The health care system within the United States is ostensibly market based and therefore at least partially reliant on competition and consumer demand to regulate costs. Given this, it is curious that information about an essential feature of market transactions-costs-is typically obscure to patients until long after treatment. There is often a disconnect between this reality and discussions within bioethics about the guiding moral principles of medical practice. For instance, when discussing what must be disclosed for informed consent, the same list of required information is often mentioned regardless of the health care system in question, and information about costs rarely merits a place within this list. However, our assumptions about what a moral principle requires need to be responsive to the realities of the health care system in which the principle is applied.
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