Why Healthcare Will Never Be a Retail Checkout And Why That’s a Good Thing

Coming out of the conference olympics seasons, I overheard yet another conversation about how healthcare “just needs to be more like retail.” Someone compared claims to Target checkout. Someone else wondered why we still can’t “scan a CPT code like a barcode.” Over a decade ago, I remember a national plan hiring the Chief Marketing Officer from Starbucks so they could help them sell “health plans like coffee.” 

What Patients Are Actually Asking For When They Ask For “Retail-Like” Healthcare

These comments come from a real place of frustration, and I understand the desire behind them.  People want predictability. They want fewer surprises. They want a smoother path between themselves and the care they need. Beneath the complaints and metaphors is something more fundamental. People are not craving a retail experience. They are craving a system that behaves consistently and gives answers they can trust.

But every time I hear the retail analogy, it strikes me as the wrong frame for the problem. Healthcare isn’t struggling to imitate retail because we lack the right apps or APIs or AI. Healthcare isn’t failing to be “shoppable” because people aren’t trying hard enough.

Healthcare isn’t complicated because it wants to be.

Healthcare isn’t retail because it cannot be. 

The structure of the system prevents it and the nature of illness prevents it. Once we stop chasing metaphors that do not fit, we can begin building a form of simplicity that reflects how healthcare truly works instead of pretending its complexity is an inconvenience.

The U.S. Healthcare System Is Producing Exactly the Experience It Was Designed To Produce

The system Americans struggle with today is performing as designed. Its complexity is not an accident or a glitch. It is structural.

We built a health financing system anchored in employer-based coverage, where each self-insured employer becomes its own miniature insurer. That means every employer can design a different benefit package, define its own exclusions, decide what’s covered and what isn’t, contract separately for mental health, carve out fertility, impose unique prior authorization rules, and negotiate rates independently through a third-party administrator.

Millions of slightly different rulebooks operate at the same time which means complexity is not a side effect. It is the landscape itself.

Coverage churn adds another layer. People move from Medicaid to employer plans to Marketplace coverage and then into Medicare. They sometimes move back and forth based on work, income, or eligibility. Every transition resets everything the patient thinks they understand. Networks change. Deductibles change. Authorization rules change. Formularies change. Clinical definitions change. Prices change. 

Why There Is No Retail Analogy for U.S. Health Insurance

Nothing in retail behaves like this. You don’t buy a coat and discover that the price depends on your employer or on whether you changed jobs last month. 

In the U.S., these wild price swings aren’t a mistake. They’re the inevitable result of a system where prices are negotiated in private, vary across payers, and change based on market leverage, not fairness or logic.

Public price files have made this easier to see. The same service at the same hospital can show multiple negotiated rates as if price were shifting based on unseen weather patterns. Some files include placeholder values that appear meaningful but are not. Others list services a hospital does not even perform. Transparency does not remove fragmentation. Rather, it simply exposes it. 

Inside the system the problem is similar. Different departments and systems often interpret rules differently. Patients and clinicians can receive conflicting answers while attempting to verify the same requirement or coverage detail. The issue is not confusion. It is an inconsistency created by the structure itself.

Contrast this with countries like Singapore, the Netherlands, and Australia. These countries can deliver genuine shoppability because their systems were designed to allow it. Benefits are standardized. Prices are regulated or fixed. Coverage is stable and not tied to employment. Networks are either irrelevant or tightly managed. There is one fee schedule or a very small set of them.

Shoppability isn’t a natural feature of healthcare. It is inherent to systems that were built for coherence. Ours was built for something else.

Health Is Not a Product. It Is a Moving Target.

Even if we had a perfect insurance system, healthcare still couldn’t behave like retail, because health itself is fundamentally different from any product you can buy.

In retail, the item is the item. A bottle of shampoo doesn’t change because of who you are. A bag of apples doesn’t become pears when the cashier scans them. A flight doesn’t become a train ride halfway through the transaction.

Healthcare is living, evolving, unpredictable. A routine checkup can uncover a new diagnosis. A screening mammogram can become diagnostic the instant something questionable appears on the image. Chest pain at 2 a.m. can be indigestion, or a myocardial infarction, or something in between. The nature of the service shifts in real time as the clinician gathers information and as the body responds.  You are not buying a standardized item or product. You are receiving expertise that adapts as new information appears. You cannot “scan” that.

Coverage Complexity Is the Real Barrier to Retail-Style Healthcare

Even if health were predictable, retail-style shopping would still collapse under the weight of coverage rules. 

