It's absolutely about transparency though. The origin of the complexity is that insurance companies usually get the bills. And insurance, which has all this machinery to deal with the hospital's machinery (see video), sends you a TL;DR and as long as everything seems reasonable - though who really knows what that is - you send your insurance co a check for some fraction of it and everyone moves on.

There are a lot of things broken about US healthcare, but chief among them is that no one is allowed to talk about cost of services. It's untouchable. It's seen as getting between the patient and doctor - again, whatever that means.