Downing

My mom fell and broke a bone in her hand a couple of weeks ago. She
was beautifully cared for at El Dorado Urgent Care, where we got in
quickly—and where, as the nurse told us, they were thrilled to
see somebody who didn’t have the flu.

They took X-rays, splinted her up and sent her on to the Tucson
Orthopedic Institute, where she got a cast the next day. After a week,
the cast started giving her trouble, so it was back to TOI, where they
took it off and put her hand in a brace.

It’s a really nice brace, well-made and comfortable. It ought to be,
because it cost $402. We know this, because she had to sign a form
saying that she’d pay for any part of its cost that Medicare wouldn’t
cover. It seems reasonable to me that Medicare may decline to pay the
full charge, because while the brace may be nicer than the ones they
sell at Walgreens for $25, it is not 16 times as nice. I’m seriously
looking into buying stock in the company that makes it.

It was $402 because a doctor prescribed it in a medical setting,
circumstances in which nobody looks at the bill, and things simply cost
what they cost. Selling stuff to patients is like supplying the
Pentagon: Welcome to the wonderful land of the surreal markup. My
mother’s hand hurt, and when you’re sick or in pain, you do not
shop for bargains—which is the main reason that the free-market
model is a catastrophe for health care.

And then, if you’re well-insured, why would you care what
your medical care costs? You wouldn’t. Unless, of course, you’re the
wife of a guy I work with.

On Labor Day, ironically enough, she suddenly developed a very
dangerous late-pregnancy syndrome and needed an emergency Caesarean
section, followed by four or five days in the hospital. (Both she and
the baby are now fine.) She comes from a “family of accountants,” as
her husband puts it, and does not pay bills she has not gone over
carefully, so she declined to fork over the $200 co-pay for her
hospitalization without seeing her statement, which is what the
hospital’s billing office invited her to do. When, at her request, she
received a copy of the preliminary statement, she found a charge for a
blood transfusion that she had refused, and some smaller phantom
charges. The billing office cheerfully reduced the charge for the
transfusion to a charge for “preparation for transfusion”—they do
have their little ways—when she pointed out the error. But if she
hadn’t explicitly asked to review the bill, it would have just as
cheerfully overcharged her insurance company. This is probably not
deliberate fraud. But it’s not exactly kosher, either.

If more of us had her DNA and her knowledge—she’s a registered
nurse who works in a hospital—health insurance would cost less.
But God knows I’m not faulting Mom or any other suffering patient for
not looking at the price tag—my husband has had two major
surgeries and a number of smaller procedures since we’ve been married,
and I have no idea what any of it cost. United Healthcare paid and left
us alone, and I’m grateful that they did.

The problem with this is that if no one cares that the health-care
system is systematically ripping off the rest of the world, bills will
be wrong, and prices will be whatever suppliers feel like charging, and
the cost of all health care will keep going up. For every horror story
of someone denied care because of cost, probably a thousand ridiculous
overcharges—$402 knuckle braces and $20 hospital
aspirins—slide right through.

This bears directly on insurance reform. Why do insurance companies
try to keep sick people from signing up? Well, because they can (for
now), but there’s another reason: They’re paying a lot of totally
insane bills. And this is why we need strict government review and
regulation of health-care costs. You know, rules?

I took the possibility that Medicare might question the cost of my
mother’s brace as a hopeful sign. Somebody needs to look at the
check.

This article appears in Nov 12-18, 2009.