Late last summer Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, announced that beginning in 2019 most American hospitals would be required to post their full lists of “standard charges” for services rendered. You can now find many of these spreadsheets online, and they list medical codes and costs for everything from a Band-Aid to a new vagina.
It’s a practice that some hospitals and certain states have been using for years, though for Verma, the idea that a patient could print out a spreadsheet and comparison shop must be quite seductive, considering her conviction that the trouble with our unwieldy and exorbitantly priced healthcare system comes down to patients’ lack of incentive to take responsibility for themselves. According to Verma, the problem isn’t that the United States has the highest healthcare costs in the world, it’s that Americans don’t have the tools to find themselves a good bargain.
A bargain, for instance, like the $28,740 abortion at Memorial Health Care in Hollywood, Florida:
At the University of Mississippi Medical Center, there are three delivery room levels on which you can give birth, though it’s unclear from the spreadsheet why there is a $3,000 difference between level two and level one:
A C-section without complications at the University of California, San Francisco Medical Center costs $90,670; a vaginal delivery with a “complicating diagnosis” is listed at $68,414. If you go to the hospital with a threatened miscarriage, the recommended cost would be a bit shy of $30,000:
At NYU-Langone in New York city, a visit to the hospital if you’re experiencing false labor—contractions that are irregular and don’t actually signal the delivery of a baby—is priced at $25,364. A visit to the operating room if you are diagnosed with a complication after you’ve had an abortion ($30,703) or given birth ($23,897) goes for $44,919:
“Price transparency is core to patient empowerment and making sure American patients have the tools they need so they can make the best decisions for them and their families,” Verma said in a speech when she announced the rule that institutionalized the release of these spreadsheets. The idea here, I guess, is to make falling ill (or receiving care) in America feel less like being thrown insensate into an expensive and incomprehensible pit and more like finding a particularly satisfying bargain shopping deal.
What the average person will get from these lists, instead, is an endless scroll through obscure medical codes next to very large sums, a faithful if accidental representation of the abject terror inspired by many hospital stays. Leaving aside how unlikely it is that a person in immediate need of medical assistance would have the time or ability to dig through difficult-to-find spreadsheets containing thousands of entires, the documents are also indexed with the kinds of technical medical language that a regular person is unlikely to understand.
Some hospitals only provide entries for individual services; others include average prices for particular diagnoses or bundles of care. And the prices next to a Mississippi hospital’s fetal monitor during labor ($1,905) or a New York medical center’s treatment of a “menstrual & other female reproductive system disorder” ($33,350) represent only what a patient would pay were they entirely uninsured, or treated out-of-network: These numbers don’t suggest anything about a discounted rates negotiated between insurance companies and hospitals, or what a person might eventually pay. Optimistically speaking, the listed prices related to giving birth could be offset by Medicaid or an individual clinic’s “charity care” program; on the other hand, they don’t include the penalties for late payment many women who visit the hospital eventually pay.
Verma’s theory about the utility of such a list, then, is full of shit.
And even if a patient were theoretically inspired to tally up what might end up on their bill, they’d have to find and calculate the combination of an emergency ambulance ride (between $1725.00 and $4,025.00, depending on the classification, plus $51.75 per mile), and, for example, an injection for a bladder x-ray ($4,994.22), an anesthesia base fee ($521.05), an operating room flat fee ($4,303.53) or the addition of a single Band-Aide ($29.00).
Kaiser Health News, when it went looking through some of these documents, found an item for $307 at a hospital in Virginia called LAY CLOS HND/FT=<2.5CM. (It turned out to be a sucre used during surgery.) It makes sense that the paper version of a hospital’s billing system, even one published in the name of transparency, would contain such perplexing codes. Trying to figure out the exact cost of a delivery, or a visit to the OB/GYN, or a vagina ($132,243, in New York) would be nearly impossible.