The Ranter

The story everyone tells: Colonial India had a cobra problem. The British put a bounty on dead cobras. Indians started breeding cobras to collect the bounty. The British canceled the program. The breeders released their now-worthless snakes. And the colony ended up with more cobras than when they started. It is the canonical example of perverse incentives. The phrase "Cobra Effect" was c...

Last week the FTC forced Ticketmaster to show the full price upfront. They complied. Which, in Ticketmaster, means the mugging now comes with an itemized receipt. The advertised price is just the bait price. Junk fees, drip pricing, resort fees, processing fees, "convenience fees" that are anything but. Markus Grant breaks down how the architecture works: catch you when your credit card...

Same doctor. Same room. Same forty-minute appointment. Bill comes in 50% higher than last time. Why? The hospital bought the doctor's office. Rewrote the paperwork. The same room is now a "facility" and you get billed for being inside it. Markus Grant breaks down facility fees: the administrative reclassification that adds 40-50% to your healthcare costs without any change in servic...

American hospitals maintain "chargemaster" prices: fictional rates that bear no relationship to actual costs or insurance-negotiated rates. A procedure that costs $400 to deliver gets negotiated at $800 for insured patients and billed at $3,500 to the uninsured. The 27 million Americans without insurance pay 8.75x actual cost. When you can't pay, your debt gets sold for 1-4 cents pe...

In 2015, Martin Shkreli raised the price of Daraprim from $13.50 to $750 overnight. Same molecule. Same factory. Same patient population. The only thing that changed was who owned the company. The healthcare industry called it an outlier. The architecture says otherwise. Markus Grant maps the system that lets one company buy an old drug and 50x the price the next morning. Pharmacy benefit managers...

In 2023, ProPublica revealed that Cigna's PXDX system reviews health insurance claims at an average of 1.2 seconds per claim. One medical director denied over 60,000 claims in a single month. 90% of these denials get overturned on appeal. Only 0.2% of patients ever file one. The architecture is the story: algorithm flags a diagnosis-code mismatch, physician signs off in 1.2 seconds, claim den...