Stop the Insanity: Bill Baby Bill

Stop the Insanity
Bill Baby Bill

Imagine a new restaurant opens in your neighborhood.

Good food.  Friendly service.  But there’s a catch.

The prices don’t make a lick of sense.  They’re all over the map—but they’re not printed on the menu.  So until the check comes, you won’t have a clue how much you owe.

A salad might set you back fifteen bucks.  Or five hundred.

An iced tea costs just a few of dollars.  But they charge a fortune for every ice cube.  And there’s a separate fee for using the glass.

A side of fries?  Better talk to the kitchen first and have your order “preapproved.”  Otherwise it’ll cost you triple.

With a business model this wacko, that place couldn’t stay open for a single lunch shift.

So why the hell is that how the entire U.S. healthcare system works?

I know I’ve spilled a lot of digital ink on the subject here in “Stop the Insanity.”  Allow me to rant just a little more.

Because I think the mystery and madness around medical pricing is the most insane part of all.

We’ve all been there.  Your doctor orders some tests or recommends a specialist.  You might have come in with, say, a pain in your shoulder.  But now you’ve got that sinking feeling in the pit of your stomach.

How much is this going to cost you?

How much will your insurance cover?

And how come nobody can give you a straight answer ahead of time?

Plenty of purchases come with hidden fees and secret surcharges.  I get that.  But the healthcare industry takes it to another level.

A level that, at least in my opinion, borders on racketeering.

First, go take a look at any medical bill you’ve ever been sent.  You practically need a PhD in BS to make sense of it—all those codes and numbers and jargony fine print.  You know they do that on purpose.

Second, the prices that doctors and hospitals charge us are ridiculous.  At best, they seem arbitrary, plucked completely out of thin air.

At worst, they feel downright exploitative.

Why is obscure blood test X forty dollars while common blood test Y costs four hundred?

Why does insurance cover most of one but only a fraction of the other?

Seriously, who decides this shit?

The prices are usually fluid, too, depending on who’s paying, when, and how.  I think the official term is “dynamic.”

But I’d call it diabolic.

Most things in life—a loaf of bread, a gallon of gas, a diamond ring—cost the same whether a poor person is paying for them in pennies or a billionaire is buying them with gold bars.

Not so healthcare… as the adult son of a friend of mine learned a few years ago.  The hard way.

A routine blood test suggested he might have an issue with his liver, so his doctor suggested an ultrasound.  Nervous, he went and got it, not thinking about the cost, expecting his private insurance would have his back.

According to his bill, the “full price” of the ten-minute procedure (that thankfully turned up nothing wrong) was over three thousand dollars.

The “allowed insurance price” was about half that.  But he was still personally responsible for over a grand out of pocket.

So he called the hospital—one of the most reputable in Los Angeles—to see if he had any options.

He was told there was indeed a third price.  But he was too late.

The hospital offers a nonrefundable “cash rate” to patients willing to put down a stack of bills upfront and not involve their insurance provider at all.

This would have cost him just six hundred dollars—over a third less than what he ended up owing with help from his insurance.

But here’s the rub.  Even if he’d known to ask about that cash rate, how could he have been certain it would be cheaper?

The billing rep actually chuckled.  “That’s always the gamble.”

Gamble??  This is a hospital, not Vegas!

Look, I don’t claim to have all the answers.  The American healthcare industry is a mess wrapped in a headache inside a nightmare.  I’ve written some big bad villains in my day, but even I could never have come up with an institution so sprawling and evil and scary.

But here’s what I do know.

As long as we’re going to keep treating medicine as a for-profit enterprise, the industry needs to start treating its customers—us—a whole lot better.

That starts with clarity on pricing and billing.  No games.  No gimmicks.

Tell us the final cost of something before we get it.  Let us decide if we want to pull the trigger, shop around, or if it’s even worth it in the first place.

That’s really the only way we’ll know if we’re getting a fair deal.

Otherwise?

We’ll keep getting, well… something else that starts with F.

—James Patterson

For more of my “Stop the Insanity” essays, please visit my Substack.