The Hospital: Life, Death, and Dollars in a Small American Town

by Brian Alexander

There was no such thing as a free market for medicine in the United States, and there hadn’t been for some time. Asking patients to become consumers burdened them with the responsibility to shop wisely in an opaque economy, even as hospitals introduced high-cost, hotel-like extras to lure them through the doors. The idea that doctors could or would steer patients to low-cost hospitals or to high-quality ones was laughable. Doctors had no idea what hospitals—even hospitals where they worked—charged for services, and neither did most other people. Hospitals and insurers kept their pricing and their insurance contract negotiations confidential. So a broken leg for one patient could wind up costing much more—or much less—than the exact same break would cost someone else.