It's retail , baby! (Explanation of Benefits Part Deux)

Even when you do have EXCELLENT insurance, price gouging is the norm--or why else could a person "negotiate" down what the insurance doesn't cover 20-30% of that charge and/or have it written off  altogether.

It's retail baby! I worked in retail for a very long time. I can't remember the exact formula, but we'd mark up the price from buyers at least 50%. So when we had a sale, we'd still be making a profit. I also worked selling furs in my youth when I didn't know any better. The mark up was tremendous. 

Same thing with purchasing a car even with no interest, banking... everything retail. The goal is making a profit, and health care is no different even under a "not-for-profit" tax shelter.

Oh... a word about employee discounts--depending upon the percentage of the discount and the items eligible, a worker is basically using his/her paycheck to earn profit for the company. It would have to be a discount on a significant mark-down to be a real deal for employees. 

Otherwise the company is essential hoarding your earnings to make a profit while at the same time pretending that the "discount" is part of your paycheck. So you're basically volunteering as free labor for a business the more you use an employee discount. It's all legal, but is it ethical to set-up a situation to further benefit a company by which employees shoot themselves in the foot to save money--allegedly? Why not just increase pay?

Same with a company that pressures employees to apply for its credit card. The company is getting a kick-back, and you're paying interest--or that's the plan and hope, particularly if you can only receive employee discounts by having the credit card.

So retail whether for-profit or even non-profit to some degree can be a shady place, including but not limited to the health care industry:

We cannot reform health care intelligently unless we understand the medical marketplace well. Debates about reform have scrutinized the health-insurance market, but they have neglected a crucially defective feature of the medical marketplace — the way doctors and hospitals charge patients when prices are not set by regulation or by negotiation with insurers.

The Problem

When patients are not protected by large private or public insurers, doctors and hospitals charge them astonishingly more than patients with Medicare or managed-care insurance. Some price difference would make sense, because insurers offer providers large volume and economies of scale.

But we are not talking about discounts of 10, or 20, or even 30 percent. Providers routinely double, triple, or even quadruple prices for unprotected patients. Such huge mark-ups can only be regarded as price-gouging — exploiting market power to charge prices virtually unrelated to actual cost or market value.

A comprehensive analysis of data hospitals report to Medicare shows that, on average, hospitals charge uninsured patients two-and-a-half times more than they charge insured patients and three times more than their actual costs. In some states mark-ups average four-fold. 

Data for physicians’ prices are less comprehensive, but information from office management systems is disturbing. Across a range of diagnostic and invasive specialty services (echocardiography, coronary catheterization, liver biopsy, upper GI endoscopy, circumcision, flexible sigmoidoscopies, hysterectomy, appendectomy, gall bladder removal, and arthroscopic knee surgery), many physicians in 2003 charged uninsured patients roughly two to two-and-a-half times what insurers paid.

Only primary care physicians appear to be staying within plausible bounds. They typically charge uninsured patients only one-third to one-half more for basic office or hospital visits than they received from insurers..., "Price Gouging By Doctors and Hospitals,"July 19, 2009; Mark A. Hall, Professor of Law Public Health, Wake Forest University, and Carl E. Schneider, Professor of Law and Internal Medicine, University of Michigan,