A couple of weeks after I first got out of Cedars-Sinai Hospital in LA, reeling from the ugly truth that I was paralyzed for life, I got a call at eight am one morning from a very nice young lady in patient financial services.

“Mr. Rucker, how are you? Hope you are feeling well. Oh, that’s nice. Listen, I’m calling because you owe us $109,000. How would like to pay that – check or credit card?”

I was struck dumb. The shock alone may have led to a near-fatal pulmonary embolism that came a week or so later. I’d have to sell the house, I thought in that frozen moment, only to realize that the house at that point was worth less than the mortgage, i.e., under water. My only hope was that they were wrong, which it turned out, months later – thank you, Jesus -- they were. It was “merely” an unsettled dispute between the Writers Guild Health Fund/Blue Cross and Cedars, though Ms. Patient Services didn’t mention that at the time. As one expert later explained it, the whole thing was an argument between two computers over the seemingly innocent words, “rehab ward.” Blue Cross doesn’t pay for rehab, so Cedars billed me. When some human realized I was in that section of the hospital for hardcore medical reasons, the Blue Cross version of HAL dropped the charge from its data bank and I ended up paying a co-payment of around $1000.

This came to mind as I recently spent three days back in Cedars, years later, and upon my departure, asked for a complete itemization of every expense. I knew that basically, like the above, this wouldn’t be money I’d have to pay – when working, the system picks up most of the tab. But I wanted to see the actual charges and maybe learn something about how these institutions interact.

Some of you may well understand the strange, altered reality of big-time medical financing, but it’s Chinese math to me. It is convoluted, un-standardized, and laden with all kinds of middle-people to “interpret” your insurance coverage. In other words, it’s a system that needs an interpreter, like talking with rural Pakistani merchants. So I called an interpreter: a dear friend, Dr. Charles Bethea, a cardiologist and Chief Medical Officer at the Integris Heart Hospital in Oklahoma City. Dr. Bethea has been dealing with this wacko system for decades. He’d know its secrets.

But first, the Cedars bill: it was $35,732.51-- for hospital services only. I went into Cedars, at my doctor’s urging, to rest and recover from a series of infections. I sat there for three days taking Vancomycin (as in, “V” for victory); a really good viral medication for the flu; and an occasional Tylenol. Nothing got more complex than switching out IV bags. What exactly cost $35,732? The itemized bill laid it out: $4411.00 a day for the room, for example; $939 x three, or $2817, for an “alternating surface bed” I didn’t know I needed; and sixty-six other separate items. All the Vancomycin only came to about $1100 bucks. I thought that was pretty cheap for a life-saving antibiotic.

But no one cleared $35,000 for this stay. An immediate discount to Medicare knocked it down to $12,385. Over $23,000 was – whoosh -- gone from the charges. And the WGA Health Fund, I’m told, will pick up the rest. At this point in the process, the bill says: “Total Currently Due From You”…$0.00. Wait a minute, I thought. There’s a major disconnect here, something not-straight-forward. How does this whole megillah work, exactly?

Dr. Bethea enters the conversation here. The first obvious question: what’s with the four grand a night for a warm bed and some caring attendants? For that, I could stay in a luxury suite at the Four Seasons, with the best commercial nursing care in LA, and still have plenty of money for room service and after-dark movies.

“They charged that fee,” Bethea says, “because they have to charge the same standardized rate for every payer, and three to four percent of their patients actually pay cash!” And this logic applies to everything else, including the undulating bed. These cash customers are not a price-sensitive group, it seems. There only a few of them, but at these prices, a few means a lot. The hospital’s exorbitant fees in their “charge master,” as it’s called, have a real purpose: soak the rich.

Hard to argue with that thinking. And remember, a hospital like Cedars does a volume business in indignant care as well, a big demand in Los Angeles County, and provides all non-paying patients the same high level of service. So what I thought was legal price-gouging or some other scam turns out to be a way of maximizing the most income for the facility to offset both increased expenses and charity patients. Bethea: “The top ten hospitals in the country average about a 5% profit margin. That’s around the same profit if you ran your own grocery store.”

What strangles the American health payment system is its complexity. Most patients know this either intuitively or first-hand. Medicare has its way of doing things, private health insurance companies – Wikipedia lists 37 of them -- have their own individual rules and regulations, and a lot of interpreters – deniers, risk assessors, negotiators, that lady on the phone who has to listen to you ####, etc – have to follow the ball and in the private companies, make money. Assuming they’re all good people – unlikely – that much bureaucratic mishmashing alone has got to create its own problems. And it can’t help from driving up costs. It’s a big payroll and everyone involved is looking out for their own 401-K.

Maybe things will get simpler under the new health care rules. It’s probably a truism among the thousands of health care policy fabricators and explainers – another growth industry – that the current system works for a sizable percentage of people because they just pay their premiums and co-pays and have no idea what the system is. Like little children or trophy wives, they don’t know the cost of things. If they did, they might grasp the impact of this tangled web and take their own health, the source of it all, a little more seriously. If I had known what things cost on that last trip to Cedars, I would have told them to forget about the alternating surface bed, for instance, and also insisted on going home a day earlier. I was fine after day two and itching to get out. But someone in a white coat said stay and I did. At the time, I didn’t know I was wasting both my time and Medicare’s money, i.e., your money. Sorry.