Why Your 401(k) Lives Under a Microscope While the Healthcare Bills Like a Pit Boss
Twenty-five years ago, Enron collapsed under the weight of its own lies.
Then WorldCom face-planted.
And by 2008, Wall Street managed to vaporize the global economy like a magician doing a disappearing act with your retirement savings.
The public was furious.
Congress panicked.
And the government swung a sledgehammer in the form of the Sarbanes-Oxley Act (SOX) and later Dodd-Frank — sweeping regulations designed to force transparency, prevent fraud, and keep CEOs from treating financial statements like creative-writing projects.
Public companies today live under this regulatory security blanket:
- Everything must be documented.
- Internal controls must be airtight.
- Pricing must be consistent.
- Invoices must reflect reality.
- Executives sign financials under penalty of prison time.
In other words:
If you sell iPhones, tractors, software, or shoelaces, you must reveal the truth.
But if you’re in the healthcare industry?
Well… welcome to the Wild West — fully sanctioned by Congress, protected by regulators, and wildly profitable for insurers, hospitals, PBMs, pharma giants, and every bureaucratic barnacle clinging to the side of the Government-Medical-Industrial Complex.
The Enron Lesson: Transparency for Investors, Not for Patients
SOX wasn’t created to protect consumers — it was designed to protect investors from executives who thought GAAP accounting was a suggestion, not a rule.
So here’s the irony:
If Enron had billed like a hospital system, it would still be in business.
If hospitals billed like Enron, they’d be shut down tomorrow.
SOX demands “truth in invoicing” for corporations, but it does not apply those same rules to the medical bills that destroy families financially every year.
The healthcare exemption isn’t an accident. It’s a byproduct of three decades of:
- political deals,
- regulatory carve-outs,
- industry lobbying,
- and a government that is more afraid of disrupting hospital revenues than protecting citizens from them.
In 2010, after the 2008 crash, the government delivered the Affordable Care Act — a politically packaged promise of transparency and affordability.
Instead, what we got was:
- rising premiums
- rising deductibles
- rising co-pays
- rising out-of-pocket maximums
- rising hospital prices
- record insurance company profits
…and, most importantly:
no pricing transparency.
The ACA regulated coverage — not costs.
And the difference has bankrupted American households ever since.
The COVID Jackpot: Healthcare’s Most Profitable Crisis
When COVID hit, hospitals got federal bonus payments for:
- COVID admissions
- COVID diagnoses
- COVID ventilator usage
- COVID deaths
- COVID emergency declarations
And providers billed at full freight under emergency powers, all with zero public visibility into the actual negotiated rates.
The result?
The largest revenue boom in modern healthcare history.
The least transparency in modern healthcare history.
Patients died.
Costs exploded.
Executives cashed bonuses.
And insurers posted record profits while Americans avoided medical care out of fear of the bill.
If there were ever a moment for true healthcare reform, that was it.
Washington chose not to.
Insanity of Medical Pricing
The graphic above provided says it all — and it’s sourced from PatientsRightsAdvocate.org, one of the few organizations actually fighting for transparency.
Prices for the same procedure vary 31× in the same state.
MRI (same machine, same scan, same state):
- $300 cash price — Landmark Medical Center
- $2,800 insured rate — New England Baptist Hospital
- $7,500 insured rate — Mass General Hospital
Colonoscopy:
- $2,300 cash
- $3,990 insured
- $9,600 insured at another hospital
Hip replacement:
- $17,579 cash
- $17,026 insured
- $62,580 insured
Let that sink in:
Cash prices — the “uninsured peasant” rate — are often cheaper than the insured rate.
Try pulling that stunt in any SOX-regulated industry and you’d face auditors, regulators, lawsuits, and probably a Netflix documentary.
In healthcare?
It’s just Tuesday.
Why This Happens: The Government-Medical-Industrial Complex
The system is built — intentionally — to shield healthcare pricing from public view.
Hospitals
Use “chargemasters” — fictional sticker prices that no insurer actually pays, but uninsured patients get stuck with.
These numbers have no relationship to actual costs.
Insurers
Negotiate private discounts that are legally treated as trade secrets, meaning patients can’t see the real price until after they’ve purchased the service.
Pharma & PBMs
Maintain a kickback-based rebate system where:
- the list price is fake,
- the real price is hidden,
- and PBMs pocket the difference through “spread pricing.”
The ACA
Did nothing to fix this. It expanded coverage while leaving price opacity intact — because transparency would threaten the revenue streams of the system’s most powerful stakeholders.
Congress
Regularly kills bills requiring price transparency because the industry lobby has deeper pockets than the average American desperately trying to afford insulin.
This isn’t a glitch.
It’s a business model.
The Double Standard: Your 401(k) Must Be Honest — Your Hospital Bill Doesn’t
Here’s the punchline:
**SOX regulates the companies that invest your money.
The ACA does not regulate the companies that take your money.**
Public corporations must justify every line on every invoice.
Hospitals can charge $7,500 for a $300 MRI and no agency demands an explanation.
If you misapply a discount at a car dealership, an auditor shows up.
If a hospital charges 31 times more for the same procedure in the same state, nobody cares. 91% of healthcare is government subsidized, so why would government, or any regulatory system care to self report? Meanwhile:
If you run a public company, your pricing must be:
- Transparent
- Published
- Consistent
- Auditable
- Justifiable
If you run a hospital, your pricing must be:
- Opaque
- Variable
- Negotiated secretly
- Wrapped in legal exemptions
- Backed by federal programs
- And immune from competition
This is not healthcare.
This is cartel economics with a stethoscope.
The Bottom Line: Regulation Protects Them, Not You
SOX and Dodd-Frank were passed to prevent financial disasters.
But the healthcare system is a financial disaster — one we live with daily — and Congress refuses to apply the same transparency standards.
Because if Americans actually knew what healthcare costs?
The system would collapse under its own absurdity.
The Government-Medical-Industrial Complex thrives because:
- prices are hidden,
- profits are protected,
- regulators look the other way,
- and patients have no choice.
Until healthcare pricing is regulated like every other essential industry, the exploitation will continue.
That is my viewpoint, now what can we do to solve the healthcare corruption crisis? Leave your ideas in the comments, share this post, or ask your representative what they are doing to increase medical billing transparency. We all pay, directly, indirectly, and heavily for healthcare.
Sources & Receipts
Price Variation Report (referenced data for MRI, colonoscopy, hip replacement pricing)
https://www.patientrightsadvocate.org/reports
Lawrence Van Horn & Art Laffer — “Informative Potential for Price Transparency in Healthcare: Benefits for Consumers and Providers” (HMP Policy & Innovation, 2019)
https://hmpi.org/2019/10/09/informative-potential-for-price-transparency-in-healthcare
CMS Hospital Price Transparency Rule
https://www.cms.gov/hospital-price-transparency
HHS COVID-19 Provider Relief Fund — Payment & Reporting Data
https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html
SEC — Sarbanes-Oxley Act (SOX) Overview
https://www.sec.gov/spotlight/sarbanes-oxley.htm
Dodd-Frank Wall Street Reform and Consumer Protection Act — Summary
https://www.sec.gov/spotlight/dodd-frank-wall-street-reform
FDIC — 2008 Financial Crisis Historical Archive
https://www.fdic.gov/resources/resolution-authority/2008-crisis/index.html
Federal Reserve — Timeline of the Financial Crisis
https://www.federalreservehistory.org/essays/global-financial-crisis
Ben Roche writes opinion editorials on his Substack at https://bensviewpoint.substack.com/
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