by dsr_ | 2026-02-23 19:48:00+00:00
At the moment, I'm in the hospital. I've been here since 0500 Friday morning. I should be released tomorrow, Tuesday. During those five days I've had services from doctors, nurses, technicians and [everybody else necessary to run a hospital]. There were multiple uses of CT scanners, ultrasounds and many machines which go Bing!. Also, a surgical operating suite, of which I remember about 60 seconds of very bright white lights and very large-screen monitors suspended from ridiculously heavy-duty supports. Like, you could safely dangle four football players of your choice (gridiron, rugby or association, doesn't matter) from them.

A team of people will compile a bill for all of those services. The bill will be presented to the insurance company whose card I showed Friday morning. It will likely be less than a million dollars, but it could easily be more than a hundred thousand dollars. That's the right order of magnitude to consider: a good percentage of a house, maybe a very large nice house.

The insurance company will claim that some of these charges are too much. The hospital knows this, and there are three mechanisms in which they justify their prices. First, although the two Tums antacids have a street value of eighteen cents when you buy it over the counter in quantity fifty, the hospital buys them in blister-packs so to avoid cross-contamination until they reach the patient. Second, it is customary to pretend that only the services which a patient actually used can be charged for, so the in-house plumber, the gas plumbers, the cryogenic fluids specialists, the oxidizing gases technicians, the potable water testers, and the electricians among a cast of thousand all need to be paid for.

And third, there's emergency care for the uninsured.

The US is cruel, but not stupid. No, I lie, it is frequently both cruel and stupid, always to people already disadvantaged in some other way. As a matter of law, a hospital can't turn away or discharge a person who is likely to die without treatment, even if they can't pay. But the government doesn't provide money to pay for that.

Finally, most hospitals or hospital systems in the US are run by for-profit private companies. I won't mention organized crime in the same sentence, but one can reasonably presume that the two are interchangeable in terms of law-abidingness and willingness to trade down ethics for an increase in profits.

So, having created the bill and sent it to an insurance company, they will argue back and forth and finally some portion of the money will eventually be transferred and everyone will be more or less happy, right?

No. Because in the US, the standard for healthcare insurance is to avoid the moral hazard of people attempting to get too much healthcare by having the insurance company bill the patient.

Remember the bill that started out as the same scale as a house? 10% "coinsurance" is often considered generous. 20% is pretty normal. Some specific services will be called out with specific fees, and others may be "disallowed" -- and sent through entirely to the patient.

That's on top of the monthly payments that have already happened.

But I work for a tech company with an unusually enlightened attitude, so I expect that my family's fiscal impact from this bout of medical intervention will be limited to the parking fees that my wife paid when she came to visit me.

It's privilege, but I'd rather that the system be reformed so that everybody got it.