Anatomy of the World's Most Insane Health Care Billing System

A few years ago, I went to the doctor for a simple procedure. I had high-deductible health insurance and would be paying for the procedure out of pocket.

Before heading in I asked the receptionist what I thought was a simple question: "How much is this going to cost?"

She had no idea. And she had no way to check. She looked at me like it was an unreasonable question. A manager contacted a third-party billing agency to get me a quote, which ended up being nothing close to what I actually paid in the end.

Economic models assume participants have perfect information. In reality, they often have no information whatsoever.

I thought this was a glaring example of how screwy health care pricing is. But I had no idea.

Source: WikiMedia, Mouzi.

A permanent pacemaker implant at Pennsylvania's Phoenixville Hospital is billed at $211,534. Four hours away at Unitown Hospital, the same procedure costs $19,747, or 91% less. 163 hospitals across the country charge at least $100,000 for a pacemaker, while 46 charge less than $30,000.

The official bill rate to treat chronic obstructive pulmonary disease, or COPD, at Bayonne Hospital Center in New Jersey is $99,690. At Lake Whitney Hospital in Texas, it's $3,134, or 97% less. Thirty-five hospitals bill an average of more than $50,000 to treat COPD, while 161 bill less than $7,500.

A kidney and urinary tract infection faces a $132,569 bill at Crozer Chester Medical Center in Pennsylvania, but $6,224 at Wyoming County Community Hospital.

Those are just a few examples I pulled out of a massive database released by the Centers for Medicare and Medicaid Services last week. The group spilled the beans on what 3,000 hospitals charge for 100 of the most common medical procedures. It then compares those "chargemaster" prices to what Medicare actually paid for the treatments, based on hospital-specific estimates of the treatment's cost, including administrative overhead.

The database -- which contains nearly 1 million data points and crashed my computer three times -- has two screaming-in-your-face takeaways.

The first is the difference between bill rates among hospitals. It's just huge. At least a dozen treatments I looked up have a difference between the high-cost and low-cost provider of more than ten-fold, and several treatments will cost more than 20 times as much depending on what hospital you're in.

The report doesn't contain perhaps the most important metric -- outcomes and quality of procedures performed. Teaching hospitals and hospitals that receive an influx of seriously ill patient transfers from other hospitals will also have higher-than-average costs.

But even looking at average prices by state shows massive discrepancies. In California, the average hospital charges $101,844 to treat respiratory infections, while Maryland hospitals bill an average of $18,144, or 82% less. New Jersey hospitals bill an average for $72,084 for "simple pneumonia," while Massachusetts hospitals charge an average of $20,722.

The second takeaway is that the gap between what hospitals charge for procedures and what Medicare actually pays for those procedures is off the charts. Of the 100 procedures tracked in the database, the average difference between "average charges" and "average payments" is -- I'm not making this up -- 72%.

Go back to my pacemaker example above. Phoenixville Hospital may charge $211,534 for a pacemaker implant, but Medicare pays the hospital $17,835 for the procedure. Unitown Hospital bills $19,747 for the treatment, and is reimbursed $15,281. What starts out as a five-fold price discrepancy shrinks to a 14% difference in the end.

Steven Brill, a journalist who wrote an eye-opening cover story for TIME earlier this year exposing discrepancies in health-care bill prices that paved the way for the data's release, wrote last week:

The hospital lobby, led by the American Hospital Association, is going to howl that publication of these chargemaster prices is unfair. Only a minority of patients are actually asked to pay those amounts, it will argue. Insurance companies, which cover the majority of patients, receive huge discounts off the list prices, though they pay substantially more than Medicare does.

True, but that doesn't settle the matter. It actually highlights some of the deepest problems. Those "minority of patients" are no small group; they're the estimated 48 million Americans without health insurance. For medical providers to say that chargemaster prices don't reflect the true cost of care is to admit that some of the most financially vulnerable Americans may be being billed absurdly inflated prices. It's ironic, but some of the greatest benefits to having health insurance isn't necessarily the insurance coverage, but the price-negotiating power that insurance companies strike with care providers.

Imagine a banana in a supermarket. It costs $1 for those paying with Visa, $3 for those paying with MasterCard, and $32 for those paying with cash. You can't sign up for Visa until you're 65, and you can only get a MasterCard if you have a nice employer or a decent income. Worse, customers have no idea that such price discrepancy exists. They don't even know how much they'll pay for the banana until long after they've eaten it.

That would be absurd. No one would put up with it.

But it's how our health care system works.

The health care industry is changing fast. If you want to learn more about the upcoming changes, check out our new special free report, "Everything You Need to Know About Obamacare." Just click here to read more. 

Check back every Tuesday and Friday for Morgan Housel's columns on finance and economics.


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  • Report this Comment On May 14, 2013, at 11:46 AM, TMFVelvetHammer wrote:


    This may be my favorite article you've written this year. I hope to see more from you about this serious issue.

    Loved the simile at the end. Very eye-opening as to how faulted the system really is.

    Question: since the ObamaCare SCOTUS decision was a commerce decision, and healthcare seems to be considered commerce, what are the potential implications for this discrepancy in charges being deemed unfair or even illegal pricing schemes?

    As you say, it seems to put those most at risk in the position to be charged outrageously higher rates versus others with preferential payment methods.

    Fool on!

    -Jason Hall

  • Report this Comment On May 14, 2013, at 11:57 AM, abeno wrote:

    I am curious to know if you broke this down by hospitals that are 'for profit' as opposed to 'not for profit' or government run. For example, I know that one of the hospitals that you cite in the article (Phoenixville) is 'for profit.' That distinction could make a significant difference in prices charged.

  • Report this Comment On May 14, 2013, at 12:18 PM, hbofbyu wrote:

    Isn't another factor that hospitals are able to write off the difference between what they charge and what the patient pays? Do they gain tax advantages by charging these high prices? Or is this only a trick used by smaller doctor's offices and clinics?

  • Report this Comment On May 14, 2013, at 12:37 PM, TMFMorgan wrote:


    I'm not a lawyer and have no answer to your question about illegal pricing schemes. But thanks for the comments.


    It's not broken out in the database. But as the article notes, some hospitals will naturally have a higher cost structure.


  • Report this Comment On May 14, 2013, at 12:40 PM, slpmn wrote:

    Great topic! Articles like this and the discussion they create are the first steps in getting this country's healthcare expenditures in line with the rest of the western world.

  • Report this Comment On May 14, 2013, at 12:48 PM, TMFDarwood11 wrote:

    Great article.

    And so many wonder why health care costs are out of control?

    Some like to blame insurance companies, but, as I am fond of pointing out, those companies simply collect and add a mark-up to pay for health care.

    Of course, the current system was designed by politicians, via the monopolies or payment systems created for Medicare and Medicaid. So should we be surprised?

    I'm looking forward to the "Affordable Care Act" article that Morgan writes in 2015-2016.

  • Report this Comment On May 14, 2013, at 1:14 PM, Thaeger wrote:


    Have you read 'Bitter Pill,' (a recent, lengthy Times piece on this subject)? I found it striking at how medical bankruptcies frequently occur to folks who not only have insurance (as do 78% of all medical bankruptcies, per Forbes), but also make over $100k/yr. The major reason being that they save money by having presumably unreachable 6-figure annual limits, and are subsequently ruined when their bills smash right through said limits without even slowing down.

    Its absolutely bizarre to think of how much $100,000 can buy in the real world, compared to what you get for it in our health care system.

  • Report this Comment On May 14, 2013, at 1:18 PM, TMFMorgan wrote:


    Yes, it's a very good read. Brill's article was the reason the CMM released this database.


  • Report this Comment On May 14, 2013, at 1:29 PM, loris8295380 wrote:

    Our healthcare system is disgusting. We need 100% up-front pricing on EVERYTHING. Is it really that complicated????? Put a price on it already!

    When I go to my doctor and if I dare to ask what something costs the staff gets really annoyed, because they really don't know and it takes up their time to find out.

    Every health clinic/hospital/pharmacy needs to have a complete list of charges for every single thing they can bill you for. They should have to post it so a person can see it before even stepping in the door. It seems reasonable. But lets face it, greed is stopping it.

  • Report this Comment On May 14, 2013, at 2:07 PM, damilkman wrote:

    I recommend everyone read the Time Article. What I got out of it was part of the problem are the not-for-profit university affiliated hospitals. Since they are not for profit they cannot generate a dividend. Accumulated cash goes towards expansion, purchasing more expensive equipment, and supporting bigger salaries. This has to be done to keep up with The Jones. In order to pay for this the mastersheet must be increased.

    The end result is that anyone without insurance is unable to afford even simple medical procedures. Then the job of billing and collections is just a matter of how determing what percentage they can squeeze from their uninsured base. Thus pricing is determined not by cost which you think a not for profit would be interested in but how revenue they can generate to build and buy more toys. If 60% of the uninsured could afford a 10K dollar procedure, you make it 100K because you might be able to generate an extra 10-15K from a fraction of that 60.

    The justification for this is the hospitals must recover the cost spent on those who are unable to pay at all. Of course using the same analogy with the banana you have to pay 32 dollars for the bananas because the store does not get reenbursed for anyone paying with food stamps. If this were reality the bananas might cost 8 dollars. However, the store uses the 24 dollar difference to expand into a Super Duper store and buy sports cars for all of the managers. Of course if you cry you only have 16 dollars, they will give you the bananas for 16, as the tables state that 32 dollars for bananas maximizes income.

  • Report this Comment On May 14, 2013, at 2:16 PM, slpmn wrote:

    If they can make restaurants disclose nutritional information on the menus, one would think it might be possible to make health care providers post the costs (or at the very least "good faith estimates" of the costs) of basic services.

