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A doctor operating on a patient's knee. Photo: Sven Hoppe/picture alliance via Getty Images

We spend a lot of time talking about how hard it is for patients to find out how much any particular health care service is going to cost them.

A bigger problem: The Wall Street Journal uses the example of knee replacements to illustrate that difficulty, but also raises a bigger, even more frustrating point: It’s hard for hospitals to figure out how much their own work costs.

The details: Gundersen Health System in Wisconsin “had no real idea what it cost to perform the surgery” and wanted to find out why it was charging a list price north of $50,000, WSJ reports.

  • That process entailed “an 18-month review” in which “an efficiency expert trailed doctors and nurses to record every minute of activity.”
  • They ultimately determined that the procedure cost $10,550 — a fifth of the price the hospital had set.
  • The review uncovered other quality and efficiency issues. Some days, there weren’t enough beds for patients after surgery, and doctors performed the procedure differently “for reasons that weren’t always clear.”
  • “Gundersen’s analysis found that the hospital had been exclusively using brand-name cement, premixed with antibiotics. The hospital slashed its cement costs by 57% by switching to a generic,” per WSJ. “It isn’t clear how the orthopedics department came to use the brand-name cement … [one doctor] said he was perplexed when the analysis uncovered it.”

My thought bubble: Good on Gundersen for trying to figure all this out, but Gundersen isn’t an isolated example. This is the system we have.

  • And even though most of us don’t pay the full sticker price for health care, our premiums and out-of-pocket costs all still flow from that top-line number — which, WSJ notes, is set “using a combination of educated guesswork and a canny assessment of market opportunity.”

Go deeper

Updated 57 mins ago - World

HRW: Over 100 former Afghan security members dead or missing under Taliban rule

Members of the Taliban movement patrol Kabul's airport in September. Photo: Valery Sharifulin/TASS via Getty Images

The Taliban have "killed or forcibly disappeared" over 100 former members of Afghanistan's security forces since the group took power in August, a Human Rights Watch report published Tuesday found.

Why it matters: Former military members and officials from the ousted government, activists and other Taliban critics are facing peril amid executions driven by revenge — despite Taliban promises of an "amnesty" with no retributions, notes the New York Times, which first reported the news.

4 hours ago - World

Barbados becomes a republic, replacing U.K. queen with president

Combination images of Dame Sandra Mason, president of Barbados, and Britain's Prince Charles at her swearing-in ceremony in Bridgetown, Barbados, late Monday.

Barbados officially became a republic at midnight local time after Dame Sandra Mason was sworn in as the Caribbean nation's first president in a ceremony attended by the United Kingdom's Prince Charles.

Why it matters: Mason replaced Britain's Queen Elizabeth as head of state Tuesday — removing the country's final remaining colonial tie to the U.K. almost 400 years after the first British ships arrived in Barbados.

Right-wingers making McCarthy sweat for future Speaker post

House Minority Leader Kevin McCarthy stands with his Republican colleagues outside the House on Nov. 17. Photo: Stefani Reynolds/Bloomberg via Getty Images

Right-wing elements in the Republican Party are complicating House Minority Leader Kevin McCarthy's attempts to become the next speaker of the House should the GOP take back the majority in 2022.

Why it matters: While McCarthy has worked carefully to build trust among the conservatives who tanked his chances at clinching the speakership in 2015, they're still circling ahead of the next Speaker vote in January 2023.