By all accounts, America has some of the best health care in the world. But it is also one of the most expensive. Getting affordable treatment is not easy. Lisa Fletcher reports on a medical practice in Oklahoma that's trying out something new.
When Pennsylvania resident Ruth Clarke needed a second hip operation, she faced double anxiety: would the surgery work, and how was she going to pay for it? Her first operation turned out to be twice to cost she was quoted.
Ruth Clarke: The first, they quoted me $32,000 it ended up to be $64,000.
Ruth is one of millions of Americans who find it’s hard, sometimes impossible, to manage the unpredictable costs of healthcare. Which is the big reason why Dr. Keith Smith decided to make a change.
Dr. Keith Smith: We basically felt like accessories to a crime and that really wasn't what we had in mind when we went to medical school. The hospitals were making a killing and the patients were financially being abused.
He and a colleague opened their own surgery center in Oklahoma City, and in 2009, they did something unheard of - posting all of the prices online. Suddenly, their patients weren’t just from Oklahoma.
Lisa: What did it tell you when people from other states started coming here for their medical procedures?
Dr. Smith: Americans look for value, they're good shoppers. People shake their head and they go, "wait a minute, this knee arthroscopy is $3,740 at this place and I sure like all of the social media reviews and I've done my homework and I was quoted $25,000 by the hospital down the street." And they start to wonder what really is going on.
Knee replacement surgery can cost up to $57,000 depending on where you get it. Dr. Smith’s center charges just over $15,000. For pacemaker placement, he bills $11,400 while the average cost nationally is over $28,000.
Dr. Smith isn’t alone in wanting to see clear pricing for common medical procedures. Last year, the Trump administration created new rules requiring hospitals to publish prices for common procedures. The rules came into effect in January, but so far, not all are complying. A recent investigation by the Pittsburgh Post-Gazette of Pennsylvania hospitals found three quarters failing to follow the rules.
Not surprising to Dr. Smith, who feels the big players in healthcare, stop at nothing to crush real competition.
Dr. Smith: It is a cartel. It functions very much like a cartel. And in spite of savagely going after each other competitively, they work together to make sure that the competition is limited enough that they still manage to do very, very well. We're not a member of the cartel.
Hospitals have defended the price variations saying costs can vary by region, facility, and patient, and other factors figure into negotiated rates, such as patient volume and hospital performance.
Lisa: How do insurance companies feel about you?
Dr. Smith: Insurance companies don't care for us and the feeling's mutual. Insurance companies make a whole lot of money when the initial charge is very, very high, and then they apply their so-called discount.
Lisa: So, they're applying a discount to an artificially inflated price?
Dr. Smith: That's right, and I won't give them that because all of our prices are online
Lisa: Give me the synopsis of the $100 aspirin.
Dr. Smith: Hospital charges a hundred dollars for an aspirin and the insurance company rides in on its white horse and applies a big discount and you only have to pay $5 for the aspirin. You and I both know if you went to your local pharmacy, you could buy all of the aspirin, probably in their entire pharmacy for $5. We don't charge for aspirin here we give them away.
Ruth Clarke is happy with the way her surgery in Oklahoma turned out, and she’ll be back if needed.
Ruth: If I need new hips, I had other new hip or knees. You know, like people I will be there. I will not. There won't even be a question.
In the end, the best advice for patients is to do what they do with just about any other big purchase: shop around before you buy.
Sharyl (on-camera): This impacts so many people. Out of interest how much was her second hip operation?
Lisa (on-camera): $22,000 no extra charges. All covered by her insurance. And as you heard in the story, her first operation, $64,000. She's still paying it off and expects to be doing so for the next few years.