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Saturday, March 11, 2006

The Robber Barons Live! (In our hospitals)

I'm starting this blog while I am boiling mad. Perhaps I will cool it by Monday a.m. but probably I'll just get hotter and hotter. Stay tuned.

Recently I went to a local Richmond hospital, Johnston-Willis, for what must have been just about the simplest surgery that could qualify as a surgery - a laparoscopic gall bladder removal in conjunction with repair of a belly-button hernia. I had skilled doctors, the surgery went well, pain was minimal, there were no complications, and, had I been a bit younger (I am 77), I would have probably come home the same day. Most patients with this surgery do. In addition this treatment and hospital stay did not cost me a cent. Medicare (read taxpayers) and Anthem (read insurance subscribers) picked up all of the tab, including the several doctors who participated on one level or another.

(So, it is past that Monday and I have cooled off a bit; however, that will serve to just make me write more clearly. I hope).

What I do want to emphasize is that this little adventure cost someone (you, your aunt, your child, your friend?) $30,000, and that is just for the direct hospital costs. Doctors, anaesthelogists, and others added to this total considerably.

It is no news to anyone that health costs are just zooming out of all reasonableness. We all seek to blame someone but who shall that be? I pretty much don't put any blame on the surgeons, even while admitting that they all like to live pretty well. Their skills and hard work are, in many cases, priceless.

In fact as I pursue this subject I find it very hard to pin down why such a minimal surgery should cost so much. My inclination is to put the blame on all the peripheral people and institutions who collect money but do not personally do anything. This would include the manufacturers of hospital equipment, the salesmen of all the new and often life-saving technology, the makers of medicines and drugs, the stockholders who are doing better than average as investors, the drug salesmen (I call them drug pushers), the distributors of the necessary supplies, and last and most responsible, the drug and hospital advertisers.

Most of you are too young to remember when one had to seek out a doctor who would diagnose the case and then direct the taking of a specific drug. Doctors, hospitals, and drug makers have now joined the commercial rat race after the almighty dollar. Doctoring used to be a prestigious occupation whose practitioners were often the most highly thought of individuals in the community.

Now a doctor's time is spent largely dealing with drug salesmen, administering his practice, interviewing new employees, dealing with myriads of government regulations, and trying to comply with ever more complex insurance rules. Oh, yes, he has to give some time to patients, too. All of this, of course, costs money.

And the cost is driven by the fact that there is a captive source of ailing patients who have no choice but to see a doctor or seek admission into a hospital.

Whether you are a bleeding heart liberal or a compassionate conservative you must certainly see that this country's steady march towards socialism counts for a big portion of increasing costs. Hospitals have to include the cost of government mandated medical care to many welfare patients when they are preparing the bills for those who can pay or are insured.

I am sick and tired of all the media attention to those "forty million uninsured" or whatever the number has risen to today. This paints a picture of all those poor people lying in the streets holding up a shaking hand and crying "Alms, alms for the needy!" Less you think I am totally hardened to this plea, please consider this. These forty million do not need or want insurance. What they want is medical care and this they get, the cost being borne by those who can pay or have insurance (or who pay federal taxes).

I have seen very little in the media about a poor person being refused medical care because he has no insurance. Admittedly, the quality of that care may suffer, the lines may be long, the care-givers often overworked and unsympathetic, but medical care is provided, even if not as desirable as it might be. This provided care is perhaps the biggest single factor pushing health care ever upward. It does cost to run an ER which is where many of the uninsured get their routine doctor and hospital care and this cost the pertinent actuaries have simply put into the billing of individuals and insurance companies.

Doctors and hospitals automatically inflate costs knowing full well that either Medicare or private insurers will give them less than they ask for. As a for-instance if a doctor thought $200 was a fair charge for the service provided he will price the service to Medicare at $300. Medicare recognizing overcharging for what it is will only give the doctor $190. Negotiation will take place, the doctor (actually his business office person), will convince Medicare that the charge truly should be at least $250, and Medicare working with government money (usually under a contract) will fold and authorize payment of $210.

Everyone is happy, including the doctor who gets the extra $10. A similar round of negotiation takes place with insurers. All this activity is mostly conducted by low level staff members or clerks, as we used to call them.

Can anything be done about all this? Probably not much, as price fixing and such have never worked in this country. If we could pin this all down to just one element perhaps congress could do something; however, it is the sum total of all these elements that make a little ol' minor surgery cost more than a decent new car.

And you know something? As I said in a previous post all doctors, and hospitals too, fail us in the long run so we can just hope that we depart this life while still solvent and not in too much debt. After all, some money must be held back to enrich "Digby O'Dell, the friendly undertaker".

Cremation anyone? Green burial anyone?


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