Thursday, February 21, 2013

Cost of Medicine: Let's Define the Problem Properly

By Rich Kozlovich
Today I came across an article by Steven Brill entitled, “Bitter Pill: Why Medical Bills Are Killing Us”.  The article is well done and is the kind of article that can really rile someone up because it finds us a villain.   American medicine!
He starts out discussing;
“a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
He goes on to explain that they had started a new business recently and couldn’t afford the costs of comprehensive coverage, which was $469.00 per month.   High, but I almost choke when I hear of people paying over $10,000 a year in premiums.   All of which seem obscene to me.  It turns out that the hospital they wish to go to  doesn’t take “discount insurance” that only pays $2000.00 a day hospital costs and are told that;
estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance.
Interesting article, and well done, and he outlines my pet peeves about the indecipherable medial bills with the seemingly outrageous costs.  But no one really believes the costs cited on the bill for some pill was where the real costs lie.  Remember that nurse that woke you up in the middle of the night to give you a pain pill….she was there for eight hours, not just the five minutes that it took to give you that pill, and there was a large support staff on duty all night long just in case they were needed.  That all costs money!  Do some of these doctors and administrators make obscene amounts of money.  I think so, but I also think that athletes and entertainers and a whole host of other people are grossly overpaid and have nothing to do with saving lives.  Who should decide how much people make?  That really is a slippery slope, isn't it.  However, I say that if we are going down that road let’s start with legislators at all levels of government.  If they are to be true public servants then let them work for free.  That's one I could get on board for since then they would stay home,  go to work and stop making laws and passing new regulations that are a major part of the problem.   
As I said, interesting article but he directs us to the wrong answer.  As I read this it is clear to me that he points the finger of blame at the American medical community accusing them of greed.  Is that a component? Of course, but that isn't the source of the problem.  
About 35 years ago my mother, who loves unions and thinks FDR was the greatest president that ever lived, said that the worst thing that ever happened to health care was the unions made the companies pay for health insurance and ultimately it was going to kill us all financially.  And that was 35 years ago when the cost of insurance was not that bad. 
Recently, just before I went in to have my knees replaced, I developed a sore throat and went to an Emergi-care.  I got into a conversation with the attending physician about why I didn’t have a primary doctor.  I explained that I sort of did, and then told my story.   I only have minor health problems like a sore throat occasionally so I hadn’t been to him for ten years.   When about two years ago I completely tore the meniscus in my right knee I called and tried to make an appointment to get a shot or anything to relieve the pain.  His receptionist, who as it turns out is his wife, told me I wasn’t his patient.  I told her that I was for many years.  She asked when I was there last and I said about 10 years ago.  She got indignant and said they don’t keep records that long and so I wasn’t his patient any longer - which I found to be a really strange way of doing business.  We went back and forth with me saying that in spite of the long span between visits I was still his patient and she should start another record.   All the while she keeps indignantly tells me that I wasn’t his patient.   I decided she was nuts, agreed that I wasn’t his patient and hung up. 
Pest control and medicine are almost identical business models, and for those of you who just snorted with indignity - it is - so get over it.
In medicine the practitioner (doctor) examines the patient, identifies the problem then determines a course of treatment and preventative care.   In pest control the practitioner (exterminator) inspects the property, identifies the problem then determines a course of treatment and preventative care.  The only differences are the costs, the problem being attacked, the tools used and the education of the practitioners.  But the business model is the same – medicine is a service industry - so get over it, and if conducted myself in that manner I wouldn't have any customers. 
I went on to say to the doctor that I wondered where all this rudeness comes from.  He said the insurance companies.  I laughed thinking he was joking saying; “the insurance companies force them to be rude?”  He said no, but they are going to pay the bill no matter how rude they are, and no matter how much you complain, they are still going to pay the bill.   
"It" comes down to this.  If someone is paying for "it" someone will charge for "it", whatever "it" may be.  The problem is threefold.  First, the unions got the companies to pay all the insurance costs, starting an upward spiral in terms of costs at every level, including what the insurance companies would be charging.  Then the government got involved telling everyone how to do everything and about the same time the attorneys got on the gravy train with lawsuits - and most importantly - no matter how insane it was all becoming someone else is going to pay for it all.  Everything my mother predicted 35 years ago had come true. 
Now the problem has been properly identified - so now what?  Now I want someone to explain to me how you are going to get everyone to accept the idea that someone else shouldn’t be paying for their health care after all these years.  I will say this.  When the day comes that they all have to compete for less dollars then things will change, and not before.  What I’m afraid of is that the economic disaster I see on the horizon will be the impetus for that change.  That is a frightening thought. 


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