Reading this after getting a bill from an urgent care facility for $500 from a visit in which my wife walked in, was immediately sent to the ER, and was in the urgent care facility for a total of about 8 minutes. $500 which I will absolutely not be paying, by the way.
The trust point is underrated in this debate. Even with perfect price transparency, switching surgeons mid-diagnosis has real costs, rebuilding a clinical relationship, re-running imaging, and losing continuity. Healthcare isn't a commodity market and can't be made into one through disclosure alone. Your Maryland experience is the proof case: regulate the prices upstream, and the comparison-shopping question becomes irrelevant.
Thank you. This one took a while to get right — 32 footnotes because every number in the piece needed to be airtight. The chargemaster is so absurd on its face that if you don't source everything, people assume you're exaggerating. You're not. The real numbers are worse than satire.
I couldn't believe that "Bitter Pill" came out in 2013 - I remember it like it was yesterday! I've been a beneficiary of this system since I became an attending physician almost 10 years ago, but America can't waste another 13 years. Both parties failed (most memorably Donald "who knew that healthcare would be so complicated" Trump). Healthcare reform is easily the most pressing and most difficult task. It requires someone intelligent who is willing to be a one term president. Maybe give Andrew Yang a try?
That's the part that stays with people. It's not fraud. Fraud would be easier to fix — you prosecute it and it stops. This is legal. Every price in the chargemaster is filed, attested, and compliant. The $800 bag of salt water has a charge code and a line item and a CEO signature. The system doesn't need to break the law because the law was built around the spreadsheet. That's what makes it so durable. Forty-two years and counting.
My family knows, My Dad, retired MN Educator with full LTC insurance package money could buy and probably subsidized, I don't know yet... $14,000 / month is what he is paying. It's up $3000/ month with the Cuts. Nobody will be able to walk away from this uneffected. Just another transfer of wealth. I want Ideas now. 18 months in and probably going to 60? He won't be a burden on the State and the State of MN knows we as family citizens won't allow him to be... Thanks
I appreciate that. The documentation part matters more than people realize — every number in this piece links to a primary source. Court filings, CMS data, SEC proxy statements, peer-reviewed studies. The chargemaster survives partly because the complexity makes people's eyes glaze over. The job is to make it legible without making it less true. If even one person reads this and then actually downloads their hospital's price transparency file, the piece did its work.
> That is not a market failure. That is the market. The market is functioning. The price is correct.
Market failure is precisely what it is. A functioning market fundamentally requires buyers to be able to evaluate competing products — their quality, their price, their ease of use/accessibility, etc. — and make decisions based on that information. If that information is not available to buyers, that is market failure.
Market failure is inherent in the nature of the industry. You can’t comparison shop and redirect the ambulance while having a heart attack. That’s why most other high income countries have some sort of major government role in ensuring access and payment for healthcare.
There is some truth to what you say, but it's worth remembering that most health care is not emergency care. The majority of people in any given hospital at any given moment are not there for heart attacks or car crashes; they're there because they're feeling sick, or have some sort of minor injury, or they're giving birth, or any number of other matters where comparison shopping is entirely possible, or would be if the prerequisite conditions for doing so were in place.
You're right, and the narrator knows it too; he just can't say it in his own voice. The line "that is the market functioning" is the character's self-justification. The reality is exactly what you describe: information asymmetry so severe that the basic preconditions for a functioning market don't exist. The chargemaster is Exhibit A. Prices are published now (since 2021), but are published in machine-readable CSV files that require billing certification to interpret. That's not transparency. That's disclosure designed to satisfy a regulation while preserving the asymmetry. The information exists. It is not usable. The distinction matters.
True but last time I was in a hospital it was because that was where the surgeon I trusted to operate on me worked. The opportunity cost of finding another surgeon, and trusting one that didn’t already know my case, made comparison shopping prices a fraught prospect. And, besides I’m lucky to live in the one state that has price controls on hospital charges. 😉
The CEO's predecessor's predecessor walked away with ~$350 million after being pushed out by the board a few months after the FBI raids. He went on to serve as governor of Florida and is currently the senior senator of the state.
Thank you for this engaging and thought-provoking piece. I really appreciated how you used the concept of “price” not just in a literal economic sense, but as a broader lens to explore value, trade-offs, and perception. The writing has a sharp observational quality that makes the argument feel both immediate and layered, inviting readers to think beyond surface-level interpretations. What stood out to me most was the underlying idea that price is rarely just a number; it’s a reflection of priorities, incentives, and sometimes misalignment between what something costs and what it’s truly worth. That distinction is particularly relevant in today’s environment, where markets, attention, and even personal decisions are increasingly shaped by framing and narrative. One aspect that might further strengthen the piece would be to ground some of these insights in a few more concrete examples or scenarios, which could help readers more directly connect the conceptual argument to real-world decision-making.
Thank you for contributing a perspective that encourages readers to look more carefully at how value is assigned and interpreted!