    And how about some "plain english" requirements for billing, which would require them to describe each line item of the bill in plain english, not medical/insurance company code that makes it impossible to understand what the charge is for. I recently had a mole removed and the bill had 6 - 8 line items of charges, maybe half of which I could guess what the charge was for. Not only was it in "code", much of the descriptions were cut off because they didn't fit in the column. Clearly, the bill isn't something that was actually intended for use by the recepient of the service.

  • Report this Comment On May 14, 2013, at 3:14 PM, astuber9 wrote:

    To see providers/insurance companies get away with these shenanigans is crazy. What is the solution? I am afraid Obamacare will only make this worse, but let's be optimistic and hope it improves. Either way anybody that reads this must admit that our current socialist system known as group health is totally broken.

  • Report this Comment On May 14, 2013, at 6:06 PM, colleran wrote:

    I had heart surgery some years ago. I was fortunate to have good health insurance. At one point, the hospital sent me a bill for my stay there. The bill was pages and pages long and almost none of the items on it made any sense to me. The total was over $100,000 dollars as I remember.

    If I had to pay it I would have had no idea what I was paying for. I am not even sure if the total was what the insurance company paid or what I would have had to pay.

    I now get co-pays on occasion for a doctor's visit or test. I just pay it rather than try to figure out what it is for or whether I really owe it. I made one attempt to do find out what a charge was for. It was a real ordeal and I never got a satisfactory answer.

    Mass insanity.

  • Report this Comment On May 14, 2013, at 6:19 PM, gmwlovejoy wrote:

    There is a US Consumer agency that is concerned about how much interest a consumer is charged on a mortgage or an auto loan & they regulate car dealers so they won't gouge consumers- why are they not involved in this issue where those with no insurance & paying cash are at a disadvantage

  • Report this Comment On May 14, 2013, at 6:19 PM, dgmennie wrote:

    My recent medical bills have been astounding what with co-pays for various cancer treatments. Upon dealing with all of this first hand I see a major problem in that everyone who touches you gets to send you a bill. Usually this means separate co-pay invoices from the hospital, the doctor(s) involved, the labs that do the work on blood and tissue samples, the facilities that do X-rays and CAT scans, the physical therapist, the speech therapist, etc etc.

    So I am wondering why the (relatively) huge charges from the hospital are justified when they don't include anything you came to the hospital for in the first place. Obviously the Fox is running the Chicken Coop here. If Medicare is ever to be pulled from the abyss of insolvency, these kind of billing practices MUST be done away with immediately. Apparently, the medical profession today has turned the providing of health care into a huge crazy-quilt of overlapping independent contractors as a way to boost cash flow. I've been shelling out significant funds for over nine months and the end is not yet in sight.

    If Obama and company cannot quickly figure out this scam and do something about it soon, they will be completely undone by other big-money issues involving government spending and entitlements which are perhaps far more subtle and just as fiercely guarded by special interests.

  • Report this Comment On May 14, 2013, at 6:24 PM, mikecart1 wrote:

    "magine a banana in a supermarket. It costs $1 for those paying with Visa, $3 for those paying with MasterCard, and $32 for those paying with cash. You can't sign up for Visa until you're 65, and you can only get a MasterCard if you have a nice employer or a decent income. Worse, customers have no idea that such price discrepancy exists. They don't even know how much they'll pay for the banana until long after they've eaten it."

    ^This paragraph is one of the best ever written on this site. (srs)

  • Report this Comment On May 14, 2013, at 6:37 PM, HospitalCEO wrote:

    I have been immersed in this system since 1990, mostly as a hospital CFO, and the system would be perfectly sane and sensible if the government had not essentially taken it over in the 1960's and started dictating the payment rates for virtually all medical procedures. Remeber, the billed charge has no relationship to the actual payment received by hospitals and doctors. In all of your examples of wild billing disparities, those hospitals would receive the same payment from Medicare, Medicaid, and almost all insurance plans. In addition, a great many hospitals now have plans in place to charge uninsured patients who do not qualify for Charity Care only the Medicare rate or another steeply discounted rate off of billed charges. So, billing disparities do exist and they look crazy, but the government caused it and it has no effect on what patients actually pay out of pocket.

  • Report this Comment On May 14, 2013, at 6:45 PM, oldcyclist wrote:

    A few points: I'm not defending all teh obscene differences.

    1. Hospitals in large metro areas are going to have higher overhead just because of where they are. Condo i New York or San Francisco vs Fresno or Bakersfield.

    2. Teaching hospitals, as noted, will have higher costs.

    3. In CA earthquake resistant structures will add to the building costs and any required retrofit.

    4. Salaries for almost everyone will be higher in places mentioned in the first point.

    5. The insurance paperwork is outrageous. Every company has its own set of forms aand criteria for submital. Every plan had different deductables and co-pays. Medical providers have to hire many more people just to process the billing all added cost without added health care.

    That said, these difference should be able to be teased out and added in to the base cost of a proceedure's re-imbursement package.

    We need some form of single payer system. Currently the insurance companies and medical corporations have no incentive to reduce profit or costs.

    Our system is broken. We pay double the amount paid in other industrialized countries and recieve less in benefit. Perhaps exposing this type of thing and the insurance policy exchanges can help.

  • Report this Comment On May 14, 2013, at 6:48 PM, will1946 wrote:

    There is no system and never has been one. Everything is random and arbitrary. That is not system, and it should be controlled by the government.

    Very good article!

  • Report this Comment On May 14, 2013, at 6:49 PM, CKH0 wrote:

    The medical business is saintly compared to the cost abuse of the academic business. A poor patient cannot be forced to pay, but academics have made sure that their customers (students) who are broke will be hounded until they die. Today the ethics, quality and value of higher education would be called fraud in any other business.

  • Report this Comment On May 14, 2013, at 7:00 PM, benjonson wrote:

    The difference between charges and payment vary widely depending upon the insurance carrier. Hospitals and doctors contract with insurance companies for specific rates for specific procedures. Private insurance contracts pay the most and Medicare and Medicaid pay the least. Contract rates vary between all health insurance plans. Health care providers billings must cover the most expensive contract. The provider then writes off the "contract adjustment". Articles like these don't appear to take these facts into account and, thus, give a false view of what actually goes on. Health care insurance isn't actually insurance. Rather it is a 3rd party payor. That is one reason why it is so expensive. People don't need health "insurance" to pay for a flu shot or annual exams or most health related visits. People need insurance to indemnify them against catastrophic illnesses and procedures. If home owner's insurance was like health "insurance", the home owner's insurance would pay for mowing the yard and fixing the screen door and instead of costing $900.00 a year, it would cost $ 15,000.00.

  • Report this Comment On May 14, 2013, at 7:11 PM, whitneygreene wrote:

    I suspect that the 1,800 page ObamaCare legislation did not help on this mess. Probably made it worse?

  • Report this Comment On May 14, 2013, at 7:17 PM, whitneygreene wrote:

    benjonson makes excuses for the mess that is medical charges. But it is a point that all the "little" or imagined illnesses add up to a lot. That is why co-pay is essential in any insurance plan. If a patient has to share the cost, or face a deductible, he will think twice about wasting the time of providers. But that is a relatively small point compared to 10x differences in pricing for the same procedure.

  • Report this Comment On May 14, 2013, at 7:23 PM, driller101 wrote:

    Why we need a single payer healthcare system.

  • Report this Comment On May 14, 2013, at 7:27 PM, lau56806 wrote:

    benjonson is correct that health care insurance isn't actually insurance. Rather it is a 3rd party payor. That is one reason why it is so expensive. People don't need health "insurance" to pay for a flu shot or annual exams or most health related visits. People need insurance to indemnify them against catastrophic illnesses and procedures. If home owner's insurance was like health "insurance", the home owner's insurance would pay for mowing the yard and fixing the screen door and instead of costing $900.00 a year, it would cost $ 15,000.00.

    Just like home insurance, the insurance should be based on need. You do not just have one premium so that everyone is paying for Bill Gate's mansion coverage.

  • Report this Comment On May 14, 2013, at 7:32 PM, whwmdpc wrote:

    As a physician, I cannot agree more with this article re the insanity of our current system (or non-system). Getting an d distributing cost information from my own hospital was impossible.

    My wife was hospitalized and required oximetry. The daily charge was more than the machine cost the hospital.

    Atul Gawande's New Yorker article examining costs in a Texas community is also worthwhile.

    Transparency is part of the solution. Transparency with regard to charges but also setting up a way to compare policies and make informed consumer choices about coverage assuming that we do not go to a single payer system which makes the most sense.

    Moving away from a fee-for-service model is also necessary. The incentives are set up to do more and MD's do respond to the incentives.

    "Insurance companies" are also part of the problem. There is little no true competition and they simply serve as a conduit to pay providers.

  • Report this Comment On May 14, 2013, at 7:43 PM, pickerupper wrote:

    HospitalCEO is correct that Medicare determines what the hospital will get for a given procedure, in a given town at a particular hospital. The TIME article pointed this out and concluded that one thing we could do to reduce health care costs would be to put MORE people onto Medicare, at a younger age, but have them essentially pay for it. The government has by far the most price leverage and, at least according to the TIME reporter, pays the hospital according to what a particular procedure should cost, not what the hospital says it costs.

    HospitalCEO complains that the government caused this mess and then goes on to say that even some hospitals are now charging the same as the Medicare rate for uninsured patients. Perhaps (s)he could explain how Medicare determining the cost somehow caused prices at different hospitals to be so wildly disparate?

