The Healthcare Industry's Dirty Secret: Uncertainty is the Strategy

When price transparency isn't transparent at all – and why that's exactly the point

You walk into Best Buy. The 65-inch TV has a price tag: $799. You know what you'll pay.

You walk into a hospital for an MRI. The price? Nobody knows. Not the receptionist. Not the billing department. Not even your insurance company can tell you for certain.

This isn't incompetence. It's strategy.

The Numbers Are a Shell Game

Having led healthcare organizations through financial transformations, I've seen the chargemaster from the inside. Here's what patients don't know:

• Hospitals list prices at 10x what they actually accept from insurers – billing $5,000 for an MRI but happily accepting $500 as payment in full

• Walk into the ER for stitches: $2,500. Walk into urgent care for the same stitches: $200. Same procedure, same outcome, 10x price difference based solely on which door you entered

• Your insurance company negotiates different rates for the same procedure – sometimes multiple contracts with the same hospital

The federal government mandated price transparency in 2021. Three years later? Only 21% of hospitals comply. The other 79% would rather pay fines than reveal their pricing schemes.

Because uncertainty is profitable.

The Three-Card Monte of Medical Billing

Here's how the game works:

Step 1: The Chargemaster Fiction

Hospitals create a master price list that's pure fantasy. A Tylenol listed at $37. An IV bag at $137. These aren't real prices – they're negotiating positions. Starting points for a game where you don't get to play.

Step 2: The Network Shuffle

Your insurer has three contracts with the same hospital. Need a knee replacement? Depending on which "network" you're in, that hospital might charge your insurance company $15,000, $22,000, or $31,000. For the exact same surgeon. Same operating room. Same outcome.

Step 3: The Cost-Shifting Shell Game

Hospital loses money on Medicare patients? No problem. Shift those costs to the commercial insurance rates. Insurance pushes back on MRI prices? Fine – increase the "facility fee" instead. It's financial Whac-A-Mole, and patients are always the ones getting whacked.

The Psychology of Price Darkness

62% of Americans worry about affording healthcare.

56% describe medical bills as their top source of stress.

64% call paying medical bills "highly stressful."

But here's the cruel twist: We've trained patients to accept this uncertainty.

After years of surprise bills and pricing black boxes, patients have developed learned helplessness. They stop asking about prices. They accept that healthcare costs are unknowable. They've surrendered.

The Illusion of Control Through False Transparency

Here's where it gets truly insidious.

Hospitals now publish their "negotiated rates" online. Patients find these spreadsheets and feel relief. Finally! A number! Your insurance negotiated $2,100 for that knee MRI. You can plan. You can budget. You feel in control.

This is illusory agency – the false comfort of thinking you understand something you don't.

That $2,100 "negotiated rate"? It's psychological theater. Here's what you discover after your procedure:

- The $2,100 was just the hospital's portion

- The radiologist bills separately: $400

- The contrast dye wasn't included: $300

- You hadn't met your deductible: Add $2,000

- There's a "facility fee": $450

- Your total bill: $5,250

You thought you knew the price. That feeling of control? That relief you felt finding that number?

Pure illusion.

It's worse than not knowing, because the false certainty prevents you from asking harder questions. From demanding real change. From recognizing you're still being played.

The transparency movement gave us comfort without control. Knowledge without power. Numbers without meaning.

We traded our outrage for spreadsheets that lie.

The Transparency Theater

"But wait," hospitals say. "We published our prices online! We're transparent!"

This is gaslighting on an industrial scale.

Imagine if Best Buy buried TV prices in a 50,000-row spreadsheet. Listed the screen separately from the power cord. Added a "retail facility fee" at checkout. Charged extra for the remote but didn't tell you until you got home.

It would be unthinkable. In healthcare, it's standard practice.

Finding a "negotiated rate" buried in that spreadsheet doesn't help when:

- That rate doesn't include the anesthesiologist (separate bill)

- Or the radiologist (another separate bill)

- Or the mysterious "facility fee" (surprise!)

- Or what you'll actually pay after deductibles, co-insurance, and out-of-network gotchas

The published prices are a pacifier. They quiet our demands for real transparency while changing nothing about the actual patient experience.

It's transparency theater. All performance, no substance.

The Human Cost of Uncertainty

I spoke with a small-business owner last month. She needed routine surgery. Called five hospitals for prices. Got five different non-answers:

"We'll need to check with billing." (They never called back)

"It depends on your insurance." (She has insurance)

"We can't quote prices in advance." (But they'll sure collect in advance)

"Check our website for transparency." (10,000 procedures, zero clarity)

"You'll get an estimate after pre-authorization." (The estimate was wrong by 300%)

She delayed the surgery for six months. Not because she couldn't afford it – but because she couldn't budget for the unknown.

She had the money. What she didn't have was certainty. And in American healthcare, that paralyzing uncertainty can be more damaging than the illness itself.

Half of U.S. adults can't pay an unexpected $500 medical bill.

In what other industry would this be legal?

What Real Transparency Looks Like

We don't need more spreadsheets. We need healthcare pricing that works like everything else in the economy:

Binding Estimates

- You get a real quote before treatment

- That quote includes everything

- The price is the price

All-Inclusive Pricing

- No surprise bills three months later

- No phantom "out-of-network" providers at in-network facilities

- No facility fees that appear from nowhere

Comparison Shopping

- See prices across providers

- In plain English

- Before you commit

Consumer Protection

- If they quote wrong, they eat the difference

- No balance billing

- No financial gotchas

The Bottom Line

Healthcare will never be affordable until prices are knowable.

Every other industry figured this out centuries ago. Airlines show total prices. Restaurants include tax. Even car dealerships – famous for shady pricing – must display sticker prices.

Only healthcare gets away with this deliberate darkness.

The industry spent $4.7 billion lobbying, including against transparency, over the last decade. They didn't spend that money because transparency would help their business model.

They spent it because uncertainty is their business model.

Until we demand real prices – not spreadsheets, not estimates, not "it depends" – we're not patients or consumers.

We're marks in a con game where the house always wins.

What's your worst healthcare pricing surprise? Have you ever successfully gotten a firm price quote before treatment? Share your experience in the comments.

Follow for more breakdowns of healthcare's hidden mechanisms and the uncomfortable truths the industry doesn't want you to know.

As a former healthcare CEO and current healthcare AI consultant, I'm committed to exposing practices that prioritize profit over patients.