A lot of people don\u2019t look closely at their medical bills. If they did, they might feel like they were reading a Monopoly board: $10 for an aspirin, $400 for Boardwalk. None of it seems real \u2014 and in many cases, it isn\u2019t. The bill might show $10 for aspirin, but the actual price paid, after insurer negotiations, could be 50 cents. It could also include someone else’s aspirin. Since few\u00a0consumers pay the bill directly,\u00a0the incentive to care about cost evaporates.<\/p>\n
That\u2019s part of the core problem in U.S. health care. When a third party \u2014 government or employer \u2014 is footing the bill, the system stops rewarding cost-consciousness and starts enabling inflation. This has led to a bloated, disconnected market where prices are inflated, savings don\u2019t benefit patients and cost-shifting is the norm.<\/p>\n
This distortion is particularly visible in how governments reimburse providers for care. In Washington state and elsewhere, Medicaid pays providers well below the actual cost of delivering care. Medicare comes closer, but still underpays. So hospitals and clinics make up the difference by charging private insurance plans more. That\u2019s called cost-shifting. It\u2019s the quiet tax on your employer or individual plan you never voted for.<\/p>\n
As public coverage expands without paying its way, private payers shoulder more of the load. Premiums rise. Access narrows. The system strains.<\/p>\n
Instead of addressing this imbalance, lawmakers often double down on it.<\/p>\n
This year, Washington\u2019s Legislature passed\u00a0Senate Bill 5083<\/a>, capping what hospitals can charge for services provided to\u00a0government employees and their dependents. That might sound good on paper \u2014 lower costs for the state and its employees \u2014 but it means someone else will have to pick up the slack. Typically, that \u201csomeone\u201d is private insurers and the employers and workers who rely on them. Price controls don\u2019t eliminate costs; they shift them.<\/p>\n