    If hospitals can't be trusted to bill to recoup actual costs (for "non-profit" hospitals) then maybe more government involvement is part of the answer. Being very conservative, I never thought I'd say something like this but ---.

  • Report this Comment On May 14, 2013, at 7:50 PM, pickerupper wrote:

    I fully agree with whwmdoc. I would also add that, in addition to cost transparency, outcome transparency for both hospitals AND doctors would be most welcome.

    The whole medical system, costs and competency/outcome, has been shrouded in secrecy for way too long. If the medical consumer were given information about costs and competency (e.g. infection rates at hospitals, re-admission rates, etc.) then things would change in a hurry.

    For a fascinating look at the lack of outcome/competency transparency in our medical system, read "Unaccountable", a book by well-respected surgeon Dr. Marty Makary.

  • Report this Comment On May 14, 2013, at 7:53 PM, Rainmany8 wrote:

    Back in the olden days, Doc charged the poor folks he treated minimal prices and often accepted livestock or produce in exchange for his medical services. He made it up from the more affluent patients in his community who could afford to pay more. Now, Doc charges the poor folks 1000% more than he charges the most affluent of his patients, the insurance companies and government programs. Why he does this in hard to understand when you consider that a majority of his overhead is paying the extra help he needs to provide the paperwork justifying the meager amount that the insurance patients are willing to pay him. Our medical system has gone completely nuts in the interest of “special interests”. When the government has full control of your medical care, they will have full control of you.

  • Report this Comment On May 14, 2013, at 8:11 PM, solyom wrote:

    Some hospitals like a for profit one in Oklahoma City owned by physicians post their charges. You need this you pay this. No changes. Their charges are quite low.

  • Report this Comment On May 14, 2013, at 8:19 PM, TrumanTrout wrote:

    My three step solution:

    1. Soothe ourselves with some rhetoric about the US having the greatest healthcare system in the world.

    2. Avoid serious consideration of single payer systems that are used in other developed nations. Don't ask people there if they would like to change to be more like the US.

    3. As this in an investing site, buy big insurance and big pharma. If you can't beat 'em, join 'em. They sure pay nice dividends.

    Truman Trout

  • Report this Comment On May 14, 2013, at 9:45 PM, jomueller1 wrote:

    Americans love it complicated.

    You again confirmed this statement. But please don't tell that certain politicians who believe we have the best health care delivery system in the world. These guys think the of the USofA as the world. They don't speak a second language (I only speak 4) and they never lived and worked in another country.

    All too often I hear: This cannot be done in this country. Where is the curious spirit of the 19th century when everything was possible? Did the capitalists get too fat and lazy and afraid they may loose their spot at the money trough? I suspect that 20 to 30 million people make a living from the waste of the overpriced health care. But health care was not meant to be a job program, or do I misunderstand this whoe thing?

  • Report this Comment On May 14, 2013, at 9:55 PM, rntoots wrote:

    This is no surprise to me, I have worked in healthcare for 33 yrs. No other industry would put up with this and the waste is incredible!

  • Report this Comment On May 14, 2013, at 10:12 PM, rothd51 wrote:

    I found this article sadly amusing. I am a physician in private practice for 35 years. When I started out I had no "billing dept." My pts. paid $15 for a visit on the way out. There was no "billing." They almost always paid at the time of service, like at the gas station or the supermarket. At the end of the year a few of them dropped off insurance forms for me to fill out. My wife collected the fees. That was my staff, me and the Mrs. I now have banks of computers, a huge billing staff and payroll. I could charge a million for the visit, but I'm only getting what the insurance pays. "Writing off" the balance is misunderstood. There is no tax "write off" for fees you don't collect, only taxes on the fees you collect. Take it from a doc on the front lines; the chaos in medical billing was wrought by financial types with MBAs who could not care less about anyone's health.

  • Report this Comment On May 14, 2013, at 10:15 PM, stan812 wrote:

    Government is never the answer. Transparency is the answer. Publish the prices and let the users decide, just like when you buy a car or a banana. The prices will equalize on their own, all by themselves, and we don't need to hire an army of bureaucrats.

  • Report this Comment On May 14, 2013, at 11:49 PM, irvingfisher wrote:

    Hospital Administrator: Ah, I see you have the machine that goes ping. This is my favorite. You see we lease it back from the company we sold it to and that way it comes under the monthly current budget and not the capital account.

    [Everyone in the room applauds]

    Hospital Administrator: Thank you, thank you.

  • Report this Comment On May 14, 2013, at 11:50 PM, irvingfisher wrote:

    Hey Stan812. It takes 18 times more people to handle medical bills in the US that in Canada's bureaucrat-laden system.

  • Report this Comment On May 15, 2013, at 12:20 AM, dosterling wrote:

    Last week I received a "preventive care" readout from Medicare. In 2011, I supposedly received 6 separate services that I did not receive. One, for example, was for "obesity counseling." I am a 5'6 woman and I weigh 138 pounds. The other "services" were equally absurd. Someone along the line is scamming Medicare. However, the last time I called Medicare about a service I did not receive (or want), I was told I'd have to take that up with the provider. I called the provider, and of course they said they'd take care of it. Any guesses as to whether or not they did? It's no wonder Medicare is broken. There needs to be a REAL ombudsman to call when we see that we've been billed for services not performed. Those of us who want to be really honest and monitor our Medicare readouts have nowhere to turn if the charge isn't legitimate.

  • Report this Comment On May 15, 2013, at 12:26 AM, jomueller1 wrote:


    You mention non-profit hospitals as a problem. I live in the relatively rich town of Boca Raton. For a few years I worked at the local hospital. They depend a lot on donations and still write red ink, almost every year. They squeeze the employees to death. Since more than ten years they are constantly cutting, from retirement benefits to insurance to salary to cafeteria, and so on. Raises are something out of a Hollywood movie.

    This hospital definetely does not try to keep up with the Joneses.

  • Report this Comment On May 15, 2013, at 3:02 AM, jillsman wrote:

    As a physician I would love to be able to compete on price, and I would love to be able to get paid for every case I do. Implement those two reforms and I could probably cut my fees about 50-70%. The problem is that my fees are usually set by insurance companies and are not negotiable. This has the perverse affect of driving prices up, knowing that the billed amount will get cut by the insurance company. Secondly, that sticks people with no insurance with the highest bill. But most of these people don't pay, so I have to try to recover that cost from those who do pay, leading to higher bills. And so goes the viscous cycle leading us to where we are today. It's not that other countries have cheaper care, it's that they ration it to keep costs down. In plain English, what that means is that those systems tell patients who don't meet certain criteria that they will not be treated, or have to wait for their treatment. In the words of an angry Canadian Supreme Court Justice "Access to a waiting list is not access to health care". The Affordable Care Act compounds this problem by adding layers if expensive bureaucracy and seeking to regulate health care delivery, which is not at all the problem. In short, we have an insurance problem, not a health care problem. This could be fixed by creating a system to provide insurance for those who can't afford it or are "uninsurable" and by the rest of us dealing directly with insurance the way we deal with automobile insurance. If you notice, because automobile insurance is an open market, insurers fall all over themselves to compete. The same is true for mechanics, if you bother to call around and get quotes on repairs. Why can't we do this for health care? I'm ready to put my bid in for my work!

  • Report this Comment On May 15, 2013, at 6:55 AM, devoish wrote:


    The Affordable Care Act is a "system to provide insurance for those who can't afford it or are "uninsurable"".

    Compared to single payer, or medicare for all, it is a very bad system because it continues the roll of private insurers in choosing which doctors you can afford to see and which healthcare options those doctors can provide you, instead of doctors.

    It also continues the fantasy of having "choice" in what healthcare options my insurer will cover as if I know what is in the plans until our insurers tell us what is not paid for during that operation you just had, just like they tell your Doctor what he is getting paid.

    In the end all our insurers are providing is lucrative incomes for their executives and the executives of the hospitals and clinics they are in collusion with.


    And this comment by IrvingFisher is my favorite in the whole thread because it really gets to what is wrong is with capitalism;

    "Hey Stan812. It takes 18 times more people to handle medical bills in the US that in Canada's bureaucrat-laden system."

    Basically the lives and productivity of 18 people are being wasted because the "investment industry" underpays people to do nothing but funnel the wealth created by Doctors and Nurses and Cleaning Staff to provide excessive and unsustainable rewards to a minority of people who do not do anything productive to earn that wealth instead of actually providing healthcare and giving working Doctors and Nurses and Cleaning staff better lives and some time at home with their families.

    Best wishes,


  • Report this Comment On May 15, 2013, at 8:10 AM, jasjfarrell wrote:

    How do you call a particular doctor or hospital and ask for a quote for a procedure and all of the additional costs?

  • Report this Comment On May 15, 2013, at 8:19 AM, 8207 wrote:

    Pharmacy reimbursement is only slightly less messed up than what you described. After 32 years in that industry, I walked away.

  • Report this Comment On May 15, 2013, at 9:10 AM, pharpost wrote:

    Excellent article, and the analogy was perfect. Though it doesn't solve the problem of the vastly differing costs for health care, it does help show how Affordable Health Care will enable those who can't get it, be able to get the same discounts that those of us get with being in a large group plan.

  • Report this Comment On May 15, 2013, at 9:14 AM, profstevenj wrote:

    Although it is easy to blame the hospitals for these high hospital charges and high differentials in charges across hospitals, that is an overly simplistic look at the problem.

    Unlike most businesses, hospitals provide their services to many customers who cannot pay for the care they receive. In many cases, hospitals are mandated by law to provide their care regardless of ability to pay. In other cases it is part of their mission as a not-for-profit organization to care for everyone regardless of ability to pay. But you can't provide that care out of thin air. Ultimately, someone must, and does, pay for all the free care hospitals provide.

