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The shocking world of US health costs

Dec 20, 2025
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INSIGHT

Every Item Becomes A Bill Line

  • US hospitals itemize nearly every service, turning small items into separate bill lines that inflate totals.
  • Elisabeth Rosenthal explains consultants pushed hospitals to bill every pill, IV bag and 15-minute block to boost revenue.
INSIGHT

340B Creates Markup Incentives

  • The 340B program lets eligible hospitals buy drugs about 50% below retail and then mark them up.
  • Rosenthal says hospitals often keep the margin instead of reliably returning savings to community care.
ANECDOTE

Screws Priced Like Moon Rock

  • A patient was billed $4,000 per screw to fix a broken foot, prompting disbelief about material costs.
  • Rosenthal recounts many bills where routine items and separate procedures push totals into the tens of thousands.
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