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Why Our Health-Care System Doesn't Work



June 20, 2011 – Comments (9)

True story. 

I have high-deductable health insurance, so most of what I get I pay for out of pocket. I'm OK with this, and actually think the system would work better if more people were in the same situation.

Here's why.

Since I'm paying out of pocket, I naturally ask "How much does this cost?" before every procedure. After asking today, the desk worker looked at me as if I offended her. "I  have no idea. No one's ever asked" she said. Are you kidding me? She got a manager, who didn't know either. He called a remote billing office, which took 15 minutes to figure it out. Both gave the impression that I was being unreasonable by wanting to know. 

This was a simple procedure. It cost less than $100. I bet 30 other people had it done in the same office today. Was I the only one who knew how much it cost? What kind of business operates in a world where customers are totally oblivious to costs? 

One where prices spiral out of control, that's what kind.  

9 Comments – Post Your Own

#1) On June 20, 2011 at 9:48 PM, L0RDZ (83.95) wrote:

i also have a high deductible personal policy that I pay for myself and the  medical field is a freaking joke if you try to ask or see about what things costs ~  they will laugh at you or look at you like your crazy or they will ask to see your insurance information again and  perhaps ask you for payment  upfront ?  but than again they won't know how much it costs ?

They will pile on ridiculous charges, and heaven forbid you actually do get sick and the insurance people start acting funny, and start denying payments.

Funny how it seems unreasonable to ask for prices, to them.

Not funny for the responsible  people who actually pay their own treatments.

I think if we stripped all gov employess and gov politicians and rats  of their coverage and made them buy their own high deductible  policies maybe thing may change.

But that would be too easy.



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#2) On June 20, 2011 at 10:57 PM, devoish (96.41) wrote:

last time I had that procedure, the doctor checked with my insurer before he did it. My insurer did not ask the doctor what it would cost. My insurer told him what it would cost.

Bet my insurer has more leverage and paid less than you did.

Best wishes,


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#3) On June 21, 2011 at 4:02 AM, CMFTomBooker (< 20) wrote:


devoish has a good point. IMHO, you can't discern price on the front end by a deductible or co-pay.

If you want a thorough lesson on the price shell game find somebody whose insurance capped-out in the middle of treatment and cure. This is the only way you get a true before-and-after. Note, I'm talking about price. Cost is for another soap-box.

In my case, my Fortune 10 employer's solid-gold private insurance popped a cap on my wife in the middle of 14 months treatment, cure, and treatments to resolve collateral damage from the original treatments.

As the big numbers on the bills start rolling in without the insurers' "Paid. FYI-Only" stamp on it, you get expert-shopper motivated, plus vite. You also get price-aware, if you can calmly change to dry underwear, sit down and compare apples to apples.

Just on one part as example, several pricing strategies become evident....

In Hospital A, per minute charges from the hospital for treatment or recovery sq footage are $60/min for somebody with coverage. And $85/min for somebody without coverage. The hospital will accept $50/min from Insurer A and $45/min from Insurer B. (long story, but I had an inexpensive, yet penny paying supplemental)

Hospital B, which is 8 miles away from, and just as Main Line Phila as Hospital A, had lower Suggested Retail Prices for covered and non-covered, but wanted $50/min from Insurer B.

And Yep, there is no menu with prices. That's because the menu prices often change every 6 months and they don't want the design and printing costs of pretty 3-color plastic coated menus, like Buffalo Wild Wings has. ;)

It's like going to Chipotle for the first time, except without the prices on the boards. You're not quite positive what you ordered, there's a good chance it will work-out well for you anyway, and you just hope to god you won't need a credit card to cover your short cash at the register.

FYI for that other someday soapbox moment, I got to pay my way out very close to insurance-accepted levels. It was made more difficult by those payment-risked non-covered prices. But the key was the old personal Bankruptcy Laws which were hanging in space when I finally got the meeting with the aggregate Billing Service provider. "Here's a signed/dated audit of my total net quick, which will fulfill your Total Suggested Retail Prices, and bust me plus some extra. And here's what I owe on the final 10 yrs of my mortgage. Almost the same amount."  The meeting took 20 minutes, no threats/demands. All he wanted was a copy of the financials, and what I had in mind. he thanked me for "being proactive". A week later I got a letter of intent to amend payment due, which was soon followed by the littany list of payment items looking unimpeachably similar to the insurer prices. Maybe with 5% or so extra as my cost-of-doing-business in the insanity of the healthcare world. .

