don't understand; that they don't even know the price of things; some say it's basically impossible to know.
I haven't gotten prices up front (but I don't ask either). I have never been surprised by "oh actually this isn't covered, sorry". My insurance gets billed, either they pay the charge or (if I haven't met my yearly deductible yet), I do. Everything works smoothly.
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