$250 vs $9 vs $1: Case #10,314 – How Our US Health Care System is Whacked Out

Lisa reads a lot of news, and naturally sends me a steady stream of things she finds interesting. Among items today was this NPR piece on a teacher who was billed $100K for care that was outside network. Of course it reminds me of my own considerably less intensive foray into such things.

Of course, the issue is larger than just the big things.

Here’s another personal event that happened a few months ago.

It started when the phone rang:


“Mr. Collins?”

“Yes?”

“This is so-and-so at the pharmacy.”

He went on to ask about a prescription my doctor had called in. I’d recently had a small procedure and needed an anti-bacterial substance of whatever kind to put under a band aid. The doctor had provided a prescription. The pharmacist asked if it was okay to deliver this as an ointment rather than a cream. The doctor, you see, had specified a cream.

“I don’t care,” I said. “What’s the difference?”

“The cream is $250, the ointment is $9.”

“Sign me up for the ointment,” I replied, quite proud that I didn’t break out in psychotic laughter at the idea of $250 for a tube of anti-bacterial cream.

The pharmacist then called the doctor to get permission, and I got a $9 tube of ointment.


This is bad enough, right? If that pharmacist hadn’t stepped up and said “hey, do you want to save 27,778% on your cost?” I would have gotten to the pharmacy and been faced with the question of forking over 250 bucks for something my doctor said I needed. I expect I’d have just done without—which might have been fine, but I can imagine a lot of people getting out the checkbook while trying to decide if they could skimp on dinner for a month to make it up–and, heck, what would have happened if I didn’t do it, and ran into an infection?

Of course, though, it doesn’t end there.

I mean, the tube I received was a little bigger than a travel tube of toothpaste. It held 22 grams of the stuff. I mean, it’s kind of a big-assed tube when you take into account that at the end of the day, I needed three (count’em, three) little dabs the size of one of those Dippin’ Dots ice cream buttons.

So this means that, while I walked out of the pharmacy “pleased” to pay only $9 instead of $250, at the end of the day I needed $.09 worth of medication rather than $9.00—and that’s being generous. Let’s be generous again and say that the packaging of the tube itself would be a whole buck. My raw need here was $1.09. Max. So, after insurance and after being “saved” by the pharmacist, I paid $9 for $1.09 worth of care.

Amazing, right?

Almost as amazing as the fact that no one in the chain seemed surprised at all.

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