Not many people understand the true cost of healthcare in America, and for most of my adult life I didn’t, either.
For 21 years I had some of the best insurance money could buy. At practically every appointment I’d have an admin person tell me, “You have really great insurance.” I’d smile, tell her I was aware of that, and pony up a little co-pay a few months later. It didn’t matter what the procedure was – surgery, check-ups, dental cleaning, labor and delivery – we paid very little out of pocket.
We rarely stressed about the nickles and dimes in those days, but boy let me tell you: When you’re no longer insulated from the true cost of healthcare by insurance, you see the boondoggle for what it is. Modern medicine is a scam milking patients at every step, and it uses a sliding scale to maximize how much they can take from us, preferably without our knowledge. Insured Americans are largely unaware of how much they’re actually paying in the form of lower paychecks via insurance deductions, and they’re certainly not aware of how much everyone else is charged.
A Great Awakening
In 2018 I walked away from the gigantic multi-national corporation I’d worked for since college. I became an independent writer and along with that, a self-pay medical patient with seven kids to care for. A few days before my last day at work, my writer wife and I found out we were expecting another baby. Surprise! Within days we discovered that delivering our baby with a midwife at a birthing center was going to cost almost $10,000, and that was after the self-pay discount.
*blink blink* *cough*
Excuse me? Did you say ten thousand dollars. Like with four zeros?
We had delivered two babies there previously – under my “really great” insurance, mind you – and I don’t remember those events making a dent in the monthly budget, much less the annual one.
As the years went by, healthcare only got more expensive from there.
So, You Busted Your [fill in the blank]. Now What?
Depending on the time of day or the severity of the problem, you may end up in an urgent care facility or an emergency room. Either way, before you leave you’re going to get charged a separate bill just for walking into the exam room. And for a self-pay individual, that means taking the second gut punch of the night.
You’ll need to agree to pay the full amount up front. If you ask, they might give you a 30-40% discount. If not, you’re done; walk on out and find another facility with a payment plan. If you shop around, some of them will work with you, but that’s a hard find when you’re nursing a busted [blank] or wrenching from a failing organ. Your only other option might be the ER, which might be a delayed cost but also more expensive by multiples of ten.
So you sign the form agreeing to pay a minimum of $300 just to see the (hopefully) competent doctor on duty. If you live in Wasilla, Alaska, this is when you should pray you don’t get stuck with [name removed because my wife doesn’t want us sued].
Maybe there are X-rays, or an ultrasound, or labs. That will be another $300-$1500 on top of the five-minute doctor consultation.
Maybe the doctor looks at your $350 X-ray, and confirms you’ve got a busted hand.
They begin splinting it, but at no point will they tell you how much that is going to cost. The reason for that is because a 4×15” piece of quick-setting fiberglass and an Ace bandage to hold it is going to cost you another $300. Never mind that you could buy the same thing online for $20, or that the facility buys it in large bulk rolls for a fraction of that. You’re not paying for the raw materials, you’re paying for something else. And try as I may, I have yet to discover a reasonable explanation for the markup.
But that doesn’t fix it. That visit is just a band-aid. In order to actually treat your broken [blank], they’re going to refer you to a specialist:
Wait, what?
Oh yeah. You need to see a specialist. We’ll write you a referral.
Can’t you just set the bone and wrap it up right now? Aren’t you a doctor?
I’m not a specialist.
They don’t cover broken hands in doctor school?
You need to see an orthopedic doctor.
What did doctors do a hundred years ago for broken hands?
Set it and splint it for a few weeks.
Can’t you just do that, then?
Here’s your referral to see a specialist. They’ll call you to arrange an appointment.
Can I at least see the X-ray?
We’ll send it over to the specialist.
A Special Kind of Expensive
Thus far we’ve been using the broken hand example, but this is really the default programming for all medical issues nowadays. Suffering from a kidney stone? Here are some drugs and a referral to a urologist. Got a weird heart flutter? Let’s get you to a super-duper cardiologist who will order some tests (at a separate facility, no doubt) and then translate them for you (in a separate appointment, so they can charge an additional $300-900).
And on and on it goes, because doctors aren’t allowed to just be doctors anymore. Knowledge and experience aren’t the key factors in the modern era. There’s a carefully contrived hierarchy that medical practitioners need to conform to in order to stay in business.
Getting back to our narrative:
After the initial non-treatment for whatever you’re suffering from, you make the appointment with the specialist, probably several weeks in the future.
When you finally get to that appointment, you’ll once again sign the I-agree-to-pay-in-full paperwork, hopefully remembering to again ask for a discount and an estimate (which, unlike in every other profession, is really meaningless).