    When the vast majority of your customers (Medicare, Medicaid, and insurance companies) pay amounts that provide little if any profit (Medicare and Medicaid tell hospitals what they will pay, and insurers have tremendous negotiating leverage), how can you survive as a hospital if you have a large number of poor customers who get their care for free? The answer, you must jack up your charges on those few remaining customers who do not have insurance.

    In other words, there is great cross-subsidization, where the few uninsured who can and do pay for their care, are also paying for the many who cannot or do not pay for their care. Hospitals set their charges so that the amount they collect from those few patients provides them with enough money to stay in business.

    The great differentials we see from hospital to hospital are often the result of the wealth of the community. If no one is poor in one area, then those who pay for their care don't wind up subsidizing care for those who can't pay. If there are many who can't pay in another area, then the few who can pay in that area, wind up with a huge burden.

    So the problem is not what hospitals are charging. The problem is that we have a huge number of uninsured people, hospitals must provide care for them, and there is no formal system for paying for the costs of that care.

    It would seem logical for the cost of their care to be a burden carried by the government, just as basic education is. But that is not the case. The hospital is on its own to figure out where that money must come from.

    Imagine if we said that all elementary schools were financially on their own without school tax revenue. They have to provide education to all children, regardless of ability to pay, and they have to raise their own revenue from charging families for the education. In some neighborhoods each family might be able to pay for their own children. But in other towns, where some could not afford to pay, the school would have to charge much more, so that those who could afford to pay will cover the cost of their own children and also of the children whose families can't afford to pay. Of course, that means that charges would tend to be higher in poorer neighborhoods than richer ones!

    That is the major factor at play in the extremes we see in hospital charges.

    If you are interested in assessing whether hospitals are efficient or are wasteful in providing care, you would be better off to focus on their cost of providing care - not the amount charged for the care. Cost info is also publicly available from Medicare.

    If you are interested in assessing whether hospitals are making outrageous profits, you are better off focusing on the profits the hospital makes, rather than the amount it charges.

    Suppose it costs each of two hospitals $30,000 to implant a pacemaker. One hospital charges $200,000 and the other charges $31,000. It is quite possible that the hospital charging $31,000, about a 3% mark up, is making a bigger profit. Having to charge enormous amounts, is usually a sign of having many charity care patients. And having many charity care patients is likely to lead hospitals to lose money.

    So we have to be very careful about jumping to conclusions in an area that has great complexities.

  • Report this Comment On May 15, 2013, at 1:02 PM, goxi168 wrote:

    With aging baby boomer and high unemployment rate, the rising health care cost affects everyone of us. It is terrible when you are sick and having no money to see a doctor.

  • Report this Comment On May 15, 2013, at 1:17 PM, HospitalCEO wrote:

    Pickerupper, you had the following question for me:

    Perhaps (s)he could explain how Medicare determining the cost somehow caused prices at different hospitals to be so wildly disparate?

    I will try - Medicare did not determine the cost, they determined only how much they were willing to pay for procedures (Inpatient DRG, Outpatient CPT, etc...), and many procedures were paid at less than actual cost for some hospitals. This started way back when most private insurance was still "charge-based" (i.e., the insurance plan would pay 80% of the charge and the patient would pay 20%). Because of this, many hospitals and hospital companies put in larger or more frequent charge increases to offset the losses they incurred on Medicare payments. If a hospital was increasing their chargemaster by an average of 10-12% per year for 20 years compared to a hospital doing a 5% annual increase, that essentially is how the gross charge disparities developed over time. Also, many hospitals added more and more chargeable items and services to their chargemasters over that time period while others either neglected to do so or purposely chose not to.

    A long time ago I had a man in my office literally crying over his wife's hospital bill of about $20,000. She had come to the ER having a stroke and our doctors saved her life. She was in the hospital for 10 days, so her bill was $2,000 per day. The man's out of pocket cost after the insurance paid us $12,000 was going to be $3,000 for a total payment to the hospital of $15,000. I told the man that we only charged about $83.00 per hour for saving his wife's life, and his cost was only going to be $3,000, or about $12.50 per hour. He totally changed after that and agreed he hadn't thought about it that way, and thanked me for listening.

    I would love to see a return to a totally free-market where the lowest-cost and highest-value providers could negotiate fair prices directly with consumers, but I will not hold my breath waiting for it.

  • Report this Comment On May 15, 2013, at 1:53 PM, poach wrote:

    Seriously Morgan, with healthcare taking 17% of the economy I shudder at how long this will go on till sanity prevails upon people, but like HospitalCFO, I am not holding my breadth.

  • Report this Comment On May 15, 2013, at 2:15 PM, poach wrote:

    P.S. I'm swearing off bananas...

  • Report this Comment On May 15, 2013, at 4:14 PM, bbell46356 wrote:

    We need more consumer choice and more competition to control health care costs. We won't get that with single payer. When something is perceived as a right and also perceived of as "free," logic dictates that the cost will escalate to the point where rationing is the only option.

  • Report this Comment On May 15, 2013, at 4:39 PM, Teo123 wrote:

    1. This is a great article. Thank you.

    2. Our health care system does amazing things to a lot of patients but it also bankrupts too many patients -- and for too many simple procedures even when such people have insurance.

    3. I don't know of a single-payer advocate that believes s/he has a right to free health care. S/he simply believes that health care -- like education --should be a part of the services s/he gets for paying taxes.

    4. I don't know enough about Obamacare and what it will and won't do, but I do know that requiring folks to purchase private insurance, alone, won't drive down the cost. I like that the preexisting conditions are covered. I like some other aspects. But until we address the Phoenixville Hospital vs Unitown Hospital discrepancy, we'll continue to have serious problems.

  • Report this Comment On May 15, 2013, at 5:16 PM, Costanzawallet wrote:

    A single payer not for profit system with controlled and standardized payments is the only sane way to go. Using the private system for something like this, and tying health coverage to employment is pure insanity.

  • Report this Comment On May 15, 2013, at 9:05 PM, wajoum wrote:

    The number one cause for bankruptcy in America? you guessed it, healthcare bills. And if you don't have insurance you are responsible for twenty times what an insurance co. would have to pay? now you know why we all need health insurance, to keep us from losing everything in bankruptcy, thankfully we have a president who understands this problem, and I am looking forward to what the healthcare exchanges can do for us in dire need of insurance. Bob

  • Report this Comment On May 15, 2013, at 9:14 PM, RLAprof wrote:


    In answer, yes. One of the benefits of charging the highest prices to those who are the least able to pay is that you get to charge off the amount not collected as a loss in revenue.

    You have already collected a substantial amount from the insurance companies to cover all of your patients, and then you deduct the overcharge for those that you know are unable to pay and get a tax refund. And you also get stories in the paper about how much your hospital benefits the poor, because it provides these services gratis.

    Welcome to amerika.

    But don't get me wrong, because O-care is nothing but a change in the way we insure health care to all, and has nothing to do with the way in which we provide it.

  • Report this Comment On May 15, 2013, at 9:22 PM, Smokeyblu wrote:

    I agree the system is broken, but several factors are left out of the article & the conversation. One being the insurance industry is allowed to function as absolutely no other business un the mccarten fergusson laws. They can strong arm / fee share / any medical hospital/ group legally. That needs to be repealed to truely level the playing field. The second falls from the first, many medical do actually cost at least twice the negotiated rates. To make up the difference, others are charged double- i agree this is rediculously and ethically wrong. Three falls to doctors giving up control of the business side of what once was their business, once a hospital group takes over fees are out of control. Many docs felt pushed into this with mounting paperwork required for reimbursement, the threat of hospitals refusing to allow them to admit patients w/o 'joining' and in some cases greed. Fourth, one proceedure on patient A does not equal the same proceedure on patient B, patients are human and have inumerable variance. If a pacemaker placement becomes complicated it could take twice the OR time, supplies, etc. i hope we stop looking at healthcare as solely commerce. It is not and never was. It was a profession the highest learning & highest ethics. Docs are bound to a much higher standard, not that of 'making a buck' but that of caring for the human organism.

    People travel to the US for this high quality care, now that medicine has been lowered ro the level of merely commerce we will cease to be a nation of high ethics and reknowned research. You guys just better eat right, exercise & pray for health because you will no longer receive the worlds best healthcare much longer. Take a good long look at the walmart- that will be the future of healthcare in the US. And that is not intended as any kind of compliment.

  • Report this Comment On May 15, 2013, at 9:44 PM, Estrogen wrote:

    Love your stuff Morgan. I remember my UCLA economics professor back in the 80's saying that healthcare is the one industry where you have no idea what the price is before you purchase the service.

    I thought HMO's were supposed to solve these issues?

    Keep up the great work, Morgan.


  • Report this Comment On May 15, 2013, at 9:50 PM, TMFNewCow wrote:

    this is amazing, morgan. reminds of this classic quote:

    -- Evan

  • Report this Comment On May 15, 2013, at 10:00 PM, dogedook wrote:

    A few thoughts from a veteran practicing physician who offers a lower "self-pay" rate for uninsured patients and who pays for his own health care sans "insurance" (not all uninsured people are a drain on the system, btw):

    benjonson relates an important fact. Insurance is supposed to "insure" you against a significant financial loss, not indemnify you from basic financial responsibility. US health insurance is not insurance. It is a proxy payment system replete with price management and controls. These days, you contract with and pay an "insurance" company to basically negotiate for and pay for the kind of health care they think you need. You can't maintain the authority to decide what you need and how much you will pay for it when you delegate the responsibility for such to a third party.

