medicine


The opaqueness of medical pricing 1

Go to almost any business for a product or service, and you can expect to be told what it will cost you, or at least to get a plausible estimate. The big exception is medicine. You’re never told what anything will cost. If you press your provider, the best you’ll get is a spread of a couple of orders of magnitude. People sometimes get hit with huge charges that they weren’t prepared for.

I recently experienced a bit of this. My medical provider billed me for $630 for a routine blood test as part of an annual physical. This came as a complete surprise. I called the billing department, and the man who took my call said that I should have been billed only for the copay, with insurance covering the rest. He filed an inquiry on it, which he said might take a couple of weeks to process. This left a big question open: Do blood tests by my provider routinely cost over $600? That’s a lot, regardless of whether I’m paying for it or Medicare is. Since he was working for billing, he wasn’t able to answer that question.
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Overcharged: Why Americans Pay Too Much for Health Care 1

Charles Silver and David A. Hyman, Overcharged: Why Americans Pay Too Much for Health Care, Cato Institute, 2018.

Book cover for Overcharged It would be hard to believe all the outrages described in Overcharged if public information and personal experience didn’t back them up so much. We all know that medical costs are skyrocketing. This book goes into many of the details and provides a comprehensive explanation.

A number of my experiences make more sense in the light of what I’ve read there. One time a full surgical team, including an anesthesiologist, showed up for a procedure to remove a routine sebaceous cyst from my scalp. I had already said I didn’t want general anesthesia, and I continued to refuse it. I’m sure he got paid anyway. Fortunately, I had very good insurance at the time.

Another time I underwent a biopsy for prostate cancer because of elevated PSA. It turned out negative. I had recently had a bladder infection, which is a common cause of high PSA, but the doctor didn’t care that it was most likely a false positive. I won’t go into how disgusting the prep, the procedure, and the aftereffects are. Once I sued a doctor for overcharging, only to learn that in New Hampshire, you can’t sue a doctor in small claims court without an expert witness. (At least that was what he told the judge, and she didn’t contradict him.) In terms of practical economics, that means you can’t sue a doctor in small claims court. We all know that the very idea of getting a price or even an estimate in advance for a medical procedure is a joke, even though it’s expected for any other big-ticket expenditure.
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