A Merry-Go-Round: Medicine and Money

Money brings out the worst in our medical system.

I asked how much the procedure would cost.
“Don’t you have insurance?”
Yes.
“Then your insurance will cover it.”
Right. But again—how much does it cost?

She smiled. Not the helpful kind.

Nobody knows—or so they say. Not the doctor. Not the nurse. Not the person scheduling the thing. Cost is a forbidden word in American healthcare. You're not supposed to ask, and if you do, you’re the one making it awkward—you’ve violated some sacred, unspoken rule that protects the cash flow. Money talk is bad manners. Asking the price of care is like asking the pastor how much he gets paid to forgive you.

Doctor, nurse, and accountant

Try it. Ask what a test or a procedure costs. Watch them stall. “Well… it depends on your insurance.” Then a pause. Then the slow, polite shuffle that says you should drop it.

Here’s what I eventually found out: inserting two wires under the skin on my back, attaching a battery pack, and handing me a little remote to turn it on and off—$250,000.

A simple outpatient procedure. Yes, there was a knife—but just enough to make a neat incision to slide in the hardware. No hospital stay. No team of surgeons. The guy who did is a D.O. anesthesiologist who pivoted to pain management. Anesthesiology already pays extremely well, with average salaries around $450,000 to $500,000 a year, and higher in certain specialties or regions. But pain management can pay even more. No emergencies. No trauma calls. Just a calm office, a steady stream of injections and implants, and billing codes with teeth. With the right setup—owning the clinic, specializing in high-margin procedures like spinal cord stimulators and nerve blocks—income can reach $1 million or more. It’s not just care. It’s a business model.

And of course, none of that price was mentioned up front. No estimate. No fee schedule. Just a calendar appointment and the same vague comfort: “Don’t worry, your insurance will handle it.” As if that makes the cost disappear.

Again—how much does it cost?

Let’s look at some other numbers. A woman in Texas had a normal childbirth. No complications. Her bill? $37,000.
A man in Florida had a mild heart attack, stayed overnight, and went home the next day. $137,000.
An uninsured guy in California cut his hand chopping vegetables. Four stitches: $3,200.

And none of these prices were disclosed ahead of time.

It’s hard to price shop when the price isn’t disclosed.
Actually, it’s impossible. You’re not given the information. You're given forms to sign and a pen to sign them with.

And here’s the kicker: those sky-high prices? They’re not even real. Insurance companies don’t pay retail. They negotiate. They settle for a fraction of the billed amount. One doctor friend told me flat out—it’s a game. A kabuki billing ritual. The provider jacks up the sticker price, the insurer pretends to negotiate, and they agree on a quiet number behind the curtain. But if you don’t have insurance? You get charged full retail—and then some.

So the uninsured don’t just pay. They pay more. Often multiple times more than what insurance pays for the exact same procedure. In what other industry, do the people with the least leverage pay the highest price?

And then the real fun begins.

A friend of mine had an MRI at the Mayo Clinic. A half-hour scan. The bill? $4,000. The claim form included a small checkbox for “location of service"—just two options: “office” or “hospital.” Someone at Mayo checked “office.” The insurance company treated it as a basic office visit and paid $75. That was the cap. When asked to correct the box—to accurately reflect that this was, in fact, a hospital-based MRI—Mayo refused. Despite numerous pleads, including a letter to Mayo’s president, they still refused to change the location box. The form had been submitted. That was the end of it. No corrections, no appeals, just $75 against a $4,000 charge and the rest dumped on the patient.

It would be fun to find an MRI machine in a doctor’s office. You’d have to knock out a few walls and park it next to the ficus. But as long as the checkbox says “office,” the billing department gets what it wants—and the patient gets the shaft.

And have you noticed how eager emergency room doctors are to admit you to the hospital? Even if you're stable, hydrated, and ready to go home, there's often a hard push toward “just staying overnight for observation.” Translation: $3,000 per night, plus separate doctor bills, pharmacy markups, labs, and whatever else they can itemize. It’s not treatment—it’s monetization. A bed filled is revenue secured.

Try to leave and they slap in your record: “Against medical advice.” AMA and make it sound like a crime. And to them—and their pocketbook—it is.

Say no, and you're suddenly noncompliant. Say yes, and you're billed like a luxury hotel with no checkout time.

This isn’t about medicine. It’s about money.

And there are a lot of people caught in the crossfire. Over 26 million Americans are uninsured—more than the entire population of Australia. Many more are underinsured, meaning they technically have coverage but still can’t afford to get sick. And yet, despite leaving tens of millions of vulnerable and bankrupting families daily, we still spend twice as much per person on healthcare as other wealthy countries. Not 10% more. Not 30%. Double. And they cover everyone.

We’ve managed to design a healthcare system that is both stunningly expensive and fundamentally cruel.

You don’t get a number. You get a vibe. A cloud of insurance codes and clerical indifference. You sign the consent forms, and then you wait.

This isn’t a healthcare system. It’s a con. The rules are simple: if you don’t ask, you’re on the hook. If you do ask, you won’t get a straight answer. Either way, someone profits.

We’re told we have the best healthcare in the world. But if no one can tell you what anything costs—if even asking is considered rude—then what you’ve got isn’t a system. It’s a racket.

Because in this game—rigged with hidden prices, coded billing, and billion-dollar incentives—the only loser is the patient.

Need a ride to the hospital? That’s $3,000 by ambulance or $50,000. If they send the chopper, they'll send the helicopter if they can. Two of my friends were transported by chopper and their spouses were waiting at the hospital when the helicopter arrived. You won’t get to choose, and you won’t see a price tag until you’re conscious enough to be billed. Even with insurance, expect surprise charges: a couple grand for the ride, five figures if you left the ground. And yes, they’re almost always out-of-network. In this system, unconsciousness isn’t a crisis—it’s a revenue stream.

Once you arrive, the meter keeps running thousands per night for the bed, hundreds for every pill, every IV, every fleeting specialist who drifts by and vanishes. The emergency room alone can run $1,500 before they even decide to admit you. If they do, that’s another $3,000 a night—plus doctors, plus drugs, plus a blizzard of separate bills from every department that lays a finger on you.

This isn’t medicine. It’s monetization.
The hospitals know it. The insurers know it. The doctors know it.
The only one still pretending it’s about care is the patient—and they’re the one picking up the tab for the whole show.
Victims once in the ER. And victims again when the bill arrives.

Additional: https://www.theatlantic.com/ideas/archive/2022/02/why-does-the-us-make-it-so-hard-to-be-a-doctor/622065/