I don't know about you, but I am never thrilled to go to the doctor.

Needles, sickness, injuries, and that crinkly paper they make you sit on.

But the worst part is the inevitable headache of trying to pay for the visit.

The American medical billing system is like putting salt in our metaphorical wounds.

It's standard to have no idea of what a procedure will cost when we agree to it.

Then, six weeks later, this piece of paper written in an alien language appears to inform you that you owe such and such for such and such, and how would you like to pay for that?

If we want to engage productively with our healthcare system, we need to have a basic understanding of what's going on behind the scenes.

Only then can we protect our health as well as our pocketbooks.

♪ When measured by GDP, the U.S. is one of the wealthiest nations on earth, so it's understandable that we, as a group, might pay more for the healthcare we receive.

But when you compare what we pay as a ratio to our GDP to other similar countries, we are an outlier.

We pay far more for our healthcare than the size of our economy would suggest.

There's no shortage of theories as to why that is.

Issues like defensive medical care, bloated administrative costs, higher doctor pay, and drug prices all contribute.

But when you start sorting through the mound of complicated data, it's really hard to single out a clear villain.

Many healthcare experts believe that the main reason our spending is so high is because the price is high.

Don't get that confused with the cost.

The cost of a good is the expense required to make and provide the service.

The price is the amount that the customer is willing to pay for it.

In layman's terms, the cost of our healthcare actually isn't unreasonably high, but the price markup is.

Normally, a seller's market occurs when demand exceeds supply.

This results in an increase in competition, which drives up the prices and allows the bulk of the pricing power to be wielded by the seller.

Theoretically, a free market economy could balance this by allowing consumers to not buy the product outright or buy their products elsewhere; and this happens to a degree in the form of medical tourism.

But for most of us, flying to Mexico or Thailand for a medical procedure simply isn't an option.

And as for foregoing medical care completely, mm, good luck with that.

A critical factor in keeping it this way is a criminal lack of pricing information.

Think about it.

When do you finally know how much your care costs you?

Not till weeks after you've already bought it.

We also typically don't pay for it directly ourselves, thanks to insurance companies.

Medical pricing sheets are traditionally disclosed only to them and not the consumer.

Imagine if you wanted to buy a house, but you couldn't see the listing price before closing.

Only your realtor, working on commission, is allowed to see the price in advance.

That's basically what's happening here.

The way other wealthy countries, even those with large private insurance companies, have dealt with this is through government regulation, but for the most part, the U.S. has completely stayed its hand.

Stanford economist Victor R. Fuchs said it this way: "Governments usually eliminate "much of the high administrative costs "of insurance, "obtain lower prices for inputs "while keeping tight control "on the number of specialist physicians "and expensive technology.

"In the United States, "the political system creates choke points "for diverse interest groups to block or modify the government's role."

Suddenly this whole mess and political hullabaloo makes a lot more sense.

The one large exception to this is Medicare, which is a government program that covers medical costs of those over 65 and some younger folks with disabilities.

This accounts for just under 20% of the entire U.S. population.

So it shouldn't come as a surprise that when you have that much medical care to negotiate for, you can create some serious leverage.

A recent study showed that the same service at the same facility would have cost a privately insured person 2 1/2 times more than one covered by Medicare.

Now, other than voting and calling our representatives, which you should do, we don't have a ton of individual sway when it comes to changing things at the top.

But we do have more power than we think when it comes to the bills that show up in our mailboxes.

This is Kiyera, and she's what you might think of as an extreme couponer when it comes to medical costs.

Let's see what we can learn by following her.

When she got hired at her new job, she sat down to compare the costs of the three separate plans available to her.

She was a bit confused as to what each plan actually covers, so she called her HR department for a little guidance.

This is a critical step.

Though medical benefits are really important to people, most don't actually understand what their policy does or doesn't cover.

How can you effectively use something you don't understand?

Now it's time to make a plan for urgent and emergency care.

Urgent care facilities are for medical needs that can't wait to see a physician, like a dog bite, but aren't immediately life-threatening.

The ER should be used for life-threatening needs.

These visits can get expensive in a hurry, with the average ER visit clocking in around $2,000.

Kiyera checks out Google Maps and calls two to three places that are closest to her house to see if they accept her insurance.

Now they're entered into her phone so she can easily speed-dial them if anything should happen.

Third, Kiyera never accepts a medical bill at face value.

Every time she goes to the doctor for anything more than a checkup, she calls and asks for an itemized bill just to see if the things she's being billed for actually occurred.

Billing errors are frighteningly common.

Experts estimate medical billing errors to be present 75% to 80% of the time.

Fourth, she actually shops around for her care.

For nonurgent procedures, she spends some time on websites like Healthcarebluebook.com or Fairhealth.org.

These sites are like the Kelley Blue Book for medical care, giving her average prices for things like tests and procedures.

Kiyera compares the prices and even calls the hospital ahead of time to settle on it before she walks in the doors.

That's right-- you can actually negotiate directly with a hospital ahead of time.

Sometimes she finds herself looking at a bill for a procedure she couldn't shop for.

But many larger institutions, like hospitals, actually have medical billing advocates on staff to help patients, but you usually have to ask for them.

And if Kiyera is experiencing a financial hardship or was without insurance for a season, simply mentioning this can help knock down the price.

There are even independent third-party advocates that you can hire yourself, which may well be worth it if you're facing an especially large bill.

If navigating all this feels overwhelming and unfair, you're right, it is.

Our medical system can leave us feeling powerless and lost, but just because we might feel powerless doesn't mean it's totally true.

If the system treats us more like consumers and not patients, then let's take every opportunity we can to be the savvy shoppers we know we can be.

(both) And that's our two cents.