More or Less The shocking world of US health costs
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Dec 20, 2025 Elisabeth Rosenthal, a physician-turned-journalist and editor at KFF Health News, delves into the startling realities of US healthcare costs. She explains why prices for the same medication can skyrocket in hospital settings, highlighting the complexities of hospital markup practices. Rosenthal reveals how the 340B program contributes to inflated charges and discusses the political power that protects these pricing structures. The conversation takes a deeper dive into shocking examples of outrageous bills and the burden of rising medical debt affecting millions.
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Itemized Billing Multiplies Costs
- Hospitals itemize and bill every supply and action separately, which inflates total charges dramatically.
- Elizabeth Rosenthal explains this practice began after consultants pushed hospitals to monetise all services.
Many Hidden Line-Item Charges Add Up
- A hospital bill charges not just the drug but packaging, paperwork, and staff time, compounding the cost.
- Rosenthal notes the pill itself may be only six times pharmacy price before extra line items inflate it further.
Discounted Purchases Fund Hospital Markups
- The 340B program lets qualifying hospitals buy drugs at deep discounts and then charge higher prices to patients.
- Rosenthal says hospitals often keep the margin instead of fully returning benefits to their communities.
