Not long ago, Cathy Birker-Hake tripped over a hose in the backyard of her Valley Village, dislocated her shoulder, and went straight to the emergency room.
"This is one of the really stupid accidents," she told me, still embarrassed that such a trivial accident requires emergency medical treatment.
63-year-old Birker-Hake said her shoulder was put back in place at Providence St. Joseph's Medical Center in Burbank, and she was given a sling to keep her arm still during the healing period.
The hospital charges $6,223 for two emergency visits. Birker-Hake said her insurance company Oscar Health paid nearly $4,400 of this.
Then, a few weeks ago, a Carlsbad company called Breg received a bill, which described itself as "the second largest supplier of orthopedic braces in the United States." (The largest seems to be DJO Global, formerly located in Carlsbad, now in Texas.)
Birker-Hake may have settled accounts with Providence, but Bregg wants to buy the cloth sling she got for an extra $200-or more ceremoniously named DLX Shoulder Fixer L.
Her experience is another example of face-to-face medical pricing. It usually reflects not the real cost, but what healthcare companies think they can get rid of.
From hospitalizations and prescription drugs to medical equipment and related supplies, Americans spend approximately $3.5 trillion on health care each year.
According to data from the Organization for Economic Development and Cooperation, Americans face an average of more than $10,000 in medical expenses each year. Due to insurance, out-of-pocket expenses are usually lower.
The organization found that the country’s per capita health care expenditure is about twice the average of all comparable countries. France, Canada, Japan, the United Kingdom, Australia-their citizens pay less than half of what we pay.
I am not blaming a manufacturer of orthopedic devices for this difference. But what Birker-Hake is going through helps to emphasize how stupid our system is.
Multiply her $200 sling by all the stories of $50 Tylenol and $3,000 in MRI, and you will soon understand how our health care expenditures shamelessly exceed those of other developed countries that have long ago thought of picking up patients. Is unacceptable business behavior-and take regulatory measures to prevent it.
Lawrence Casalino, professor of health care policy and research at Weill Cornell College of Medicine, said: "In general, we pay higher prices for everything-medicines, supplies, hospital services, doctor services."
He told me that higher prices “usually stem from market forces”—that is, lack of competition and transparency—and “the ability to make unexpected bills”.
The unexpected bill is what it sounds like: charging patients unexpectedly after receiving treatment.
Most other companies disclose their prices in advance, which is only fair and essential for a highly competitive market. Healthcare is one of the few industries. When you have almost no recourse but to pay, it will tell you the cost of things after the fact.
Birker-Hake was surprised, to say the least, the price of the sling she got at the hospital was $200—especially after she had coughed up her own $1,800 to add to the $4,400 paid by the hospital. Her insurance company.
This does not include the nearly $1,500 in insurance premiums she pays each year.
Birker-Hake showed me some pictures of Breg slings. This is not a particularly complicated device.
Place your arms in a horizontal bag and lean against you. A shoulder strap draped over the shoulder. The other strap is wrapped around your waist.
DLX Shoulder Anti-theft Device L is probably a large-sized luxury shoulder anti-theft device. Breg's website states that it is "made of soft, breathable cotton material. It can be used for left or right side applications. Plush, full foam belt Provide extra comfort for patients."
Birker-Hake pointed me to several similar straps on Amazon. Their prices range from US$12.99 to US$16.99.
The Breg version is beautiful, just like a sling. I'm not sure if those plush all-foam tapes are about 900% higher than similar products.
Birker-Hake complained to her insurance company, which is investigating the matter. In a letter dated August 15, the insurance company admitted that Breg's allegations "complied with the requirements of the Accident Act."
Therefore, Oscar Health agreed to pay $5.86 of the $200 fee.
"Six dollars?" Birker-Hake told me. "I mean, really?"
Now she wants to know what to do. "This is a fabric with shoulder straps and belts," she said. "Two hundred yuan, it seems a bit unreasonable."
Breg spokesman Hilary Schuler-Jones declined to answer questions about the price of luxury shoulder anti-theft devices.
“It’s important to note,” she said, “Breg’s customers are not patients, but healthcare providers.” In most cases, “we don’t sell our products directly to patients, so we don’t have a patient price list. "
Hospitals or clinics can buy Breg's products at discounted prices, and then increase the price as they like. Or, in Birker-Hake's case, they distribute products on Breg's behalf, and then Breg follows up on his own bill.
The company realizes that its equipment may be much more expensive than similar products online. It has a webpage dedicated to this topic.
Basically, what the page says is that receiving a sling directly from a doctor or hospital can eliminate all guesswork, so this is important.
"The immediate availability of this product is to buy goods online and then wait to receive benefits that it cannot provide," it said.
Does this justify the 900% higher price? Breg's position is that you get what you pay for.
But you did not. The healthcare market is different from other markets. Its customers often have no choice when seeking goods or services-they need immediate attention.
In addition, if most people know in advance that it will cost an extra $200 and they can get almost the same thing for only a small part of the cost, including any costs that may be required to accelerate delivery, then most people may refuse the doctor’s Suspenders.
My advice to Birker-Hake is that she pays the bill. She didn't want debt collectors to chase her, which made it worse.
But this is another example of the health care system focusing more on profit than on patients.
Why do we spend so much on health care than other countries? This is not because of a company.
It's all like this-and the government, unlike the governments of other developed countries, refuses to take any action on this issue.
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David Lazarus is an award-winning business columnist for the Los Angeles Times. He also appears on KTLA Channel 5 every day. His work was published in newspapers across the country and led to the enactment of various consumer protection laws.
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