People aren't likely to have $18,000 on hand either (typical $2,000
deductible plus 20% copays, assuming all services are covered). An
$80,000 tab would not hold up in a free market system without insurance and entitlements. We know from other countries that our costs are grossly inflated. You can't take current prices and assume that would be the going rate in a self-pay market. After all, it doesn't take $3,000 to stitch a toe, nor $80,000 to observe a blockage. Those are external, non-medical price factors that you are paying for (one of them being the insurance industry itself), and they don't need to exist.
Here is one article discussing the cost-effectiveness of flat-rate medical plans (no insurance) and how they are much less costly and tend to be higher quality.
http://healthland.time.com/2011/06/21/decent-health-care-without-the-insurance/">http://healthland.time.com/2011/06/21/decent-health-care-without-the-insurance[/URL]
A similar model could be established for major medical services too. The reason they probably aren't common is because hospitals and insurance companies (both competing for their services) have the political advantage to fight their permits. There have been private surgery centers popping up all over Alaska, who do accept insurance plans or self-pay, offering services at a fraction of the cost that hospitals do. They are always met with resistance and often lengthy, costly legal battles because price-gouging hospitals don't want to lose that revenue. The surgery centers that have gotten permits get patients from all over Alaska, who travel great distances to save money there (versus using their local hospitals). If the model of bypassing insurance saves money at the clinic level, it makes sense that it would save money on a larger scale also (given adequate population). So I imagine these surgery centers could be even cheaper if they adopted this model and bypassed insurance too. But fighting local hospitals is one thing; trying to fight against the insurance industry and all their powerful lobbyists would be insurmountable. And now with Obamacare, it would just be pointless. Patients who already have insurance have a vested interest in using that insurance.
The point is, one must be careful about touting the benefits of insurance, when the high prices they "protect" against are largely influenced by them in the first place.