President Obama dropped in to a summit of health insurance CEOs last month to ask them to help make the Affordable Care Act work better for all involved. He also sent out letters asking them to join him in a campaign to get more young, healthy people covered, which would both benefit health insurers and bring down premiums for everybody.

The presumption is that the problem with our healthcare system is that we have made healthcare a for-profit enterprise with greedy health insurers coming between patients and their healthcare providers. And to a certain extent that’s true. But there’s another problem: the healthcare providers themselves can be greedy price-gouging assholes.

LiveScience reports on a Johns Hopkins study that says hospitals “jack up costs strategically:

“Researchers… found that many hospitals charged more than 20 times the cost of some services, particularly for certain services like CT scans and anesthesiology. The researchers said that the pattern of charging suggests that hospitals strategically look for surreptitious ways to boost revenue.”

And it’s not just CT scans and anesthesiology. They also do it with other high tech procedures like EKGs, MRIs and brain scans. And don’t even get me started on the cost of a tuna sandwich in the cafeteria.

Billers know that reading your hospital bill is like trying to decipher the Enigma code, so they sprinkle in hidden, jaw-dropping costs that you wouldn’t think to question.

“The pricing can have serious consequences for the payer… Hospitals whose costs for a CT scan run at about $100 may charge a patient $2,850… In 2013, the average hospital with more than 50 beds had an overall charge-to-cost ratio of 4.32. That is, the hospital charged $4.32 for every $1 of its own costs. However, at most hospitals that they examined, the researchers found that the charge-to-cost ratio was far higher in departments that were technologically advanced. The highest was in the CT department, with an average ratio of 28.5.”

I guess they figure we’re stupid and vulnerable and we’ll just assume that tests with all the state-of-the-art, electronic gizmos must cost a small fortune. Now we know why they keep those gowns open in the back – because you’re about to take an ass screwing.