The recent Wall Street Journal article on Emergency Room prices in Boston illustrates a central fact about American health care - it’s almost impossible to get an accurate picture of what you as a consumer will be charged for a specific health care service, and what share of those costs you will have to pay, for anything -- anywhere.

In part, that’s because so much of our system assumes that you don’t care. The system assumes that, because of insurance, customers don’t face the costs of their care. It also seems to assume that all services are the same, and will be priced the same, wherever you go. Otherwise, what sense does it make that most decisions are made on the basis of geographic proximity or availability, with little or no regard to quality or price?

Unfortunately, that’s not what American health care is actually like -- at all. With modern American insurance plans, many of us now pay 100% of the bill for emergencies, or for regular office visits with a doctor, because benefits really only start taking effect once they’ve met a $5,000-$10,000 annual deductible. One may assume that their insurance has negotiated them a meaningful discount -- isn’t that in theory what insurance is doing for you? -- but this piece demonstrates clearly how false that assumption is.

It also isn’t true to state that all American health care facilities offer the same level of care, and should be priced identically. Even within one city like Boston, different physicians, and different facilities, have different specialities and different levels of service they are able to provide. It makes sense that they are not priced identically, but it doesn’t make sense that so much of our payment infrastructure assumes that they are.

This problem is why we exist at Sesame. For the millions of Americans with high deductible health insurance plans -- or the millions with no insurance right now -- real prices, and the ability to compare them, are essential. Sesame works with tens of thousands of medical practices across the country to list up-front prices, up-to-date availability, and vetted quality and appropriateness data to help patients who both (a) need care and (b) care how much it will cost them. In a health care system that, for decades, has only focused on putting patients in beds or waiting rooms with no regard for the impact on a patient’s financial health, hundreds of thousands of patients have already used Sesame to make decisions that incorporate availability, quality, and pricing.

Consumers can see this data right now, at sesamecare.com. And even if you don’t choose to pre-pay for care through us, you can get an immediate sense of which facilities near you are more or less affordable. But for anyone with a high deductible plan, paying up-front on Sesame will save you money on thousands of health care services relative to your copays and deductibles. Especially compared to the shockingly inflated rates some insurers have “negotiated” for care at local facilities.