As you wait, you notice the specialist’s office has big windows, trendy signage, expensive furniture, exotic fish tanks, and (in Alaska) a beautiful brick fireplace. They call your name, and then you get to stroll the wide corridors of expensive décor in search of The Specialist – who might as well have a big “S” symbol on their chest. You spend three minutes talking with a pleasant millennial in trendy clothes, and after they leave, you have ample opportunity to bask in the opulence of the exam room. Just as you begin wondering who’s paying for the most expensive leather stools you’ve ever seen, the specialist walks in:
So there’s nothing I can do here. We’ll need to set you up with an MRI/EKG/CT/Magical MacGuffin in order to really know what we’re dealing with. Then we’ll know how to proceed.
*cue The Specialist’s sympathetic grin*
Why did I have to make an appointment for you to tell me that?
We always want to have an initial consultation.
But why? You didn’t do anything. Couldn’t we have done this over the phone?
No, we need to get a feel for the patient’s unique circumstances.
Didn’t they send you the X-rays?
Yes. I just looked at them.
You just now looked at them? Like, for the first time? You didn’t look at them when you received them from the urgent care two weeks ago to see if this needed more urgent treatment?
We have a lot of patients. We just look at them before we walk in to see you.
But if you’d looked at them when you got the referral, you could have saved me the trouble of coming in. You could have just called me to tell me I need to go to a different facility to do the MacGuffin thing. Right?
The Specialist seems confused, and mildly insulted by the insinuation that your time is worth as much as theirs.
But then we wouldn’t have gotten this face to face interaction. It’s important to get a feel for the patient. How does next Friday sound for you? We’ll just schedule you over there.
* condescending smile*
Let me interrupt this narrative to say that this may or may not be a word-for-word interaction I personally had with an orthopedic blowhard in Wasilla, AK who’s name might rhyme with [rhyme removed because my wife doesn’t want us sued].
How much are you going to charge me for this visit?
The specialist refers to a newly arrived millennial with a clipboard, called in for backup no doubt to answer questions about costs, billing policies, and other things the specialist has little interest in.
$590.
But you didn’t do anything. Not even an exam.
I didn’t need to examine it. I could tell by the X-ray.
How much will the Magic MacGuffin thing at the place next week cost?
I don’t know. Maybe around $2000.
Keep in mind that by this juncture in the three-week ordeal, all you’ve paid for is data collection. They haven’t actually fixed anything, and if you’re keeping score, you’re already in for over $1000.
Competition Breeds Excellence (But the Opposite is Also True)
If you were a car, all of this would have been accomplished in the free diagnostic portion of the visit.
If you were a house, you would have had guys walking around, trying to figure out the minimum amount they’d need to charge in order to get their guys paid and the job done to your satisfaction.
Not so in the medical industry. They don’t really care about your satisfaction. They don’t really consider your budget. If you raise the issue of cost, they might consider your “social situation” and try not to let it show how inconvenient that “social situation” is to their preferred methods of treatment, or timetable.
If you question what they’re doing or ask them if someone can offer you a better price, they’ll look at you like you’re from Mars. Most of them don’t know the actual costs and don’t care. Insurance typically pays for everything and most patients have it, so they likely haven’t a clue how much those disposable arm slings cost you and everyone else in the system.
If you’re unfortunate enough to need surgery to fix your whatever-it-is, the specialist is ironically the least of your problems. That’s because the hospital is going to charge you five figures, maybe even six, for the simplest surgery.
Self-pay patients learn early on that the standard price of a surgery can be cut in half by paying everything up front. That should cause you to raise your hand and ask:
Why are they so quick to knock the price down by 50% if I agree to pay it myself?
When a jeweler, street peddler, or car dealer does that, it means their markup is unreasonably high.
Here’s another answer: They’re still making a profit regardless of how much you pay. And the less you know about their margins, the better.
The hospital will likely offer you a payment plan without interest (which is nice) but that still means you may be on the hook for $30,000 or more for the next several years of your life.
The next time you have a surgery, or any medical treatment for that matter, ask for an itemized receipt. You’ll be amazed how much you’re being charged for every little thing. Those nutritionally bankrupt boxed foods they wheel into your recovery room are no exception.
Did you know that one hour of salt water (IV) by itself can cost $962? And that’s just for the parts, not the labor to get it into your veins. Opt for a privately-owned hydration center and you might only pay around $200 for a bag of NAD (Nicotinamide adenine dinucleotide) administered in full. Why the disparity? Because when insurance is paying for something, you’ll likely never see the devilish details anyway.
Or how about the fact that the first 15 minutes in the O.R. costs $10,000? That’s while they’re still setting everything up.
