$2,525 for an Allergy Test

Medical bills in the U.S. are seen as a joke: “To be driven around the corner in an ambulance: $1,800.” “Spend the night in hospital to be monitored: $4,000.” When we received the first bill in the mail, I had trouble in finding the humor in it.

Our daughter had to have a blood test taken. Two dozen tiny jabs in the lower and upper arm, 20 minutes waiting time, then the skin redness and size of the contusions were measured. No big deal, we thought, until the bill came: The doctor charged $1,104 for this service. As if that were not enough, the bill from the clinic followed a day later: another $1,421. Welcome to America.

There is no one who would consider such prices to be reasonable. Even in the hospital, no one could explain these costs. “We have checked it. The bill is correct.” Furthermore, you can’t even get more information from the “patient advocate” responsible for inquiries. Americans appear to have become accustomed to health care costs and treat hospital bills as a force of nature that they can neither understand nor influence. The sums of money that are demanded are accepted with an air of humor that implies powerlessness. At least, this is the view we take from the wealthy, because they can afford the insurance.

Fictitious Prices

Yet what do those who are not insured do? If an allergy test costs as much as a two-week vacation in the Caribbean, how much would a complicated treatment cost? Who comes up with the astronomical prices that the doctors and hospitals demand? Can a health care system ever function in such a way?

No, it just doesn’t work. Americans possess the most expensive health care system in the world by far — and yet with highly dubious success. The infant mortality rate is shameful, and life expectancy is as low as in almost any other industrialized country.

Price levels in the health care market are increasing randomly and are largely unregulated. Furthermore, the question of who should bear the costs incurred is much disputed. Every discussion as to why these costs exist at all is avoided in the hospital lobby.

“Why Medical Bills are Killing Us” was the headline in Time magazine in February 2013. The publication dedicated its entire edition to a 36-page health care report by journalist Steven Brill. Brill meticulously dissected several health care bills and pinpointed the smallest amounts that were charged for absurd items: around $1.50 was charged for an acetaminophen tablet. On Amazon, 100 of these pills can be bought for that price. Even more extreme prices emerge on another invoice: 88 diabetes test strips at $18 each (piece price on Amazon: 55 cents) and 19 niacin pills at $24 (pharmacy price: around 5 cents). These are services that are often not included in the daily cost of the intensive care unit, which comes to $13,225. This can quickly amount to $902,452 — a huge burden to a woman who has just lost her husband to lung cancer.

It is difficult to maintain composure in the face of such costs. Each clinic has its own price list. These lists are named “charge-master” and teach one lesson above all else: The market that is capable of regulating the health care system in America has completely failed. A system in which the seller can set prices as they see fit has nothing to do with the market economy. What patient would dare to rebel against their doctor, especially when it comes to possible life-threatening diseases?

The extent to which the public is being deceived by their belief in the self-regulatory power of the private sector can be shown in the fact that the state insurance — Medicare for the elderly and Medicaid for the poor — are treated in completely different ways. Often the tariffs, which should by law be based on actual costs, are set at a tenth or even a fifteenth of the list prices. It is even more difficult for private insurers to negotiate price discounts, although most of them manage to force the adventurous prices of the charge-master down by around one-half. However, these are hardly bargain prices.

From the Middle Class into Poverty

However, the worst hit are those who are uninsured. It appears that those who can least afford it are faced with the most horrendous medical bills. Despite this, the very poorest are in no way the only ones who are affected. Some people who consider themselves to be members of the middle class can suddenly be plunged into poverty by a medical emergency. Many contracts provide that the insurer pays for the costs only up to a maximum amount.

Two figures are symbolic of the destroyed illusion of a market-regulated health care system: 62 percent of all personal bankruptcies in the U.S. are as a result of illness and the medical bills associated with that illness, and more than two-thirds of those who are financially ruined in this way believed that they were insured before they fell ill.