For too many Americans today, the fear of illness has been joined by a second, equally daunting fear: the fear of the bill.

This isn't a recent phenomenon.

Rising healthcare costs have become a constant strain on family budgets and employer health plans alike.

We feel it every time we open a billing statement or get that dreaded explanation of benefits – wondering not just what we owe, but why.

The numbers tell the story. According to the U.S. Bureau of Labor Statistics (BLS), healthcare prices have increased more than 500% since the time I founded Susan G. Komen in 1982.

In 2024 alone, according to a recent Newsmax report, total U.S. health care spending rose to an astonishing $5.3 trillion — up 7.2% from the year before — driven by escalating prices across the system. That level of growth is unsustainable for families, employers, and taxpayers alike.

A key reason costs are spiraling isn't just the care we receive; it's the way hospitals bill for that care.

According to independent health researchers, hospitals account for nearly 40 percent of the growth in national health spending in recent years, and part of that surge stems from billing practices that sometimes pad costs rather than reflect the services actually provided.

When the system charges for complexity everyone ultimately pays more.

A recent analysis by Blue Cross Blue Shield documented a troubling trend: hospitals are increasingly billing insurers — and through them, patients — for more complex care than was actually delivered, a pattern driven in part by a shift in coding and documentation practices.

In some cases, AI-driven "coding intensity" added millions of dollars in charges for routine care, like maternity services, with no evidence that patients received any additional benefit.

This is not an isolated phenomenon, it reflects systemic weak spots in how care is documented, coded and paid for.

Too many providers bill without complete medical records, inflate reimbursements by "up-coding" services to a higher level of severity than warranted, submit duplicate charges for the same care, or lean on opaque facility fees that add hundreds or thousands of dollars for services that look no different than they did a year ago.

These practices may sometimes arise from sloppy processes — but when they persist across the system, the effect is the same: inflated costs that are passed on to consumers.

A recent investigation by The Washington Post detailed how routine scans and brief procedures are generating five-figure bills for patients, largely because of opaque "chargemaster" prices.

Even when insurance covers a large portion, patients are often on the hook for coinsurance tied to high list prices, sometimes leading to significant out-of-pocket obligations.

These billing distortions don’t just hurt individuals, they ripple outward.

Insurers, faced with higher hospital bills, must collect higher premiums to stay solvent.

Employers see their benefits costs climb, cutting into wages and hiring.

Taxpayers pick up the tab through Medicare and Medicaid. And through it all, lack of transparency and accountability leaves patients in the dark, without the basic tools to compare prices or question charges.

Gallup recent found that roughly one-third of respondents — the equivalent of more than 82 million Americans — said they have made at least one trade-off with daily living expenses to afford healthcare.

From a consumer protection standpoint, we cannot wait for perfection to demand accountability. We need stronger enforcement of price transparency rules so that families can see and compare costs in advance.

We need tougher penalties for fraudulent or deceptive billing. And we need better systems that ensure reimbursements reflect real, medically necessary care.

To get there, we must start with accountability: rooting out coding abuse, duplicate charges, and billing without documentation.

Doing so would bring down costs for everyone: lower premiums, lower out-of-pocket expenses, less financial stress for families, and fewer dollars wasted in a system that should be about health, not hidden charges.

Nancy G. Brinker is the founder of The Promise Fund and Susan G. Komen, and served as U.S. Ambassador to Hungary and Chief of Protocol of the United States. To read more of her reports — Click Here Now.