Does Anyone Really Know How Much Medical Care Actually Costs?

Presumably so -- I've heard of practices and clinics that refuse insurance of any kind and are entirely "cash and carry." Even those prices are distorted by the overall climate, but at least they're prices directly negotiated between provider and patient, so they presumably communicate some kind of coherent information on cost of provision, scarcity of staff and equipment, etc.

For those of us with "insurance," not so much.

Case in point:

I recently had an office visit with a specialist.

The medical equipment involved included, to the best of my recollection, a scale, a thermometer, and a sphygmomanometer. In other words, stuff that is neither especially expensive nor costs a lot to operate (like, say, an MRI machine).

The visit's total length was around an hour, probably 20 minutes of which was spent waiting due to technical difficulties (a regular old desktop computer went down -- hard drive problem that kept it from booting up) and patient backlog (some older patients ahead of me had problem with the computerized check-in kiosk, etc., and it kind of cascaded). But let's generously call it an hour of raw time and three person-hours of work time between the doctor, the physician assistant (who did most of the heavy lifting), and other staff (receptionist, nurse, et al.). My real guess is less than two person-hours because most of those people are multi-tasking, but I don't want to lowball the costs of provision.

My co-pay was $35. Not bad at all.

According to billing, the full charge for the visit was $747.

That seemed high to me until I did some research on salaries, etc. In addition to going high on person-hours involved, I went with the higher numbers I found for doctor pay, etc. and used the two highest salaries I found (doctor and physician assistant), and multiplied even that by 1.5 to account for non-salary costs to employ someone. I came up with staff costs of about $420.

According to Becker's Hospital Review, median hospital labor costs as a percentage of operating revenue run 54.2%. Which, based on my labor calculations above, would mean that the hospital expected to bring in about $775. So the "real" price of my appointment (as opposed to my co-pay) was only about $28 (3.5%) off of what the labor numbers I SWAGed would lead me to expect.

The combined "real" bill for my echo cardiogram and nuclear stress test last week came to $4,787. Of course, those things involved expensive equipment, drugs, more focused staff time and more of that staff time involving people with specific technical credentials, etc. But once again my co-pay was $35.

If the whole pricing scheme just sounds bizarre and even crazy to you, it does to me too. But it occurs to me that my "insurance" pricing is tasked with absorbing some of the difference between actual costs and what the hospitals and clinics can bill for the same services when provided to Medicare and Medicaid patients, administrative costs of complying with government regulations, etc.

That is, I expect that in a free market, cash on the barrelhead pricing would be significantly less than the numbers you see above. But also more than I could afford to pay ;-)