    I have to disagree with a point I read in this thread that we need to move away from the fee-for-service model. If fee-for-product/fee-for-service works for the majority of other kinds of businesses out there, then why can't it work for Medicine too? We need to move to a REAL fee-for-service model where patients and providers actually negotiate with each other on price and where providers compete with each other for business and on prices. Price controls and management by third party payors (and this includes Medicare and Medicaid) are what has wrecked the system in the first plachould be worth?.

    Will price fixing, controls and management, i.e., a bureaucratically managed single payor system really fix the health care problem? Like someone else noted above, bureaucratically managed single payor systems elsewhere in the world save money but they do so by rationing care. Do you really want your government deciding for you what kind of health care you need, what it is worth and when you should get it?

  • Report this Comment On May 15, 2013, at 10:57 PM, erikwalter07 wrote:

    I have to, respectfully, take issue with your article. Much as I did with Mr Brill's Time cover story. I will admit up front that I have worked in healthcare since 1991. I have worked for insurers, pharmacy benefit managers, an ACO, and now a healthcare system. I offer this both in the interest of full disclosure and as my bona fide. I'm sure most people will view me as an apologist as opposed to someone with a depth of knowledge gained over 20 years, but what can you do?

    For accuracy, you should correct your statement that the list provides prices for "100 of the most common medical procedures". This is not the case. What it does provide is the most common DRGs or diagnosis related groupers. Procedures are performed but DRGs are roll ups which encompass much more.

    This is not a minor point of semantics but it is one reason why you can't figure out what your hospital stay will cost up front. Your stay in a hospital does not necessarily follow a narrow, pre-determined path. it is instead filled with branches and sequels. No one can know, with anything but an educated guess, what services you will receive during your stay. DRGs provide a convenient rubric for billing services and supplies which are normally associated with a given illness or chronic disease state. Further, at the time you come into the hospital you do not usually have a diagnosis right away. In fact, the coding associated with the CMS release won't be done (usually) until you have left the hospital. Further, even within a DRG there is a lot of room for additional charges which makes the data CMS released, at least that which I downloaded, much less informative.

    I looked at the CMS data for the area where I live, Minneapolis/St Paul. Most hospitals had a very narrow discount range - the large county hospital which provides a lot of indigent care had, as you might expect, the lowest discount - meaning it was billing closer to the CMS fee schedule. One of the larger, more respected hospitals in the area, Abbott Northwestern, had the deepest discount. Most of the other hospitals had discounts hovering in the early 60s. Hospitals in a given area have a very narrow differential among their peers.

    Much has been made of the price range - and you do as much in your article. But in reality, the comparison you provide is absurd. Someone living in Southern California (where the cost of living and thus doing business is high by most peoples' standards) could not very well plan to be treated for a heart attack in Arkansas and so it is meaningless to compare the two.

    Another critical distinction not being made is the notion of complexity. Not everyone who presents with a given condition will have the same situation - co-morbidities, concomitant medication therapies, social situations, any number of factors can lead to increased costs. It's entirely possible that people of this sort may self select to more expensive hospitals because they anticipate a higher level of care.

    As to medical bills driving up bankruptcies - I believe this is tied more to the fact that providers and collection agencies are more willing to report delinquent debt than they have been historically. In other words, years ago you could ignore medical bills with little consequence. Now it is a push between the collections account on your credit record and declaring bankruptcy.

    While our system isn't perfect, it certainly isn't the monster of greed and waste the Brill article painted through his cherry picked high cost hospitals and ill-informed consumers who brought some of the hardship on themselves by making poor choices even though they had time and facilities at their disposal to make better decisions. Certainly the healthcare debate is not over, but it would benefit from more thorough explanations of the process, less anecdote based on small n's, less emotional debate.

  • Report this Comment On May 16, 2013, at 6:32 AM, Zorba78 wrote:

    I am a physician; an intensivist to be more specific. (Intensivist: A physician who specializes in the care of critically ill patients, usually in an intensive care unit (ICU). I have been exposed to different models of health care provision, both here and abroad, and I was involved in health policies debates on the local level in Albuquerque, NM. The article brings up an important issue, and the commentators bring up a multitude of other important issues as well.

    Regarding cost/pricing of services: there is almost a complete lack of transparency, and that is by design and not coincidental. The billing system is so fractured that it’s impossible to give any patient a decent idea on how much the costs will be. On a pursuit of trying to figure out the expense of the daily labs and interventions I order on my ICU patients, I realized how ignorant I was in terms of realizing the unnecessary financial burdens I can place on the shoulders of my patient or her/his family; burdens that were completely avoidable and won’t have any impact on care or outcomes. For example: ordering a potassium serum level test (as an isolated stand alone test) was more costly than ordering a basic metabolic panel (which includes the levels of potassium and other electrolytes like sodium, chloride, etc). Another example: ordering Combivent (an inhaler for asthma/COPD) is on average 5 times more expensive than ordering Duonebs (which have the same chemical components delivered in a different method). In both cases, my patient would have received the same care, without having to foot a larger bill. I believe that cost awareness is very important, and should be part of our education as health care providers. I think it comes without saying that the patient has the right to inquire about the cost of services; and to get an answer. If we want to take a real free market approach to health care; is it not prudent for patients to have an idea about costs at different clinics/institutions so that they can make informed decisions?

    I did part of my training at the VA system, and I learned many things about myself as a physician and about the health care system in general, by contrasting the model of care in the VA to those of some private health care systems. The VA system has many efficiency, and many deficiencies. Overall, it provides very good care at a low cost, with outcomes that are comparable to other systems. The VA system has enough patients to a point that much better pricing of medications can be negotiated with big pharma. My veteran patients didn’t have to worry about not being able to afford their medications or procedures, and didn’t have to negotiate the cost of their care with me or with anybody else. The VA system had national protocols to guide provision of care, with clear limitations at times regarding provision of certain services. The VA system is definitely the purist example of socialized medicine that you can find here or internationally actually (yes, I hate to break this news, but we have socialized medicine in America). Our representatives in D.C. are covered by the Walter-Reed VA system, and I am 100% sure that none of them would be willing to drop their coverage for a private insurance: aka, they enjoy the benefits of socialized medicine. When it comes to electronic medical records, I loved using CPRS (the VA version of EMR), simply because it was a national network; if my patient lives in Florida, and she/he got sick while visiting family in Albuquerque, I can access all their medical records from their primary care physician and from previous VA hospital visits in 2 minutes, eliminating a multitude of wasted efforts to collect data, or to order unnecessary scans or procedures, and having a positive impact on care by providing me with the information I need most; especially when the patient is sick to a point where they cannot communicate. At the same time, I used to get very annoyed by the long bureaucratic process of getting certain necessary interventions approved or contracted out to other facilities, not to mention the long waiting times.

    Regarding rationing of care: I’m not sure why this comes across as such an outrageous idea to physicians and to the public: we have been rationing care since the first physician saw the first patient and this definitely applies to Americans as much as it applies to all citizens of the world. The fallacy of endless resources is; well; a fallacy. There are more ideas than resources, and as individuals, institutions, societies, governments …etc; we allocate resources based on prioritization. Now, the real debate in my mind is how to balance out individual autonomy against societal needs/burdens. Of course this is not a problem if you have the means: whether you are in America or in Swaziland, you can get the best care if you have the money upfront. It’s a question of how to provide the best possible health care services to the majority of the population. Anyone who thinks that rationing of care is a new kid on the block needs a serious reality check.

    Regarding PPACA (aka Obama care): there is a lot to criticize in the bill, however the benefits outweigh the drawbacks:

    - No life time limit on benefits: this will prevent insurance companies from cancelling your insurance when you need it the most: when you are chronically or seriously ill and require expensive therapeutics or procedures. I had patients who were dropped off the insurance plan as their bills accumulated and the insurance company was unwilling to keep footing the bills (something that many insurance-paying Americans weren’t told is a possibility).

    - No limits on patients’ capacity to buy insurance when they have pre existing conditions: this will decrease the chance to zero of you not qualifying for health insurance when changing jobs or location of residence (aka; having to change insurance plans)

    - The individual mandate: there is no way insurance companies can remain solvent without everybody paying their share of the cost: whether healthy or not. Basic math yields to the fact that if you are obligated; as an insurance company, to sell a policy to anyone knocking on your door (the no pre-existing condition limit), that the only way to offset costs of covering the ill have to be in part covered by premiums paid by the healthy.

    - A higher percentage of the dollar you pay toward your health insurance policy will be actually used to take care of your health expenses; which means less for administrative overheads. Administrative overheads for private insurance companies are on average about 4-5 times those of Medicare. I’d rather that almost all of the money I pay toward my premium goes toward taking care of my health care bills (or the bills of other patients in the system); rather than to cover for the administrative costs of a fractured system.

    Regarding fee-for-service: the idea of patients negotiating costs with their doctors; this is like asking the sheep to negotiate with the wolves (the same metaphor applies to patients negotiating their options with different health insurance companies). I’m not saying that the average physician has ill intentions, but the patients are definitely not in a position to negotiate the pricing of their care. At the same time, a fee-for-service model forces (or incentivizes) the physician (or the clinic/hospital…etc) to focus on productivity (and not on quality of care). A model that compensates physicians based on a combination of metrics including clinical complexity, qualitative measures of care, and outcomes is more compatible with the training I received in medical school. After all, I don’t have an MBA.

    Regarding for-profit versus non-for-profit: this is mostly a joke; the only large-scale non-for-profit health care systems in our country are the VA system, and Medicare/Medicaid.