Coverage is not a wallet. It is a moving set of conditions that determine whether something is paid, at what amount, and under which circumstances. These rules depend on the employer, the specific plan, the network, the diagnosis code, the modifiers, the place of service, the contract terms, the stage of the deductible, the formulary tier, and a hundred other tiny variables that can flip the outcome entirely.

This is why two patients can receive the same service at the same hospital on the same day and receive bills that differ by thousands of dollars.

There is another layer that is often overlooked. Different parts of the same organization can interpret the same rule in different ways. An authorization team may justify something one way while a billing system enforces it another way. These internal contradictions create the uncertainty patients often describe.

The U.S. Healthcare System Is Not Built for Uniformity

The U.S. system is not built to deliver uniformity.

And when there is no uniformity, there can be no analogy to retail.

It is easy to believe healthcare should behave like retail when looking at the small subset of services that already do. Routine primary care, flu shots, basic labs, and simple urgent care visits behave predictably. 

Their risks are low. Their variation is minimal. Their protocols are standard. Retail clinics and telehealth platforms thrive in these spaces not because healthcare is becoming more retail-like but because these services align with the characteristics of a retail product. 

But the moment you step outside these narrow lanes, retail logic collapses. You cannot shop for an emergency appendectomy. You cannot comparison-shop cancer treatment while sitting with a new diagnosis. You cannot “get a quote” for long-term care or congestive heart failure management or a pregnancy that suddenly becomes high-risk.

Chronic care in particular defies any attempt at stabilization and behaves like its own ecosystem. Conditions fluctuate and medications change. New complications emerge. Specialists rotate in and out. Coverage can shift midyear or even midepisode. No spreadsheet of prices can capture that. No “out-of-pocket estimator” can predict the pathway. This isn’t opaque because people failed to publish prices. It comes from the nature of the care itself. 

This is not shoppable. This is distinctly human.

So what should we actually be solving for?

If we stop trying to copy retail, we free ourselves to build something much better and can focus on improvements that actually matter.

We can standardize the parts that allow it, such as cost estimates for routine services and real-time checks for predictable care. We can create coherence in areas where clarity is possible. Definitions can be aligned and networks can be stabilized. Benefits can be simplified. The system can reduce conflicting interpretations that produce different answers for the same situation.

We can make coverage easier to navigate without pretending medical complexity is predictable. And we can pursue better outcomes without pretending that the complexity of illness should behave like the predictability of consumer goods.

People do not need a checkout experience. They need a care experience. They need rules that behave the same way more than once and communication they can rely on. They need a system that treats explicitness as part of the standard of care rather than something optional.

References

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Centers for Medicare & Medicaid Services (CMS). National Correct Coding Initiative (NCCI). https://www.cms.gov/medicare/national-correct-coding-initiative-edits

CMS Medicare Benefit Policy Manual. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c01.pdf

Commonwealth Fund. International Health Care System Profiles. https://www.commonwealthfund.org/international-health-policy-center/countries

Cooper, Zack, et al. “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured.” Quarterly Journal of Economics 134, no. 1 (2019): 51–107. https://academic.oup.com/qje/article/134/1/51/5026166

Employee Retirement Income Security Act (ERISA). 29 U.S.C. §1001 et seq. https://www.dol.gov/general/topic/health-plans/erisa

Institute of Medicine (IOM). Hospital-Based Emergency Care: At the Breaking Point. https://nap.nationalacademies.org/catalog/11621/hospital-based-emergency-care-at-the-breaking-point

Kaiser Family Foundation (KFF). Employer Health Benefits Survey 2023. https://www.kff.org/report-section/ehbs-2023-summary-of-findings/

Kaiser Family Foundation (KFF). “Medicaid Churn and Coverage Transitions.” 2022. https://www.kff.org/medicaid/issue-brief/medicaid-and-chip-enrollment-declines-and-churn/

OECD Health Statistics 2024. https://www.oecd.org/health/health-statistics.htm

Office of Inspector General (OIG), U.S. Department of Health & Human Services. Not All Selected Hospitals Complied With the Hospital Price Transparency Rule (A-07-22-06108). November 2024. https://oig.hhs.gov/oas/reports/region7/72206108.asp

RAND Corporation. White, Chapin, and Christopher M. Whaley. Prices Paid to Hospitals by Private Health Plans (RAND 3.0). 2020. https://www.rand.org/pubs/research_reports/RR4394.html

Urban Institute. Holahan, John, and Linda J. Blumberg. The U.S. Health Insurance System and Coverage Challenges. 2020. https://www.urban.org/research/publication/us-health-insurance-system-and-coverage-challenges

World Health Organization (WHO). Global Health Expenditure Database. https://apps.who.int/nha/database