Now that summer is over, the midterm elections are around the corner and everyday Americans will start paying attention to politics. The watchword on both sides of the aisle is “affordability,” and that very much includes healthcare. While the Democrats’ answer is, predictably, more government, shifting the cost burden to taxpayers, “Medicare for all,” Republicans’ answer should be to actually lower the cost.
Because the American healthcare system is so complex, there are many reasons our healthcare is so expensive. But one of them is remarkably simple. In some cases, we’re effectively paying twice for the same thing.
Consider a patient who visits a dermatologist to have a suspicious mole checked. The doctor examines the patient and decides the mole should be removed. Since the patient is already there, the doctor removes it during the same appointment. To any normal person, that’s one trip to the doctor’s office involving an examination followed by a procedure.
The healthcare billing system sees it differently.
Under current Medicare rules, the office visit and procedure can each be billed at close to their full rates, even though they occurred during the same encounter and some of the costs associated with providing them overlap.
The patient didn’t check in twice. The exam room wasn’t prepared twice. The staff didn’t conduct two entirely separate appointments. Yet the payment system can reimburse the services as though much of that overlap doesn’t exist.
This may sound like an obscure billing technicality. Multiply it across a healthcare system as large as ours, however, and seemingly small inefficiencies add up to hundreds of millions of dollars.
A 2025 federal audit examined Medicare-covered eye injections and found that 42 percent were effectively double billed, using this billing practice. Of the claims investigators reviewed, 92 percent didn’t meet Medicare’s own documentation requirements. Those charges alone cost Medicare $124 million in a single year. Another federal audit examining dermatology estimated that Medicare overpaid $62.9 million on claims.
These audits provide a window into the machinery of healthcare pricing, where costs that would look strange in almost any other industry can become routine once they’re buried inside a complicated payment system.
Centers for Medicare & Medicaid Services (CMS) has acknowledged the issue. The agency says there are efficiencies when the same physician provides an office visit and a procedure to the same patient and that the current payment methodology is “likely duplicating payment.”
There is now a proposal to change that.
For certain same-day office visits and procedures, the more expensive service would continue to be paid in full, while the other would be paid at 50 percent. An office visit billed at roughly $237 and a procedure at $300 can currently result in about $537 in combined payments. Under the proposed approach, the procedure would still receive its full $300 payment and the office visit about $118, bringing the total to approximately $418.
This should be common sense. If two services are performed together and share costs, we shouldn’t pay for those costs twice.
For Americans to pay less for healthcare, healthcare itself has to cost less. That means looking closely at the underlying prices, payment rules and incentives and asking whether we’re getting what we’re paying for.
The fixes won’t be glamorous. They will involve arcane things like billing codes, reimbursement formulas, and payment policies that few Americans have ever heard of. But a healthcare system that now consumes $5.3 trillion a year, almost a fifth of the entire U.S. economy, is too large to ignore unnecessary costs simply because fixing them is complicated or boring.
Americans are right to wonder why their money doesn’t go as far as it used to. Healthcare is one part of the answer, even when much of what makes it expensive is hidden from view. If we’re serious about affordability, we need to pull back the curtain on those costs and start eliminating the ones that shouldn’t be there.
Not paying twice for the same thing is a good place to start.
Ann Marie Buerkle is a former nurse and congresswoman who served as the commissioner and acting chairwoman of the Consumer Product Safety Commission under President Trump.