    The current German health care system provides; I think; a very good model that complies with the free market approaches, and delivers excellent results to the largest possible percentage of the population. Look up “Healthcare in Germany” in Wikipedia for a detailed explanation. In short; it’s a multi-payer two layered system: public layer (called the sickness funds) and a private layer. The public layer provides funds to care for citizens making less than a set income level: the funds come from joint employer-employee contributions and to a lesser degree from local governmental funds, and physician compensation rates are negotiated at the federal states level amongst organized interest groups. Persons with incomes above the set level can opt into the public system, or purchase private insurance, or purchase supplementary insurance to the public insurance…the options are unlimited.

    Just some thoughts…

  • Report this Comment On May 16, 2013, at 7:15 AM, TMFPennyWise wrote:

    Morgan, Your article is excellent and as you pointed out it only touches the tip of the ice berg.

    I know what you mean about having a high deductible (as I do too) and trying to be a responsible health care consumer and stay within my budget. Impossible. I ask every time I go to a health care provider what the cost is, mainly as an exercise in futility, but also in the hopes that sometime somewhere one of the doctors or technicians will get a clue and begin to question their medical group CEOs, medical association leaders and lobbyists, and employers about valid pricing. Whether you have insurance coverage, a high deductible,, full coverage insurance, or whatever, everyone should do this.

    But there is little or no hope for insisting on accountablity by health care providers since--as you can read in the posts above-- there is a lot of finger pointing in the other direction and insistence that health care providers' management incompetency, greed and graft is somebody else's problem to sort out. And that billing with integrity and transparency is impossible because of 'the system'.

    Now my experience in medical care in-competencies and graft is inconsequential compared to the billing nightmares I have witnessed in caring for my very elderly mother and mother-in-law under medicare (both of whom I think are seen as 'easy marks' for a billing extravaganza by providers).

    The unconscionable bills we and the Medicare program have received for services not provided at all or that were performed to pad the bill, medications not asked for or cancelled but billed nevertheless, etc. etc. is no less than stealing by the hospitals, docs, therapists, and medical providers. And when we bring it up, the docs and hospital admins mumble around and cast a blind eye. But what an eye opener for us!

    Morgan, please keep us up to date on your research and writing into medical care pricing and the needless expense to the American public. Every American should be aware of this drain on our consumer resources.

  • Report this Comment On May 16, 2013, at 7:40 AM, Herbstmd wrote:

    As Physician in solo internal medicine practice for almost 30 years, I can tell you that the system is nuts. We are paid as physicians not for thinking, but for doing looney tests that often have no relationship to the solution of the patient's illness. The more tests, the more money we receive. Treating the patient directly and succinctly achieves us nothing financially. I can restart someone's heart and receive 40.00, but pop a pimple and it's 100.00. We are forced to play a game for idiots if we wish to survive. Proper physical examination, history taking and thinking are really not reimbursed, while often needless tests and the like are, in order to pay our bills. Try eliminating malpractice fears by curbing trial lawyers if you want to see a plunge in healthcare costs. By the way, in my office, we can always tell a patient what a particular service costs in cash. The worst is government run things like Medicare and Medicaid, with Medicaid being the biggest joke. In my area no doctor in practice will take it. Just wait until the Medicaid roles triple under Obamacare, and see what it does to the taxpayers, particularly property owners. That will be a disaster of volcanic proportions that will overwhelm our working middle class. They won't know what hit them.

  • Report this Comment On May 16, 2013, at 8:56 AM, SwampBull wrote:

    The Motley Fool - you come here for the screener tools, and you stay for the Housel articles.


    *Somebody give Morgan a raise!

  • Report this Comment On May 16, 2013, at 9:20 AM, XXF wrote:

    Dmmt Morgan, I explained to one of your cronies a couple of days ago that you are reading the source data incorrectly. Stop misleading people by quoting column J for hyperbolic effect and use column K, which you can still make an argument is unreasonable disparity in prices. The actual number that should be in place of that $211,534 is their payment for procedure number (column K) which is $17,835 (which is among the cheaper charges for a pacemaker).

    You can still make the point that at Stanford Hospital a pacemaker costs $38,724 while at Thomas Hospital in Alabama it costs $12,287, but rather than doing that you write an article that is intentionally misleading. You even suggest at the bottom that uninsured individuals will be billed the "Average Covered Charges" amount when anyone involved in healthcare knows that isn't true. The hospital will provide these services as required by law and then attempt to work out some type of plan, whether helping the patient to qualify for Medicaid or (what is typically the best case scenario for a Hospital) you paying around the Medicare rate for the procedure.

    Stop posting stories that are intentionally misleading.

  • Report this Comment On May 16, 2013, at 10:11 AM, TMFMorgan wrote:


    The article addresses your point.


  • Report this Comment On May 16, 2013, at 12:10 PM, FMcommenter wrote:

    Good article and some of the best commentary

    I have encountered on a subject about which the

    the public's and the medical community's knowledge cannot be underestimated. Twenty years on a major health care system board is the basis for that


    Hopefully the current dialog will cause the purchasers of health care (government and businesses) to demand that providers post cost and quality metrics on an episode of care basis. An episode of care is the totality of services to treat a given condition. Once that occurs individuals and the organizations providing insurance for their employees can select providers based on comparative cost and quality. This will force the health care industry on to a normal competitive model with an attendant drop in costs of at least

    20% over a relatively sort period of time.

    Transforming the industry to a cost containment quality driven model is generations overdue.

    Presently all participants reap the the greatest reward with cost increases making cost containment secondary.

    On the subject of cost variance between providers

    within the same region, 200-300% occurs with some regularity with outliers of up to 1000%. It does not require a comparison between metropolitan New York and puckerbrush Texas to find such extremes.

    For companies and the government to pay insurance companies 20% of our healthcare dollar

    for healthcare processing is absurd. The above two

    conditions are a direct result of an industry not subject to traditional competitive forces.

    Warren Buffet this past weekend said healthcare is a major problem of our society. I would concur, adequate health insurance for a family costs $6/$10

    per employee hour before employee deductibles whether paid for by the employee or employer. Our healthcare model creates an economic headwind on business particularly manufacturing that dwarfs tax issues and regulation. It remains a major driver

    of the decision to offshore.

  • Report this Comment On May 16, 2013, at 1:57 PM, dogedook wrote:

    @zorba78 - I think that you may underestimate the ability of sheep patients to individually and collectively understand and negotiate fees and services with wolf healthcare providers. Look at a few other fee-for-service systems and see what you think. Does your average person understand the intricacies of fees and services for car mechanics, attorneys, accountants, dentists, orthodontists, construction contractors or financial advisors? Is it possible that one could get substandard services or get ripped off? Lots of sheep and wolves in these systems but not a lot of collective price bargaining from government, businesses and third party payors. Why not? Should the government (or any other collective bargaining entity) step in and force price controls and quality assurance measures on mechanics, attorneys, accountants and contractors to ensure that all of us sheep get quality services at a "usual and customary" price?

  • Report this Comment On May 16, 2013, at 7:11 PM, libertarian2 wrote:

    A way of providing some relief, if you can tear the politicians away from the troth being filled by the billions of the health lobby, is to provide some mandatory transparency:

    1. Requiring every hospital bill to be sufficiently detailed in the format required by Medicare and to require that the Medicare reimbursement rate be shown next to the item, and

    2. Provide that in any judicial contest of charges there will be a rebuttable presumption that the Medicare reimbursement rate is the reasonable rate, and

    3. That overcharges recovered or avoided will be subject to treble damages.

  • Report this Comment On May 16, 2013, at 8:03 PM, hbofbyu wrote:

    There are too many immovable objects (Insurance Companies, Lobbyists, Congress, Drug Companies, Lawyers) for any of this to ever change from an inch this way or an inch that way.

    The answer to America's health care problem will not be in America. You need heart surgery by the hour? Try Costa Rica.

  • Report this Comment On May 17, 2013, at 4:03 AM, Zorba78 wrote:


    My views can be biased by the fact that I take care of the sickest patients in the hospital; those who are at times unable to communicate because of the nature or severity of their condition, especially when there is no power of attorney of health who is aware of their wishes and baseline functionality. In that sense, the capacity of the individual patient to navigate through options; especially when the care providers have little or no awareness of costs of services; is limited. The patient can be under the mercy of a health care culture that worships an endless parade of diagnostic and therapeutic tests and procedures, that; in many occasions, are not supported by evidence, and can potentially cause some untoward complications. I find it very hard to maintain my patients' autonomy when she/he cannot speak for themselves, even when they have a designated power of attorney of health, since; for the most part; family members and friends are emotionally invested and can struggle with decision-making even with the best guidance from the health care provider. You can extrapolate that situation to others with varying degrees of complexity.

    That’s what I meant when noting that patients are in a tough spot. It’s like trying to pick a private health insurance plan (whether different options from the same provider, or quoting different providers): I went through this exercise with some of my patients when I was an internal medicine resident, and I can till you with a great degree of confidence that even a physician can find it very hard to decipher their own insurance plan; so how about those with little or no knowledge of health issues and terminology?

    If we want to stay away from a completely nationalized health care system (i.e. the current British model), the German model; again, provides a nice road map. Collective bargaining is a key stone of the system; interest groups negotiate pricing models at the local states level. These negotiations are the backbone of the pricing you can find in the public plan/layer. So, a German patient does not have to worry about unforeseen expenses, they only worry about how to get better.

    Again, I think that fee-for-service is a bad recipe for patients, physicians, and to the economy, and that fee-for-outcome/quality/admission/visit is a much better approach, and one that can move the health care culture in a more humane and economically sustainable direction. I’m not saying that it is the answer; there are many facets to the problems we face, but it’s definitely worth a try at this juncture.

