Barely Legally

Confessions of a Moot Court Bailiff

Imaginary Price Tags

The number one cause of bankruptcy in America is medical bills. It’s been this way for a while, although that may be changing slowly. Frankly, it’s a little ridiculous when the rest of the developed world has solved the problem. Progress is progress, though.

Here’s a really great example of how medical bills get to be so bad for so many Americans. Researchers at Johns Hopkins have named the fifty hospitals in America where uninsured folks pay ten times the list price for services.

Now, sure, you’re allowed to make a profit. That’s all well and good; but a 90% markup is something out of the Apple playbook. It’s one thing to markup a luxury cell phone for people who insist on buying one. It’s another thing to mark up the treatment of an inflamed appendix for people who couldn’t afford insurance.

From the article:

“They are price-gouging because they can,” said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health, co-author of the study in Health Affairs. “They are marking up the prices because no one is telling them they can’t.”

He added: “These are the hospitals that have the highest markup of all 5,000 hospitals in the United States. This means, when it costs the hospital $100, they are going to charge you, on average, $1,000.”

Okay, that sounds bad. But come on. Everyone knows insurance is a good thing. With Obamacare, you actually pay extra in taxes if you don’t have insurance. So really, isn’t it just the corner-cutters who get screwed by this practice?

Well, no.

The researchers said other consumers who could face those high charges are patients whose hospitals are not in their insurance company’s preferred network of providers, patients using workers’ compensation and those covered by automobile insurance policies.

Carepoint Health-Bayonne Medical Center in Bayonne, N.J., for example, also charges rates 12.6 times the actual cost of patient care. […] By comparison, the researchers said, a typical U.S. hospital charges 3.4 times the cost of patient care.

As usual, the article gets a quote from hospital spokespersons, who say that yes, they have “set” prices for each procedure, but nobody actually pays the listed price. Insurance companies negotiate bulk discounts for their customers, and the uninsured get to bargain down to less-obscene prices. This isn’t price gouging, it’s just imaginary price gouging.

Look. In law school, we were taught how to bill our friends and family for legal work. Always make up a crazy hourly rate, put that on the invoice, but then discount it down to your actual rate that you can actually bill your friends with a straight face. It’s a little dishonest to make up a fake price and a fake discount to arrive at a “bargain” price you wanted to charge to begin with.

But, you know. Lawyers. Sociopathy is kind of expected.

In our case, the deception was to avoid putting strain on social relationships by haggling over the price of legal services. It’s a passive-aggressive power play to your friends and family.

In this case, the deception seems to be… to frighten the unwell and uninsured (and the out-of-network and the underinsured etc.) into submission, by showing them an imaginary price they can’t afford next to a smaller price that will probably be the reason they’re bankrupt.