Another Reason Health Care Costs So Damn Much

Because health care providers don’t tell you how much they charge for whatever it is you need, resist any attempt by consumers to do any price shopping or comparison, and then send you a bill AFTER they’ve provided the service, leaving you no choice but to pay up.

The Philadelphia Inquirer recently told the story of a man who had two echocardiograms, about a year apart.  The tests were performed at the same hospital and his insurance was the same both times.

The first echocardiogram cost him $170.

The second?  $3101.


Why?  The first was performed by a medical group that practiced within the hospital while the second was done under the auspices of the hospital itself. The medical group did a better job of negotiating price with the guy’s insurer but the hospital, like all hospitals far more interested in its own bottom line than in the welfare of its patients, whacked him big-time.

There’s a lot of talk these days about price transparency and how, if providers were required to post their prices, problems like these wouldn’t arise.  That’s ridiculous: the only people who pay list price, which is always sky high, are people who have no insurance.  Individual insurance companies, on the other hand, negotiate different prices with every provider.  If you need an x-ray of your big toe and the list price on that x-ray is $250, one insurer may be getting it for $200, another for $100, and another for $50.

Another problem is that after the guy got the $170 echocardiogram at the hospital one year, why would he even think he needed to check on the price so shortly thereafter?  Sure, the price could go up a little – medical inflation always rises faster than regular inflation – but it doesn’t lead to prices becoming 18 times higher in a single year.

Making it even more complicated for consumers is that at any given time, you can be at a different stage toward meeting your annual deductible.  Sometimes, you’ve already met your deductible, your insurer has negotiated a good price with a provider, and you don’t have to pay anything for the service you were provided. On other occasions, you may not have spent anything toward your deductible, in which case you’re on the hook for the whole price and have to cross your fingers and hope your insurer negotiated a good price with the provider.

Like this: when off-the-shelf stuff no longer does the job

Recently, The Curmudgeon visited a podiatrist to be fitted for orthotics.  He has perhaps the flattest feet you’ve ever seen, and now, he has a neuroma (essentially, a permanently irritated nerve) on one foot to go along with it, and an orthotic, he had heard, could help with that.  (A bit of advice:  it hasn’t.)

While waiting in the examination room, a member of the doctor’s staff joined him.

“I’ve got good news and I’ve got bad news,” she declared.

“Go ahead,” The Curmudgeon replied.  “Good news first.”

“The good news,” she began, “is that your insurance covers orthotics, 100 percent.”


“The bad news is that you’re nowhere near reaching your deductible for the year and will have to pay 100 percent of the cost yourself.”

The Curmudgeon actually had assumed he’d have to pay the cost, so he had only one thing to say:

“Damn my good health.”

But this was the exception, not the rule.  Most of the time, you go into a doctor’s office, they do something for you, and then you receive a bill you never expected in the mail, which makes this yet another example of why health care costs so damn much these days:  it’s shrouded in mystery – intentionally so.  The people who provide the care typically think talking about prices is beneath them and insurers don’t give a damn what you ask or what you think, they’re going to get you, one way or another.

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