Reading this after getting a bill from an urgent care facility for $500 from a visit in which my wife walked in, was immediately sent to the ER, and was in the urgent care facility for a total of about 8 minutes. $500 which I will absolutely not be paying, by the way.
The trust point is underrated in this debate. Even with perfect price transparency, switching surgeons mid-diagnosis has real costs, rebuilding a clinical relationship, re-running imaging, and losing continuity. Healthcare isn't a commodity market and can't be made into one through disclosure alone. Your Maryland experience is the proof case: regulate the prices upstream, and the comparison-shopping question becomes irrelevant.
Superb.
Thank you. This one took a while to get right — 32 footnotes because every number in the piece needed to be airtight. The chargemaster is so absurd on its face that if you don't source everything, people assume you're exaggerating. You're not. The real numbers are worse than satire.
I couldn't believe that "Bitter Pill" came out in 2013 - I remember it like it was yesterday! I've been a beneficiary of this system since I became an attending physician almost 10 years ago, but America can't waste another 13 years. Both parties failed (most memorably Donald "who knew that healthcare would be so complicated" Trump). Healthcare reform is easily the most pressing and most difficult task. It requires someone intelligent who is willing to be a one term president. Maybe give Andrew Yang a try?
And here I thought it was all fraud... Trust and verify!
That's the part that stays with people. It's not fraud. Fraud would be easier to fix — you prosecute it and it stops. This is legal. Every price in the chargemaster is filed, attested, and compliant. The $800 bag of salt water has a charge code and a line item and a CEO signature. The system doesn't need to break the law because the law was built around the spreadsheet. That's what makes it so durable. Forty-two years and counting.
My family knows, My Dad, retired MN Educator with full LTC insurance package money could buy and probably subsidized, I don't know yet... $14,000 / month is what he is paying. It's up $3000/ month with the Cuts. Nobody will be able to walk away from this uneffected. Just another transfer of wealth. I want Ideas now. 18 months in and probably going to 60? He won't be a burden on the State and the State of MN knows we as family citizens won't allow him to be... Thanks
Thank you for documenting the truth
I appreciate that. The documentation part matters more than people realize — every number in this piece links to a primary source. Court filings, CMS data, SEC proxy statements, peer-reviewed studies. The chargemaster survives partly because the complexity makes people's eyes glaze over. The job is to make it legible without making it less true. If even one person reads this and then actually downloads their hospital's price transparency file, the piece did its work.
> That is not a market failure. That is the market. The market is functioning. The price is correct.
Market failure is precisely what it is. A functioning market fundamentally requires buyers to be able to evaluate competing products — their quality, their price, their ease of use/accessibility, etc. — and make decisions based on that information. If that information is not available to buyers, that is market failure.
Market failure is inherent in the nature of the industry. You can’t comparison shop and redirect the ambulance while having a heart attack. That’s why most other high income countries have some sort of major government role in ensuring access and payment for healthcare.
There is some truth to what you say, but it's worth remembering that most health care is not emergency care. The majority of people in any given hospital at any given moment are not there for heart attacks or car crashes; they're there because they're feeling sick, or have some sort of minor injury, or they're giving birth, or any number of other matters where comparison shopping is entirely possible, or would be if the prerequisite conditions for doing so were in place.
You're right, and the narrator knows it too; he just can't say it in his own voice. The line "that is the market functioning" is the character's self-justification. The reality is exactly what you describe: information asymmetry so severe that the basic preconditions for a functioning market don't exist. The chargemaster is Exhibit A. Prices are published now (since 2021), but are published in machine-readable CSV files that require billing certification to interpret. That's not transparency. That's disclosure designed to satisfy a regulation while preserving the asymmetry. The information exists. It is not usable. The distinction matters.
True but last time I was in a hospital it was because that was where the surgeon I trusted to operate on me worked. The opportunity cost of finding another surgeon, and trusting one that didn’t already know my case, made comparison shopping prices a fraught prospect. And, besides I’m lucky to live in the one state that has price controls on hospital charges. 😉
The CEO's predecessor's predecessor walked away with ~$350 million after being pushed out by the board a few months after the FBI raids. He went on to serve as governor of Florida and is currently the senior senator of the state.
I chose the wrong profession.
Thank you for this engaging and thought-provoking piece. I really appreciated how you used the concept of “price” not just in a literal economic sense, but as a broader lens to explore value, trade-offs, and perception. The writing has a sharp observational quality that makes the argument feel both immediate and layered, inviting readers to think beyond surface-level interpretations. What stood out to me most was the underlying idea that price is rarely just a number; it’s a reflection of priorities, incentives, and sometimes misalignment between what something costs and what it’s truly worth. That distinction is particularly relevant in today’s environment, where markets, attention, and even personal decisions are increasingly shaped by framing and narrative. One aspect that might further strengthen the piece would be to ground some of these insights in a few more concrete examples or scenarios, which could help readers more directly connect the conceptual argument to real-world decision-making.
Thank you for contributing a perspective that encourages readers to look more carefully at how value is assigned and interpreted!