The obvious story here is that people nailed today, have none of the leverage of costly, long-drawn-out process and prosecution for the money owed. Which I did. I could have sheltered anything liquid. At least enough to make it prohibitive in time and expense for them to drag it out of me, when considering the alternative of a hunk up front, with some profit in it.

So in the end of my narcissistic word-barf, the simple thought remaining is that your premise also splits true, the suggested retail price apple. A good place to start would be to demand price transparency in the front end of the more routine procedures. But that's with full knowledge that the big buck pricing insanity is further along in the tunnel.

Any move to coherency and transparency left in the hands of  the system's operators,  kinda' smells in much the same way as the guarantees to eliminate ALL of the corporate tax loopholes, if they lower the corporate rate.

But that doesn't mean it is impossible. It's likely to take a few clones of Elizabeth Warren and a few major cycles through the briarpatch of the HealthCare industry.

That puts the solution well into the dirtnaps of myself and my fellow Boomer destroyers-of-all-around-us. Maybe this abomination of a cattle-car cowpie Healthcare system will facillitate our departure, and y'all can get down to business more quickly.

In any event, it will take writers who are willing to be provocative, true to fact, with a well-honed ability to inspire people to meaningful action.

As TMF Media Corp launches Operation Gumballs with its high- advertising-value-customers for sale, somebody is going to have to put some meat on the bone of the TMF brand and its editorial narrative.

You have any plans for that? Or are the plans to out-Brooks David Brooks and get his spot as the Sunday morning DC-opinion stenographer?

Tom Booker

(There's no charge for my imperative parting needle)




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#4) On June 21, 2011 at 2:19 PM, vriguy (83.75) wrote:

It is the ultimate capitalist system - prices are set at whatever the payer is willing to pay.  As someone who is familiar with my hospital's finances let me tell you that we, like most hospitals, rarely pursue folks without assets.  Walk into our ER and we'll treat you - and in the case of many uninsured patients that means the hospital collects zero.  The folks who really get shafted are the uninsured with some assets (a home and savings).  They pay the highest prices, and it is clearly unfair they do so.

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#5) On June 21, 2011 at 4:41 PM, smartmuffin (< 20) wrote:

Absolutely correct.  The more breaucracy and obfuscation you put between the person getting the service and the person paying for it, the more corruption, graft, and greed will seep into the system.

Nobody ever asks how much a medical procedure costs.  Nobody cares.  And why should they?  And under a single-payer government health care plan, it'll be even worse.

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#6) On June 21, 2011 at 5:30 PM, Turfscape (45.12) wrote:

It shouldn't come as a surprise that the medical personnel and their office staff don't know how much something costs. The practice of Medical Billing, in and of itself, is completely ludicrous. Doctors don't bill patients. They don't even bill insurance companies. They hire third party billing services to page through huge manuals of service codes for multiple insurance carries and dicker back and forth over who is responsible for what payments. Then, the insurance companies dicker back and forth over who is primary and who is secondary...and 8 months later the patient sees "final notice" bills arrive in his mail stating that his account will go to collection if he doesn't pay (despite the fact that this is the first time he is seeing anything asking for any form of payment).

If medical groups would sit down and put honest effort into streamlining this process, I can almost guarantee a 30% reduction in medical costs overnight.

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#7) On June 21, 2011 at 10:14 PM, devoish (96.41) wrote:


That is absolutely not true that nobdy asks. the insurer asks, or in single payer, the single payer would ask.

Best wishes,


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#8) On June 26, 2011 at 10:45 PM, Bkeepr100 (< 20) wrote:

One of the quickest ways to reduce medical costs...Strict limits on malpractice claims awards...and the number of claims that any one attourny can file in a year.

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#9) On June 27, 2011 at 9:56 AM, Turfscape (45.12) wrote:

Bkeepr100 wrote:
"One of the quickest ways to reduce medical costs...Strict limits on malpractice claims awards...and the number of claims that any one attourny can file in a year."

I've heard that time and again, but there is little empircal evidence to show that this would immediately and significantly reduce healthcare costs across the board.

While I can't stand the state of abuse with malpractice lawsuits, simply limiting anyone and everyone's ability to bring suit for medical malpractice is extremely shortsighted. While there is much abuse, there are also far too many cases of serious malpractice out there. When my spleen is exposed, I'd rather not have my doctor thinking "eh, if I screw this up it's no big deal...he can't sue for more than a couple of bucks".

Tort reform is needed, but your approach is as short-sighted as saying we can reduce medical costs by simply raising everyone's taxes and giving everyone medical insurance. 

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