How distortions shape expectations

I recently suffered an injury to my foot. I got in to see my doctor the next day. They took and x-ray and confirmed no broken bones, just damaged soft tissue that should heal in a few weeks. I saw the x-ray image less than 2 minutes after it was taken. I was amazed at the clarity.

I expected to pay hundreds of dollars from my HSA account for that care, since I had not reached my deductible for the year. But, I thought it was worth it to know that I had no broken bones. I was pleasantly surprised to receive the bill. The total cost for the doctor visit and x-ray: $83.

Some say, sure, that’s the rate your insurance company had negotiated. I say, that’s closer to the rate you’d see in a competitive market where more costs are paid by patients out-of-pocket and that’s similar to what we pay plumbers and HVAC repairmen for a basic service call.

But, our expectations are different for those services, shaped by decades old market distortions of tax-deductible employer plans and third-parties paying the bills.

We might grumble about paying for plumbing or HVAC repair, but we haven’t adopted the expectation that some third-party insurance company pay that cost for us.