How Manufacturers, Middlemen, Providers, PBMs, and the Government Are Keeping Us in the Dark
• The healthcare industry is rife with secrets • Drugs and device efficacies are elusive
• Prices are kept opaque • Payers/patients lack clarity
Someone got screwed. I mean that literally, though not in that way.
I have a patient’s itemized bill in front of me which lists the price for a single screw used in his spinal implant
surgery: $12,291.00. Sound like a lot? It is. Not that he would know.
But then there’s this: his insurer doesn’t know either. It’s a mystery to them, too. Medical-surgical implants and
devices are a black box in the healthcare industry. Sure, the hospital knows what they paid for the screw, but
they’re not obligated to report that amount to anyone. So, they don’t. And the manufacturer sure isn’t telling.
Drug costs aren’t as opaque. There are a few benchmarks to go by if you know where to find them. But not
many people would know where to look for those either. Besides, by the time patients have to pay for their
pharmaceuticals there’s been so many confidential backroom deals made throughout the pipeline it’s nearly
impossible to tell if they’re getting a good price.
Healthcare as a concept is very personal for most Americans. Rules and regulations surrounding patients’
privacy are of paramount importance. These protections exist to safeguard people from fraud and exploitation
when they’re at their most vulnerable. As a whole, the healthcare industry has appropriated that concept of
privacy for themselves. And not in a good way. Whenever the topic of transparency rears its ugly head the
industry players fiercely band together to preserve their clandestine confidentialities. (Then it’s back to loudly
blaming each another about obfuscation and price gouging!)
How Does the Industry Deceive Thee?
Let Me Count the Ways.