Most people hate it when they have to see a doctor. The problem is that as we get older, we tend to frequent the health care system a bit more than when we were teenagers or young adults.

A few months ago I blogged about my high blood pressure scare. It spiked to 240/140, and doctors told me I could have had a stroke. I was given two little pills that dropped the pressure. The doctor asked if I had a headache. When I said I had a slight one, he told me I needed to have a CT scan. Technicians used a newer, smaller machine that did the job in less than five minutes. The only patient in the emergency room that night, I spent less than two hours there, mostly waiting for the pressure to fall.

The bill for the CT scan and the two little pills was $5,000—that I must pay out of pocket. This means I am out about $10,000 so far this year in health care costs (including insurance premiums). This represents a direct transfer of wealth from the middle class to the stockholders of the private emergency room that took care of me. In health care, there is little ability to shop around during an emergency. Even in non-emergency situations, recent studies suggest consumer shopping around does little to control cost.

Fast forward to this week, and my doctor is still trying to regulate my blood pressure. I am seeing him on average every three weeks, and every visit costs about $100. The doctor put me on a third medication, but told me instead of going to standard drugstores like Walgreens or CVS, I should go to Costco. He also advised me to purchase the 90-day supply of each drug, as if I had no insurance. The 90-day supply of three drugs was much cheaper than the drugstore 30-day supply of two drugs purchased through insurance.

But here’s the kicker: A lot of people were not at the Costco pharmacy one day, so I asked the specialist to ring up the drugs with my insurance information. Per insurance policy restrictions, I could only purchase the drugs in 30-day increments—and even the cash price for that 30-day supply for two drugs was more than the 90-day supply for three drugs.

In effect, there were three prices for the same drug. The first is the price for the uninsured. The second, the price for the insured paying out of pocket. And the third, the price for billing to the insurance company. These are all schemes designed to sell drugs at the maximum price the market will bear.