  • Report this Comment On May 17, 2013, at 12:51 PM, Smokeyblu wrote:

    Fee for service DOES NOT mean collective bargaining nor does it mean negotiated fees. I can understand why most physicians have forgotten how a small family practice can exist successfully on a true fee for service basis amost have forgotten that is how many existed in the past. In the past as in before insurance companies and other entities decided to make a killing in the healthcare field.

    I have run a small fee for service practice for 20 years. No, i do not make a lot of money, but my patients understand their diagnosis & their treatment options as well as the fees. They actually appreciate the extra time i & my staff take to explain as well as we can, multiple times in many cases.

    And, if you are giving a non insured patient a different fee, usually less than, the fee you file for one with insurance you are technically defraudin the insurance companies for which you file. Even if you have never signed an agreement with them. It almost every state the insurance companies are supposed to be charged the smallest fee. Yes, it is wrong for them to be able to tell you whom youay discount and whom you may not, but until laws like the mccaron fergusson act are repealed- it is the law.

    By the way, the house has voted to repeal it, the senate refuses to let it even be heard. It only puts the insurance companies on even ground with other businesses, something they greatly fear, perhaps even more than obamacare.

    Until healthcare is clearly between a patient and the physician w/minimal gov and legal intrusion it will continue to be a cluster, ahem, mess...

  • Report this Comment On May 17, 2013, at 1:13 PM, DGReid wrote:

    If I were 18, going into the medical profession would be the last thing I would consider. Even it school were free and incomes guaranteed, why would someone submit themselves to a lifetime of dealing with this kind of bureaucracy? Medical care needs to be handled at the state level rather than creating massive programs impossible to control or produce desired results.

  • Report this Comment On May 17, 2013, at 2:09 PM, MCCrockett wrote:

    I had a transient ischemic stroke over a decade ago that required a carotid endardectomy. The hospital bill was horrendous but that wasn't the real problem.

    The real problem was all the bills that I received from doctors and doctor groups that I didn't know how they were involved in the surgical procedure or my care. For all I know, they may have been standing in the hallway as I was wheeled into surgery.

    My mother gave me some critical advice. Don't pay any medical bills until you have received at least three billing statements. If you don't get three statements, the doctor was paid by insurance or wasn't involved in your surgery.

    Personally, I would like to see the primary physician or surgeon assume the role of a general contractor for the procedure. All other doctors and organizations involved would submit their bills to him for payment, he would be obligated to pay their bills, and obligated to submit the bills to insurance.

  • Report this Comment On May 17, 2013, at 2:41 PM, infopackrat wrote:

    This is the second time this week I've "discovered" something I learned 20 years ago. It was a memoir of a organ recovery team doctor entitled "Transplant." There's a discussion in it about how they were running in the red because so many insurance companies forced them to provide their transplant procedures under cost. Specifically, insurance companies were paying "in full" $80,000 for a transplant that cost the hospital $100,000 to perform. And if memory serves, the book was writen in 1989.

  • Report this Comment On May 17, 2013, at 3:57 PM, drborst wrote:

    This is a totally off topic, but I want to tell it anyway (thanks for serving as the outlet for my frusteration).

    .I have a relative in a foreign country who fell while visiting. I thought I’d be a good guy and pay his medical bills (he doesn’t care, bad credit doesn’t mean much where he comes from). Of the 6 bills I received, I offered each 20% less, because that is the discount my insurance gets. Four took the money. One (the hospital), fought me for an hour on the phone over 0.8% (they offered a 19.2% uninsured person discount).

    And the last one still makes me boil. The doctor’s billing agency took the 80%, but then sold the remaining 20% to a collections agency. I get a letter from them (addressed to my father-in-law) every 6 mos that reminds me what a sucker I was.

  • Report this Comment On May 17, 2013, at 7:42 PM, jamesmmm wrote:

    @3Fairfield--- healthcare providers who collect more than is allowed by Medicare/Medicaid can lose their licences, so not many attempt it...for other plans the providers can also run into difficulty, so many do not attempt it....

    You mentioned your mother and MIL: if they are being billed in excess of what Medicare allows, the provider probably has an exemption called "advance beneficiary notice" on file which states that the patient has agreed to pay for services in excess of what is allowed by Medicare.

    @all---Medicare limits the amounts that providers can collect from Medicare beneficiaries and pays a significant portion of the remainder.(ie: doctor bills $350. Medicare allows $200 Medicare pays $160, patient pays $40- mostly simple)

    Sign up for Motley Fools classes...I have a 5 minute powerpoint, supporting documentation and a master plan to save not only Medicare but Social Security

  • Report this Comment On May 18, 2013, at 7:36 AM, jamesmmm wrote:

    addition to comment above:

    the plan I have also saves on taxes!


  • Report this Comment On May 18, 2013, at 5:49 PM, jamesmmm wrote:

    @martyandjude---> soonafter ObamaCare takes effect, total collapse is here...but we can turn everything around, making it more bearable.


  • Report this Comment On May 18, 2013, at 11:37 PM, Hibiscusanole wrote:

    I lived in a state where, for generations, Charity Hospital was there for us. No one worried that they'd go into bankruptcy. They had, apparently, negotiated fair rates and charged us a state income tax that made up for the less than $500/yr. per uninsured person that it cost the state. One hoped for employee insurance, but did not sweat bullets if one could not get it.

    My concern is more surprises of this nature will occur

  • Report this Comment On May 19, 2013, at 12:12 AM, whwmdpc wrote:

    Thanks for an excellent article and discussion. Complex issue but clearly transparency is part of the solution. Transparency is necessary for competition to be of any benefit, but even in a system that does not rely on competition, transparency is necessary to allow evaluation of the results of different systems.

    A starting point is dealing with the significant geographic differences in services performed. I think (as a retired MD) that this remains a major concern. At some point differences in physician practices (ordering lab tests, requesting services, consults etc,) needs to be dealt with. We can't all be right. That is not the same as asking for cookbook medicine: evidence based medicine does exist.

  • Report this Comment On May 19, 2013, at 12:34 AM, HurricaneJohnson wrote:

    Plain and simple - government touches it and the cost/billing/payment structure blows up. It's funny to discuss this with someone who complains about the insurance companies over-charging, when it is the market distortion from government which is to blame.

    I also find it funny when discussing the concepts of "for profit" and "approved procedures" as it relates to healthcare. Popular wisdom is that insurance companies are greedy because of profit, yet the rate of return an insurance company makes in the healthcare industry is somewhere around 3%. People that are pro-government healthcare think that Insurance companies disapprove too many patient treatments so as to make more profit, when in fact Medicare turns down more procedures than the insurance companies.

    This will be an interesting couple of years..

  • Report this Comment On May 19, 2013, at 9:47 AM, xerohype wrote:

    Hospital and physician charges have nothing to do with what is ultimately paid out in most cases. Most people have insurance and don't pay the sticker price and even self-pay/uninsured get discounts. The reason charges are so way off is that they have to be higher than every single contract with third party payers. If they are not the hospital or health care provider leaves money on the table. More important than hospital charges are rates set by CMS on reimbursement, all healthcare services are pretty much linked to those reimbursement rates and the charges have no relevance in what those rates are.

  • Report this Comment On May 19, 2013, at 10:35 AM, xerohype wrote:

    A solution to this problem: The only way to resolve this is to get rid of third party payers and have patients feel the real costs of healthcare. If you have to choose between smoking a cigarette and seeing your doctor, which one would you choose? Most people don't take personal responsibility for their own health and choose the cigarette (or the glazed donut!). You subsidize people who cannot afford health care, but they have to have some skin in the game. That is the only way to control costs!

  • Report this Comment On May 19, 2013, at 10:52 AM, coleyounger wrote:

    Most interesting comments. I will add from my experience. I ran health plans for large employers. We had all the complaints from employees mentioned here to the point that we hired an independent (of the employer and the insurance company) ombudsman to find out what was actually going on. Our experience indicated that 5% of the time it was a patient problem, 5% of the time it was an insurance problem and 90% of the time it was a provider problem. Improper coding, failure to submit bills to insurance and balance billing were the most common. Not really a slam on doctors since on one ever went to medical school so they could run a billing service. Thus the process gets delegated to people who are less skilled or scrupulous (aka collection agencies).

    I had a lot of exposure to insurance issues in the formative years of this mess. The problem began with Medicare/Medicaid and their price controls. Insurance companies then developed their own versions to prevent cost shifting to them and their customers. The notion expressed that the greatest benefit of insurance is receiving the negotiated discounts is absolutely correct. The mandating of charity care is another method of government cost-shifting. It used to be that a receiving hospital would stabilize the patient, if necessary, and then transport to a hospital with a government contract to provide the care. Now the receiving hospital just eats the cost and tries to pass it along. Finally, there is the failed promises of HMO promoters. Remember that the theory was that if adequate preventative care could be provided, overall costs would be lowered. It didn't work to anywhere near the extent anticipated and it was the wedge to make "insurance" pay for all kinds of routine care (like getting oil changes are part of your car insurance).

    So now we have a mess and it will be getting worse. I see that a number of your commentators are advocating a hair of the dog solution.

  • Report this Comment On May 19, 2013, at 2:49 PM, MajorBob04 wrote:

    If you want more information about outcomes, you can check the same Medicare website:

    Morgan, I greatly respect many of the articles that you write. However, this issue is far more complex than this somewhat simplistic article. I am halfway through completing an MBA in Healthcare and I feel like I've barely scratched the surface.

    The simile about the banana is somewhat simplistic - what if the banana actually cost $5? And what type of banana is it? What color? How was it picked? What if the government dictated that healthcare providers have to bill according to very specific codes that are much more complex than they have to be? And what if they retroactively rejected any bills that are not perfectly accurate three years ago even though they were acceptable three years ago before Obamacare? And what if they decided to reduce the price that Medicare paid for the banana so that they could save that money to pay for the implementation of Obamacare?