The drugs they pump into you during the procedure could be $23-47 per milligram or more. And they’re gonna pump a ton of drugs into you (or your children) whether you know about it or not. Do they give you a rundown of what they’re going to inject into you, give you options and alternatives, or even ask you about them at all? Nope, they just have you sign a vague waiver in a stack of twenty other waivers agreeing to everything you’ll never know about, often while you’re under emotional duress.
We’ve all heard the lament of $10 for a bleeping aspirin, but that’s not adjusted for inflation. Now it’s $11 for a 20 milligram dose. Do the math and a single 325mg Bayer tablet – the recommended dose to try slowing down a heart attack – might cost $162.
Pro tip: If you’re ever on the receiving end of an EMS call, make sure they do all of the checking-to-see-if-you-need-to-go-the-hospital things outside of the ambulance. The second they wheel you into the back, the meter is running, just like a taxi. Take that aspirin on the sidewalk and it’s free, but they probably won’t give it to you there.
And here’s a nice little kicker: That first hour of observation after the procedure costs $1938, and $452 for every hour thereafter. So while you’re sitting in that hospital wondering when the next nurse is gonna knock on your door, watching the “healthy” soy-and-sugar mayo packet congeal on your bed tray next to the uneaten second half of your vending machine sandwich, just know you’re paying $400/hour for them to poison your newly repaired body.
Getting Back To Sanity
There was a time in history when you could call up doctors, have them treat you, and then figure out an acceptable payment method. Maybe they’d even be willing to barter. No more, as we all know, due to liability insurance and medical licensing board interference.
But just imagine if the next time you needed stitches, you could look up the doctors in your town, peruse their profiles and the services they offer, and read through a reviews section like you do with just about every other major purchase and contractor. You’d soon know who the one-star morons are.
What if they were willing to negotiate your price upfront before any work is done? No need for a clipboard full of paperwork to fill out – maybe just a liability waiver like the mechanic, scuba diving instructor, or gun range provides. They state the cost for care, and you agree to pay it before anyone gets started.
Imagine if the costs for common illnesses and injuries were listed on the wall of every urgent care facility, like a menu. It wouldn’t take long before competition set in, and the standards of care and costs associated with it found their free-market equilibrium.
Just think how much it would change our world if a doctor or nurse were free to treat patients like grown ups who can decide for themselves what Best Medical Practices entail, without the unholy oversight of scientifically-ignorant medical boards beholden to Big Pharma and the insurance lobby.
Imagine if we allowed those with a passion to heal to actually do so, unencumbered by the stranglehold of exorbitant facilities and legal costs.
You may say I’m a dreamer, but I’m not the only one.
Everyone agrees that our healthcare system is broken. There is universal acknowledgment of that fact. The industry giants will nod in agreement, say we need some new legislation to make it affordable for all, and then turn around and pay politicians from both sides of the aisle to craft bills that maintain the status quo.
I recently listened to a surgeon say that if his patient were a Chinese billionaire and money wasn’t an object, his surgery would be cut and dry, easy peasy, with everything done in a day. For you and I that’s just not the case, because it’s not designed that way.
Individuals within the industry might (might) care about patients, but the industry itself couldn’t care less. What it cares very much about is profiting from your illness, for as long as possible, preferably for life. The easiest way for them to maximize that profit is to disguise it under layers of paperwork and mildly digestible monthly premiums and co-pays, and make you feel like you can’t question it. They’ve mastered that dark art.
But just like with the intake nurse and the diagnostic mechanic, there is something we can do about it: Take a few minutes during your next follow-up appointment to ask for some itemized receipts off of your patient history.
You might be shocked at what you didn’t know you were paying for.
How can we right the ship? It seems daunting, and I admit I don’t know the solution. But before we start down the path of busting up the scam, we need to learn how the scam operates. That starts with information gathering, and that we can do on our own. Unfortunately most people don’t have the time or inclination to do so; it’s a little element that the medical industry relies on to keep us in the dark about the true cost of healthcare. But let’s shine a light on it, starting today.
You can follow me on Telegram, Substack, Truth Social, GETTR, Gab, and X.
You can subscribe to receive new posts to your inbox as well as get information on my latest novel, book four in my modern war series. If you enjoy my work, please consider supporting us with a paid subscription. Keep fighting.
My latest book, Those Who Face Death, is now available online wherever books are sold. This is the fourth book in the Modern War series.
If you enjoyed this article, you may want to check out these as well:
If you’ve yet to experience Science Goes Boom, come on by and check us out.
Subscribe for free and receive weekly, family-friendly science videos every Friday. If you’d like to donate to the page, it will help me continue providing this content.
