Price tags: the elephant in the room in health care

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.

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