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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

Fringe right plots new attacks out of sight

Illustration: Aïda Amer/Axios

Domestic extremists are using obscure and private corners of the internet to plot new attacks ahead of Inauguration Day. Their plans are also hidden in plain sight, buried in podcasts and online video platforms.

Why it matters: Because law enforcement was caught flat-footed during last week's Capitol siege, researchers and intelligence agencies are paying more attention to online threats that could turn into real-world violence.

Kids’ screen time up 50% during pandemic

Illustration: Sarah Grillo/Axios

When the coronavirus lockdowns started in March, kidstech firm SuperAwesome found that screen time was up 50%. Nearly a year later, that percentage hasn't budged, according to new figures from the firm.

Why it matters: For most parents, pre-pandemic expectations around screen time are no longer realistic. The concern now has shifted from the number of hours in front of screens to the quality of screen time.

In photos: D.C. and U.S. states on alert for pre-inauguration violence

National Guard troops stand behind security fencing with the dome of the U.S. Capitol Building behind them, on Jan. 16. Photo: Kent Nishimura / Los Angeles Times via Getty Images

Security has been stepped up in Washington, D.C., and state capitols across the U.S. as authorities brace for potential violence this weekend.

Driving the news: Following the Jan. 6 insurrection at the U.S. Capitol by some supporters of President Trump, the FBI has said there could be armed protests in D.C. and in all 50 state capitols in the run-up to President-elect Joe Biden's inauguration Wednesday.