Economies of scale are supposed to bring costs down. But in health care, large hospitals are often more expensive than smaller ones because they can demand higher payments from insurance companies, which are then passed down to patients.

In most realms, those with the least ability to pay should receive the biggest discounts. In health care, it is often the uninsured and indigent who receive bills with the full “chargemaster” fee — the wildly inflated prices that nobody really pays — while large insurance companies get the biggest breaks.

And why is it that I can shop for a mechanic in minutes from my phone but doctors’ fees are a mystery? In a battle of dueling bureaucracies, the Supreme Court recently dealt a blow to price transparency in Vermont, where the state wished to publish a database of fees and other information. An insurance company, Liberty Mutual, objected to turning over the data on what it paid doctors and hospitals, and the Supreme Court agreed. The justices argued that, according to the A.C.A., only the Department of Labor, and not individual states, had the right to collect this data. The ruling affects almost a dozen states that are pursuing similar initiatives.

Finally, our insurance system drives up costs for everyone. Between 1998 and 2015, the cost of cosmetic surgery for top procedures, which is paid by the consumer and not covered by insurance, rose at about half the rate of inflation, while overall health care rose at around double the rate of inflation — more than a threefold difference.

It’s no surprise that people with connections, like the chief executive, resort to any means they can to navigate this system. It’s more worrisome when doctors do the same. As a medical student I would never have dreamed of accepting special favors just because I was part of the exclusive M.D. club. When I was living in New York City, friends encouraged me to obtain the prestigious “M.D.” license plates, which came with special parking privileges — quite a perk in Manhattan. But I was never on call at a hospital that required expedient parking, so I didn’t get the plates. This didn’t stop many others, however.

Nepotism occurs in many fields; friends and family of New York City police officers often carry Patrolmen’s Benevolent Association cards, which may confer special treatment in a traffic stop. It’s human nature for a group to look out for its own (especially groups like physicians that originally consisted only of white men). Bonds forged in sleep-deprived situations involving life and death create a special kinship. Physicians originally provided free care to their own to keep doctors from trying to treat themselves, but the tradition is also an acknowledgment of mutual respect.

But when everyone is feeling the pain of decreased access and increased costs, physicians currying favors will only foster resentment. Shouldn’t we be advocating for reform, rather than finding our own shortcuts?