    I have two brothers and two sisters-in-law who are doctors. I have a sister who has five masters degrees and has worked in healthcare for 50 years, including public, private and military healthcare organizations. They are giving up their private practice because it's just not worth practical anymore. Back to the banana simile - what if all the supermarkets and stores closed because the government made it too hard to sell the banana because the paperwork and threats of audits and non-payment were too high?

    I think you've inspired me to write an article for the blog network . . . though I have to admit that the best summary of this issue can be found in the book "The Battle for America's Soul" by Dr. C. L. Gray.

  • Report this Comment On May 20, 2013, at 5:49 AM, jonesericr wrote:

    I heard this on NRP last week and wasn't all that surprised after being in the hospital in Japan for a cyst removal. My charge, I'm not a Japanese National and can't use my wife's, she is a National, insurance since she changed jobs and I work for the US Navy Civilian work force, was $4500.00 based on the yen rate at the time. When I asked how much the doctor told me to ask the folks downstairs, I couldn't find anyone who knew and the liaison from the base hospital couldn't either. No one knew and the hospital systems here don't run the same as they do in the states. Rates are still lower here, I think that same procedure would have cost 3x that with fewer days spent in the hospital. You go in a Japanese hospital it's probably a minimum of 3 days 2 nights. That would cost a pretty penny in the US regardless of the procedure being done.


  • Report this Comment On May 20, 2013, at 5:08 PM, hlk31 wrote:

    The US health care system is completely screwy. The reason is the for-profit motive. Doctors, hospitals, payers all have an enormous stake in the game. That's why it doesn't get better, only more unfair to the consumer.

  • Report this Comment On May 21, 2013, at 3:13 AM, jamesmmm wrote:

    I wonder How things will be when ObamaCare becomes the law of the land. Will care get better or less costly?

  • Report this Comment On May 21, 2013, at 10:53 AM, mtnrunner2 wrote:

    Very enlightening. Unfortunately rather than getting the hint that free markets would be a good direction, government policy makers will advocate the use of yet more government force to compel price disclosure and mandate standard prices. Exactly the wrong solution.

  • Report this Comment On May 21, 2013, at 4:36 PM, chowdachief wrote:

    I have recently complained about these exact same issues to our doctors and 3 doctors in my family. This system defies all logic.

    On a recent trip to a ultrasound tech, we were asked to sign a release assuming full financial responsibilty for the services provided. Naturally, I asked a few questions about the cost. Yet, the doctor's office didn't know how much they were going to charge. As a consumer I simply wanted to know my highest possible liability. If the insurance company pays zero, what would I owe? Unfortunately, the doctor didn't know what they planned on charging, the insurance company doesn't know how much they will pay, and I'm stuck with a pregnant wife in need of an ultrasound and a 'full financial responsibilty' form in my hands.

    What a huge flaw in the health care system. At least with mortgage defaults you can point blame at the consumer b/c they knew the terms of the agreement. Not in the health care system. Hopefully more articles like this will raise awareness on the issue. It's absolutely nuts!

  • Report this Comment On May 21, 2013, at 4:40 PM, chowdachief wrote:

    Addtionally, I've heard way too many rationalizers use phrases such as, "can you put a price on saving a life?" or "you're not sick anymore, right? so what are you complaining about?"......That line of thinking is an attempt to coerce and intimidate people into blindly throwing their money at health care professionals and institutions. It is wrong and immoral.

  • Report this Comment On May 21, 2013, at 5:41 PM, heavyoiler wrote:

    The whole health care system needs to be reformed from top to bottom. Health care costs and the cost of health care procedures in the U.S. are much more expensive than in the other industrialized and advanced countries of the world. As a trend, the cost of health care in the U.S. has been increasing at a rate twice the rate of inflation.

    The cost of health care in the United States has quadrupled since 1990. Simply put, the cost of health care in the U.S. will become more of a problem for everyone because of the ever increasing cost in real, inflation adjusted dollars. Just about every year the cost of health care in the U.S. becomes a larger and larger percentage of the Gross Domestic Product and it is not sustainable.

    I suggest you go online and search for and read these two articles:

    "Why An MRI Costs $1,080 In America And $280 In France"


    " Why Medical Bills Are Killing Us

  • Report this Comment On May 21, 2013, at 11:48 PM, Caberna wrote:

    As a physician's wife I can relate how overworked, and underappreciated physicians are these days. They have no control over healthcare bills as they are strictly regulated by a variety of agencies. Hospitals force them to take call for free to keep their staff appointments so they get called in the middle of the night to come in and see patients in the ER. Patients don't show up for appointments creating missed revenue and refuse to pay their copays. Half of what is collected goes to overhead.

    Medical school is expensive, and our own daughter will owe $350,000 upon graduation. She has been charged 8% interest since the first day of school. It is also very difficult to have to study and deny yourself so many things while you are spending 10+ years getting your medical education.

    You need to read your insurance documents very carefully and understand what will be paid and what you will owe. Your provider frequently has to get preauthorization from the insurance company

    and can tell you how much it will cost.

    At least we have a choice. You can join an HMO and pay less but seek care only through their system or you can pay more and get a choice like being able to go to Stanford.

    Socialized medicine will make your choice for you.

  • Report this Comment On May 22, 2013, at 1:41 AM, FoolishLav wrote:

    "You can always count on the Americans to do the right thing…after they have exhausted all other possibilities."

    Sir Winston Churchill

  • Report this Comment On May 23, 2013, at 12:17 PM, livtwoski wrote:

    ROFL at those who think billing plays a substantive role in the cost of our health care. What a joke.

    Take two popular health care canards: inefficiencies and litigation. Lets dismiss for a moment that, at times, the litigation it meritious....

    Both of these canards impact health care costs to the consumer at a statistically insignificant level and that supposed 'business' types here cannot do that math is laughable.

    Health care is expensive because it is a non-commodity being treated as a goods n service and we're the only country that has not recognized that. Why? Because of profit.

    And the ONLY people who argue on behalf of for profit health care are a.) those who benefit from it i.e. insurance companies, insurance middle-mgmt., b.) those who are too stupid to realize a national health care policy is not 'socialism' or 'communism' (review history if you truly believe that - it's absurd).

    For-profit health care is an abject failure for the individual, our humanity, and for our country. There is really no viable economic or business argument that can be sustained absent, as I said, some canards from the intellectually challenged or those who profit from it in some fashion.

  • Report this Comment On May 27, 2013, at 10:58 PM, enginear wrote:

    I've always (I've worked in one hospital or another for over thirty years) been irked by the lack of pricing or even caring what the price is by physicians and their staffs, AND hospitals (although they are more likely to be able to give some sort of inaccurate estimates).

    I want to believe markets work well, but they certainly won't if you can't get any information about the price of the products. To those who say doctors are blameless... get real! for the last thirty years I have watched them drive all the financial decisions made in the hospitals, yet leave the uncertainty anywhere but on their own heads. This leaves them in the 'terrible' position of making several hundred thousand dollars annually, and liable for those horrid malpractice suits (should we let them off the hook?).

    Truth be told, doctors are smart, well educated, dedicated, and they do work their butts off (unimaginable hours!). To say they are not responsible for a lot of the mess is foolishness though. They have vast influence, even if they've put themselves, over the course of the years, out of the responsibility loop. Individually they can hold their hands up and say 'its not my fault', but as a group, over the last fifty (?) years, they cannot.

    By the way, I do not hold Insurance companies blameless here. They are as much at fault (if not more). They have all promoted the opaque model of healthcare: Get what you and your loved ones need, don't be concerned with costs. (The oncology business is a cash cow that should be treated as mad cow was in Britain - how much is a year and a half with no hair and no strength worth to... not you, but all of America?).

    Seeing the database is a great start, but more information giving the American public the ability to compare healthcare outlets (of all types) would be very helpful.

    Its a mess!

  • Report this Comment On May 28, 2013, at 1:41 AM, newhandle wrote:

    Writeoff? That is a joke. What the hosptials know and now the doctors are leaning is that there are companies which purchase for cents on the dollar unpaid bills. Those are bills rejected by insurance companies. The secondary market then rebills using other codes. So what happens is for example, on patient x, the hospital can't collect $2,000 for code 12345. They sell that for $20. Now they have an $1,980 loss. They then can take that loss off of their taxes. That loss is then only $,1485 using Co. tax rates. They can make that up easily by charging $129.80 for a box of Kleenex and calling it a mucus recovery system for 12 patients.

  • Report this Comment On May 29, 2013, at 8:56 AM, sonrisa1 wrote:

    Thank the "STARS" I live in the UK & Europe, it is fairly straightforward & we pay a smallish tax & that covers nearly everything but not Dental now just a proportion.

    The USA seems to be the land of greedy ripoff merchants in most areas.

  • Report this Comment On November 05, 2013, at 8:16 AM, benjonson wrote:

    This is the stupidest article ever published. First of all, why would he assume that someone who answers the telephone and schedules appointments would have a clue how much his procedure would cost. Would he walk into a restaurant and ask the hostess how much his bill would be before he ordered? Everyone's insurance pays differently for the same procedure. He's an adult, I assume, although this article doesn't sound like it was written by an adult. Why didn't he take some time and call his insurance carrier before he went to get an idea what the cost would be. What is insane is that people don't take responsibility for themselves and then blame someone else. Medical billing and pricing is complicated, no doubt, but the childish assumptions posed by this author are simply out of line and Motley Fool should be ashamed for publishing something this lame.

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