There's a simple answer—it can't. Or at least it shouldn't. There's no way a simple throat swab intended to determine whether a patient has strep should cost more than a few hundred dollars (and in any other rich nation, it wouldn't). But in our health care system, the combination of doctors and labs and private insurance companies, has figured out how to make it so ridiculously expensive to get very basic care. Alexa Kasdan is the patient in question.