“If there had been a sign on the wall that said there was a facility fee, I would have gone home.”

It’s the closing quote in the medical billing investigation published in the Press Herald on Sunday, and it says it all. Portland resident Sean Dundon, one of nine Mainers profiled as part of the reporting, was slapped with a $510 “hospital facility fee” after a visit to Northern Light Mercy Hospital to have a kitchen injury – Dundon did not require stitches – cleaned and dressed.

Dundon – who was ultimately unsuccessful in his attempts to appeal the charge and, with a high-deductible insurance plan, had to cover the cost himself – is far from alone in believing the American system of medical billing to be “intentionally obfuscating and confusing.”

Reporter Joe Lawlor spent three months investigating the extent of the dysfunction as it has recently played out in the state of Maine. Nothing lays the shadowy, stressful nature of procuring and paying for health care in America as bare as the account of the people who come up against it and pay the price, more than 100 of whom brought their horror stories to the paper.

The long-running dispute between Anthem and MaineHealth – settled just last week – exemplified the tension and ever-present risk of cost-shifting in the market. MaineHealth said Anthem denied full payments for services, while Anthem said MaineHealth was overcharging, particularly for medications. The patient was, as usual, caught somewhere in the middle.

With an arrangement as fraught as this one, the instinct is to identify and pursue dramatic system-wide reforms. Most commonly promoted is a single-payer system, where the government would set and manage payments, paid for by taxation, in a structure that would mostly rule out insurers.

Supporters look at it as a way out of a very messy status quo; detractors think of it as a risky proposition that could lead to health care being underfunded. In all the debate over the years, no state has succeeded in getting a proposal over the line and no coherent federal vision has emerged.

While that doesn’t mean it’s not worthwhile to contemplate sweeping overhaul, immediate efforts would be better directed toward insisting on transparency in the existing system. Until we can altogether change the way we finance health care, we must simplify the manner in which it’s financed.

Regulating and capping charges; supporting patients when it comes to inspecting and fighting bills, and requiring upfront disclosures on costs and coverage, where they can be offered, would go some distance toward improving the system we already have.

To say this is simpler and more deserving of our near-term energy is not to diminish the immense challenge of even modest reform within the existing framework. The just-passed Inflation Reduction Act contains health care provisions that took decades to get over the line.

Medicare will now negotiate prices for high-cost drugs (Americans pay between two and three times what citizens of other countries pay for prescription drugs, more in many cases). The legislation also brings in a $2,000 out-of-pocket cap on prescription drug costs in 2025.

Elsewhere, federal guidance on arbitration of so-called surprise medical bills (under legislation known as the No Surprises Act) was issued just last Friday.

Maine would do well to emulate places like Connecticut, which is among the states that have been proactive in cracking down on the insidious creep of facility fees, requiring clear disclosure in advance and limiting and banning facility fees in certain contexts.

This kind of attention to detail brings needed uniformity and definition to a deeply unpredictable and frequently incomprehensible landscape.

Without losing sight of the long game – up to and including the possibility of a whole new system – getting some figurative signs up on the wall seems a reasonable place to start.

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