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Posted on March 2, 2020 at 12:28 PM

Every week, I visit my local grocery store.  Thanks to the miracle of texting, I have a pretty good idea what of my family needs for the coming week.  Each week, our supermarket offers BOGOs (“buy one, get one”) for different products.  With this in mind, I will consciously switch brands to get a “two for one” deal.  When I check out, I make sure to see how much money I saved – sometimes it is as much as ten percent of my total bill.

Imagine how silly that seems when compared to process of paying for surprise medical expenses.  It is now a common occurrence to make use of the local urgent care center or emergency room, pay the co-pay, and then be hit by a sizable bill in the mail a few weeks later.  Saving a few dollars on an extra loaf of bread hardly seems worthwhile anymore.

How many other things are as truly surprising as surprise medical bills?  And what would we have done differently if we had known that we were going to get one and how much it would be.  (Yes, I understand that we sign a piece of paper that says we may receive bills from outside-the-network providers.  But how many of us are in the position of saying, “Thanks for letting me know. I will be leaving now without treatment”? It’s not exactly like putting a loaf of bread back on the shelf.)

Dr Marty Makary of Johns Hopkins University has written a book addressing the costs of health care entitled, The Price We Pay:  What Broke American Health Care – and How to Fix It  (Bloomsbury, 2019).  In it, he tells his story of travelling throughout the country, dealing with health care systems who send their patients into bankruptcy, and other tales of unscrupulous behavior.  Dr Makary is a very good story-teller.  More than once I thought to myself that I would want him to help me with any billing issues I might have with an unsympathetic health care system.

The chief villain of The Price We Pay is the ‘middle-man,’ the institution (usually a step removed from physicians, nurses, etc.) which raises the cost of health care simply because it can.  Makary calls out in particular some Group Purchasing Organizations (GPOs) and some Pharmacy Benefit Managers (PBMs) who, he believes, unnecessarily raise the price of health care.  By singling out some places where one might find savings in medical billing systems, Makary contributes to the ongoing discussion of the cost of health care.  Whether or not his suggestions will fix the entire system is another question.  I am reasonably sure that it will not persuade those who are currently advocating “Medicare for all.”

Some might wonder if the cost of health care is an ethical issue at all or if it is a diversion from other, more important matters.  I contend that it is, because it affects the way we approach an illness and its possible treatments.  To surprise one with an outrageous bill after the fact hardly seems ethical.  If a medical event leaves one bankrupt, can it really be said that system has done no harm?  Makary concludes with a well-stated challenge to those in the medical field:  “As witnesses to birth, sickness, and death, we know that all humans are created equal and deserve to be treated with fairness and dignity.”

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