Family health insurance now costs $20k per year

[3SailAway]

As @TatinG says

For some reason (known only to bureaucrats and administrators), procedures are paid at higher rates than examinations. So internists talking to and diagnosing a patient are valued less than lopping off a mole or doing a colonoscopy.

The system gives low (or no) payment for the time it takes to get a thorough history, find the root cause of problems, or manage the complex interaction between different issues. High payment for doing stuff, especially surgery.

For example, my mom is having intermittent back pain and sciatica. She is very active for a woman in her 70’s and the pain is scaring her and slowing her down a bit. Internist immediately sends her to orthopedist. Orthopedist orders expensive scans which show spinal stenosis. Orthopedist wants to do invasive procedures, possibly surgery, despite lack of evidence that this would help, and risk of complications.

Meanwhile, spinal stenosis is par for the course when one is older, and Mom may actually need yoga, PT or a change in her exercise routines. Frustrating.