Olga Khazan:

There is, however, a way to eliminate those bank-busting surprise medical bills without eliminating health insurance. Just ask Europe. Several European countries have health insurance just like America does. The difference is that their governments regulate what insurance must cover and what hospitals and doctors are allowed to charge much more aggressively than the United States does.

When I described surprise medical bills to experts who focus on different western-European countries’ health systems, they had no idea what I was talking about. “What is a surprise medical bill?” said Sophia Schlette, a public-health expert and a former senior adviser at Berlin’s National Association of Statutory Health Insurance Physicians. “Seriously, they don’t happen here.”

Almost all Germans are covered by a variety of health insurance, such as “sickness funds,” which are financed through taxes. Almost all doctors and hospitals accept these plans. About 90 percent of Germans never see a bill for their doctor visits, and the rest are covered by private insurance, which usually reimburses whatever they get charged. According to the researchers Roosa Tikkanen and Robin Osborn at the Commonwealth Fund, there’s a flat co-pay for people who are hospitalized, capped at a maximum of 280 euros—or about $315—for a 28-day stay. And doctors, too, are not allowed to charge more than the payment rates that are negotiated between the sickness funds and the doctors’ associations. A very small number of the country’s physicians are private and don’t accept the sickness funds, but they have to tell patients how much they’ll charge before a patient is treated, removing the surprise element.