> I started asking questions,” the nurse said. “I was told that if we didn’t mark things up like this, insurance companies wouldn’t give us what we want.” > He

> I started asking questions,” the nurse said. “I was told that if we didn’t mark things up like this, insurance companies wouldn’t give us what we want.” > Healthcare providers routinely ignore the actual cost of treatment when calculating bills and instead cook up nonsensical figures to push reimbursement from insurers higher. This is the real story of health care, in a nutshell. Providers say "A procedure costs $100." Insurers say "Great, we'll reimburse you $50 for it, or you won't be in network." Providers say "But it actually costs $100." Insurers say "Fine, but cut us a deal in exchange for our business, and charge us $50." They hammer out a contract that specifies $55 for that procedure. On the next procedure, which costs $200, the providers (and their facility) stops to think. "Wait, insurance is going to ask for a substantial haircut on whatever number we give them." So providers say "This procedure costs $400." Insurance says "Fine, we'll reimburse you $200." Providers say "Oh no. Fine, we'll take it." Then a few years later insurance analysts get around to noticing relative cost differences, and the entire dance starts over again. The fundamental problems with US health care are (1) the lack of end-user (patient) visibility into costs before undertaking a procedure, (2) opaque insurance-facility contracts, & (3) the bullshit dance between facilities, middle people, and insurance companies that end up adding confusion, delay, and costs to what would otherwise be simpler transactions.