So, what does it all cost? Part One

Medical billing in the United States is, to put it charitably, a mess. So, although this surgery was two months + ago, and you'd think all the bills would be in by now, they're not, so we're going to have to take this in stages. Here's what we have so far:

According to Blue Cross's Statements of Benefits, providers, hospitals, therapists and pharmacies have "charged" a total of $122,601.44. (This is not the final total. I don't have all the bills yet.) This is what we may call the "list price." No one knows where this number comes from, including the people providing it. The hospital bill in particular ($112,317.60) is a complete fantasy. Hospitals themselves don't know what their services "cost," nor is this important to them (or anyone else). The "list price" is paid by those of the uninsured who do not file in bankruptcy. Almost no one actually pays this price.

Of this total amount so far, Blue Cross disallowed $70,686.35 and paid $49,009.51, leaving the net due, again, so far, at $4,180.11. (My numbers might be off $20 or so, I'm numerically challenged.) Of this I have paid, so far, $1,261.50. Two bills represented by the Blue Cross information forms, the bill from the hospital and the bill for the walker, have not yet arrived.

I am saying "so far" because I am not convinced that all the bills have yet arrived. In particular, I have a bill from the surgeon, but the price is so low that I'm certain that this is not the "real" bill.

A number of thoughts occur me here. First, there is the never-never-land quality of all these numbers. These prices are not arrived at in the same way that cars, say, are priced. Cars are priced, roughly, by calculating the cost of manufacture and adding to that the cost of transport and the cost of selling, including dealer costs, plus profit in some measure to all concerned.

Human services cannot be "priced out" in this fashion. What does it "cost" a surgeon to operate? Well, doesn't he or she amortize all those years of training and study, the cost of maintaining an office, and add to that whatever he or she thinks the market will bear? That's certainly how I bill my time. Hospital costs are even more complex, because, as a result of a number of factors, a lot of people who use hospitals pay nothing, or the government pays very little for them, and the rest of the costs of operation must be spread among the rest of us. This is, of course, a hidden tax.

It is not my understanding that hospitals in this country are gold mines, generating huge profits. Rather the contrary. Doctors are not getting rich either, not any more.