I've worked as an ER/Critical Care nurse for 15 years, and this author is correct in saying that health care costs in this country are particularly opaque. I h

I've worked as an ER/Critical Care nurse for 15 years, and this author is correct in saying that health care costs in this country are particularly opaque. I have absolutely no idea how much the stuff I do costs. That can be a good thing as well as a bad thing. I'm not tempted to ration care at all because someone doesn't have insurance. So, if you get sick, we take care of you regardless of ability to pay. We have to, it's the law. But, the other part of the problem, is that people without insurance often come to the ER when they are ill, because they haven't established a relationship with a doctor or clinic. So, when they get sick, they go to the ER and purchase the most expensive care possible for their earache or sore throat. Think about it, in the ER, we are trained and prepared to save lives in a heart attack, keep you alive long enough to have an operation if you get shot in the chest, or administer antidotes in case you get bitten by a rattle snake. We have all that equipment lying around just in case, and we're trained to use it. But, many of our patients have ear infections, runny noses, back aches and sore throats. Not exactly cost effective care. A big reason for the lack of transparency in hospitl billing is that there are different tiers of payment depending on insurance. The hospital negotiates different rates with different categories of insurers. Out of network private insurance pays full price or at times refuses to pay full price. In-network private insurance generally negotiates a 70-80% rate. Medicare and state public insurance generally pays a 15-50% rate. Non-Insured patients get billed at the full rate, but generally only 20-30% of those people fully pay their bills. So, many hospitals will give you a discount if you pay cash within a month or two of your visit. Also, doctors aren't able to bill by the time they spend with you. Because of Medicare, the whole industry pays per diagnosis. So, if you get diagnosed with a pneumonia, Medicare pays a flat rate no matter how long you stay in the hospital, either 1 day or 10. Finally, most hospitals, if they are making money at all, are operating on a 1-2% profit margin. It doesn't take much for them to go under, and they often need and get subsidized from the state or federal level. 15 years ago, I was very Conservative politically, thinking that market forces would sort it all out. But, the longer I work in health care, the more I think that we should just go to a single party payer system. I actually think that it would actually eliminate a lot of bureaucracy and cut a lot of costs. It'd be a hard sell in this country, though.