Thursday, October 04, 2007

The $2000 bag of saline.

Over on HBO, like other places in cyberspace or the local coffee shop, there is a good deal of discussion around the issue of health care. Between the unveiling on Hilary-Care redux bringing the topic back into the presidential race or the recent veto by President Bush of S-CHIP, it seems to be forefront in our collective minds right now. The debate rages between those who believe that our system of health care is the greatest in the world and the intrusion of government will only ruin it to those that believe that we are mired in some sort of dark age of humor treatments and leeching and that we need government to swoop in and safe us all. The truth is, we are somewhere in between. Our medical system is still the best in the world in some respects, high end surgery and expensive cancer treatment, and bottom of the pack in others, ER care and primary care services.

Of course, this debate is rather remote for most of us who have insurance and are healthy. It isn’t until you get sick and have to interact with health care system that you can see that there truly is a problem.

Recently, my wife got sick. Nothing life threatening, just a simple flu that had her bed ridden for a week where she was unable to go to work, eat much of anything, and left her in a general state of misery. After about 6 or 7 days of dealing with it, she finally gave in and decided to seek assistance from our much vaunted medical establishment. We made an appointment and went to see a doctor at one of the various Swedish operated medical centers around Seattle. Having insurance, we went to the upstairs clinic with an expansive waiting room littered with the latest magazines and a separate play area for the tykes. We didn’t wait long before we saw a fresh young doctor who, after 10 minutes, decided that the case might be serious and he sent us down the ER for tests. We left the posh upper floor of the hospital where the clinic resided next to a state-of the-art heart institute with plush leather chairs, new carpet smell, and crisp metal signage to the bowel of the hospital. The ER was quite the contrast. It was old, dingy, there was a faint smell of urine in the waiting room, and the all the signs were simple printed pieces of paper. Here in the ER, we waited for three hours before being seen by a nurse and subsequently, a few hours later, a doctor. The treatment cumulated in a saline IV, a couple tablets of potassium, and a prescription.

The whole ordeal took about 8 hours. Of course, about 20 minutes of that was spent with doctors, about 30 minutes with a nurse, and the rest was just waiting. So, over 7 hours of waiting for 50 minutes of healthcare. We recently got our bill and before insurance that total was over $2,000. Of course we pay only a fraction of that, around $600, but I’m puzzled by those that say that our system of healthcare is okay when it takes 8 hours and $2000 to administer an IV of saline. I ask how much lower could their standards be? Do they really fear government that much that they would choose this over upsetting the status quo?

Of course, I’m sure there is a lot more to this $2,000 bill than simply the IV and the 50 minutes of labor we saw. There are behind the scenes tests, administration, and the Dr and staffs do work on patient files, etc… And, as we were setting in a bed in the hallway since all the rooms were full, we could see that nurses and doctors spent a lot of time dealing with a computer problem as they all stared puzzled at the digital board (a 60 inch plasma on the wall that listed all the patients in the ER, etc.) and said, “Can someone call the EPIC people, the system isn’t working right.” Of course, the computer isn’t a patent, but I’m sure the patients were charged for the time. And then, of course, there are overhead expenses baked into the bill and the fact that bill is marked up to cover non-payments and shortcoming from the Medicare system. In fact, that $2,000 bill probably really doesn’t have any connection to cost realities of treatment at all.

Regardless of how academic the $2000 bill is, it doesn’t really matter because the hospital knew it would probably never see that much anyway when it created the invoice. It knows that when it sends it to my insurance carrier or to Medicare that the bill will be negotiated down (usually subject to previous negotiated terms between the carriers) to a lower amount. In fact, the only person who would ever have to pay the full $2000 is someone who had no coverage at all and, in all likelihood, would be the person in the system the least likely to be able to afford it. As it was, the insurance company paid their portion, the hospital reduced the total bill by a similar portion, and we were charged the difference, the $600 bucks.

Now, for us, $600 bucks isn’t pocket change, but we can pay it without any change in our daily lives, but what about those who are not so fortunate. I can only imagine someone who lives pay check to pay check that probably doesn’t get sick day and how they would be in a similar situation (if she had health insurance). They might be faced with a $600 dollar bills in addition to a week from work without pay and now they have to make a choice between the mortgage and their hospital bill. Something as simple as a bag of saline could throw a life, already on the edge, into havoc. This is our vaunted health care system, should something not be done?

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