A tour de force article from Steven Brill over at TIME. Brill takes a long hard look at the way hospitals around the country are ripping patients off, and usually the patients least able to pay.

Charging $1.50 for a 1.5 cent generic Tylenol

I won’t quote Brill’s article at length, go read it. It’s unfuriating. He goes through the detailed hospital bills, line by line, or 7 different patients, in order to explore not only how much hospitals rip people off by charging patients $1.50 for a single generic Tylenol that costs 1.5 cents if you or I go buy it at a store. The hospital, buying such huge quantities, can surely get a much better price than that.

And if you only read one thing, read the intro to his story where he talks about the cancer patient and how the hospitals made him pay up front for his treatment, even when he was rushed to the hospital at one point – the hospital made him wait in the reception area for 90 minutes while they made sure his check cleared. Animals.

Charging a woman $21,000 for heartburn

Brill also tells the tale of a woman who thought she was having a heart attack. She calls the ambulance, goes to the hospital, three hours later they say “no, just heartburn.” And bill her $21,000. Oh, and the woman has been out of work for a year and has no insurance.

$20,000 for a non-emergency appendicitis

A friend went to a local hospital here in DC for an appendectomy. It wasn’t that much of an emergency, as the doctor told him he could come back the next morning for the operation. Total cost? $20,000. And if you have “good” insurance that pays, say, 80% of that, you still pay $4,000. When I told friend in Europe this story, about how much an appendicitis costs, they almost crapped their pants. What do middle class people do when their child gets an appendicitis? Who has $4,000, or probably much worse, to drop on a moment’s notice for something like this?

Only $35 for an emergency room visit in Paris

I also think of my retinal detachment surgery I had in Paris a few years back. I’d written about it extensively here. Long story short: I arrived in Paris for my annual house-sitting for Chris, who writes on this site, while he and his wife go on vacation. I noticed some serious floaters in my eye, and knew that this was a potential sign of a retinal tear (having had them in my family), so I went to a hospital and found out that I had a rather large tear. They tried to cauterize it with a laser – a “painless” procedure that hurt about as much as you’d imagine a laser pointed at your eye would feel. The cost of that treatment was $35 for the emergency room visit, and around $130 for the laser surgery. Back home it would have been several hundred dollars for the emergency visit itself and then maybe a few grand for the laser surgery.

A week later I went back for my check-up – the doctors had grounded me anyway, so I stayed in France for my house-sitting – and we found that the laser didn’t work, my retina was detaching, and I had to have a scleral buckle put in my eye, a procedure they would do in the hospital operating room as in-patient surgery, under general anesthesia. I immediately panicked, A) about my eye, B) about the cost. Would my American insurance even cover me in France? And how was I going to afford surgery and a hospital stay?

$26 a day for a hospital room in Paris

Well. The hospital stay costs a whopping total o f 20 euros a day, or about $26 at today’s exchange rate. And that’s expensive, you see, because the rate used to be 16 euros but the hospitals had to up it, and it caused quite the controversy in France, charging “so much” for an overnight stay in the hospital.

Retinal detachment: $2,000 in Paris; $20,000 in America

My surgery itself cost around 1,600 euros, or $2,000. When I finally got back home, my American doctor told me the cost would have been a minimum of $20,000 in an American hospital. And not because the quality of care was any better: I was at one of the top eye hospitals in the world in Paris.

Cataract surgery in America: $15,000 an eye

Our entire medical system in this country is obscene. For my recent cataract surgery (yeah, I know, I’m young for cataracts – we have no idea why I got them), the hospital alone charged me $14,000 per eye just for their fee. That didn’t include the doctor, the laser they used to cut my eye, etc. Thank God I have pretty good insurance – well, it’s garbage for prescription coverage, but is “good” for major medical – so I “only” pay 10% of the cost. But that meant I owed over $2,000 out of pocket for both procedures with “good” insurance.

And another thing. That $14,000 the hospital charge me just for the hospital facility charge, Blue Cross knocked it down to around $5,000 as I recall. That’s the “non-allowed” line on your insurance bills that never quite make sense. It’s the insurance company telling hospitals (or doctors) in their network that they’re only going to pay a certain amount for certain procedures, and the patient does not have to pay the difference. So what that means is that hospitals and doctors are charging people who don’t have insurance a heck of a lot more than they charge people who do have insurance, for the same procedures. That’s insane.

Advair: $82 in Paris; $358 at Costco in America

This is a particular pet peeve of mine: the way American pharmaceutical companies rape American consumers in order to provide artificially-subsidized low prices to Europeans for the same drugs.

Take Advair. In Paris, I can buy Advair made by GlaxoSmithKline for 63 euros, or $82. In America, I can buy the same drug, made by the same company, at Costco (cheapest I can get) for $358. Yes, GlaxoSmithKline charges Americans 5.7 times more for Advair than what they charge the French.

Oh, but it gets better than that.

Price of Advair over time

Paris America

1999: 63 euros ($82) $272.29

2012: 63 euros ($82) $358.51

Yes, that’s right. GlaxoSmithKline hiked the price 32% in the US and didn’t hike the price in France at all over the same period.

It’s one big den of thieves, the lot of them.

Health Care lobbyists spend more than 3x on lobbying than Defense contractors do

Want to know why things are so bad in the states with health care? Here’s on big reason, from the TIME piece:

According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

We’ll see next year if Obamacare, when it starts to truly be implemented, helps any of this. But I’m not hopeful. It may help with insurance prices. Maybe. But our system is a mess, and for a lot of us, who don’t have our parents’ cushy insurance and cushy retirement plans, it’s an increasingly scary place to be.