Another day and another scam in the American health care system

Our health insurer just sent an Explanation of Benefits. I went to see a doctor and she billed the absurd $528 that would have been charged to the unfortunate uninsured victim. The insurance company knocked this down to $123.75 so they paid $43.75 and I paid the $80 copayment (on top of the $30,000 per year that we pay in premium).

Except for catastrophes, it seems that nobody would need health insurance if health insurance didn’t exist and providers had to charge a retail price that had some basis in market reality. The person who can afford the $80 co-pay can also afford $123.75.


  • “A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills” (Vox): Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist. … A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December.

13 thoughts on “Another day and another scam in the American health care system

  1. Gosh it’s nothing like the old days on Little House on the Prairie when someone fell off a horse, went to see Doc Baker and he cleaned up the wound, set the splint, wrapped their head in a towel with a poultice, and accepted a few chickens and a dozen home-baked muffins as payment.

  2. Non-catastrophic coverage makes no sense for healthy people. You can buy any preventive care you need, including annual physicals and bloodwork, for under $1,000 per year if paying cash.

    Catastrophic coverage through a tier 1 like UnitedHealthcare costs around $1,500 per year for $1m of coverage with a $15K deductible, and allows you to buy coverage at their negotiated rates (except at Zuckerberg General) in the event of a major issue.

    Unfortunately the insurance cartel managed to win legislation prohibiting you from holding this kind of insurance for more than 3 years, but by comparison to an ACA plan you would save around $12,000 over 3 years.

  3. Remind the lion kingdom of its $3000 root canal before insurance. $1000 after insurance. Multiply $30,000 x 50 to find out where your retirement plan is going. Medicare now has higher premiums than private insurance.

  4. Oddly, hiring managers at my employer likes to hire 60 year-old smokers (with unhealthy spouses) for entry level $30,000/yr clerical jobs. Might explain why employee premiums and co-pays increase 10% per year.

    • That’s probably because at competitors entry level clerical jobs pay $40,000 – $50,000/year and mid-tear jobs pay is stagnating

    • The number of women doctors that become stay at home moms shortly after entering practice and having baby #1 is staggering. If you want more doctors give those med school slots to men.

    • GB: Anecdotally, this was true in our old Boston suburb. The women trained as primary care docs married men who were specialist docs and then cut back to part-time or no-time. About half of them ultimately divorced their husbands and were thereby relieved of child care responsibilities for 30-50 percent of the time, but nonetheless they did not resume practicing medicine for wages. They would put the extra time into Tinder dating. I haven’t seen the same pattern in Florida. The women in our neighborhood who are trained as doctors are working as doctors.

      Nearly 5000 couples in which both partners were physicians or surgeons completed questionnaires about hours worked. Among respondents without children, men worked an average of 57 hours and women worked 52 hours weekly. Compared to men without children, men with children worked similar numbers of hours weekly. However, compared to women without children, women with children worked significantly fewer hours weekly — roughly 40–43 hours, depending on the age of their youngest child.


      I think that the above research paper doesn’t capture the doctors who identify as female who don’t practice at all.

      is from 2019 and looks at the tendency of female physicians to quit. “Within 6 years, almost three-quarters of women physicians reported reducing work hours to part-time or considering part-time work.”

    • I’ve read similar statistics about female doctors going part-time before.

      Totally anecdotally, my internist, dentist, and dermatologist are all women working only 3 days a week. Also, my senior partner’s MD wife never finished residency or practiced medicine.

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