health care costs

Arline Feilen lost her husband to suicide in 2013. Three years later, she lost her dad to cancer. And this February, she lost her 89-year-old mom to a cascade of health problems.

"We were like glue, and that first Mother's Day without her was killer. It just dragged me down," said Feilen, who is 56 and lives in suburban Chicago. "It was just loss after loss after loss, and I just crumbled."

Health care is a trillion-dollar industry in America, but are we getting what we pay for? Dr. Elisabeth Rosenthal, a medical journalist who formerly worked as a medical doctor, warns that the existing system too often focuses on financial incentives over health or science.

Results are in from the first year of a bold change to the way hospitals get paid in Maryland, and so far the experiment seems to be working.

We recently reported on the unique system the state is trying to rein in health care costs. Maryland phased out fee-for-service payments to hospitals in favor of a fixed pot of money each year.

A key goal of the Affordable Care Act is to help people get health insurance who may have not been able to pay for it before. But the most popular plans – those with low monthly premiums – also have high deductibles and copays. And that can leave medical care still out of reach for some.

Federal health officials were advised in 2009 that a formula used to pay private Medicare plans triggered widespread billing errors and overcharges that have since wasted billions of tax dollars, newly released government records show.

Buying health care in America is like shopping blindfolded at Macy's and getting the bill months after you leave the store, Princeton economist Uwe Reinhardt likes to say.

But an online tool that went live Wednesday is supposed to help change that, giving patients in most parts of the country a small peek at the prices of medical tests and procedures before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

While reporting on the rollout of the Affordable Care Act, journalist Steven Brill was diagnosed with a life-threatening condition that required heart surgery.

"There I was: a reporter who had made hospital presidents and hospital executives and health care executives and insurance executives sweat because I asked them all kinds of questions about their salaries and about their profit margins," Brill tells Fresh Air's Terry Gross. "And now I was lying on a gurney in a hospital in real fear of my life."

Dr. Oliver Korshin practices ophthalmology three days a week in the same small office in east Anchorage, Alaska, he's had for three decades. Many of his patients have aged into their Medicare years right along with him.

For his tiny practice, which employs just one part-time nurse, putting all his patients' medical records in an online database just doesn't make sense, Korshin says. It would cost too much to install and maintain — especially considering that he expects to retire in just a few years.

Critics of America's health care system say it's really a "sick care" system. Doctors and hospitals only get paid for treating people when they're sick.

But that's starting to change. Health insurance companies and big government payers like Medicare are starting to reward doctors and hospitals for keeping people healthy.

So, many health care companies are trying to position themselves as organizations that help people stay well.

The kids are asleep, and I've settled into a comfy armchair in the corner of my New England living room, one of my favorite spots for shopping online. I've got my laptop open and I'm ready to search for a bone density test.

Hmmm ... looks like the price that my insurer pays for that test varies from $190 at Harvard Vanguard to $445 at Brigham and Women's Hospital.

To clamp down on health care costs, a growing number of employers and insurers are putting limits on how much they'll pay for certain medical services such as knee replacements, lab tests and complex imaging.

A recent study found that savings from such moves may be modest, however, and some analysts question whether "reference pricing," as it's called, is good for consumers.