Okay, I have to admit some vanity here. I hesitated to post this because, well it is gross and there is a stigma around having these things, but every once in a while I get a staph infection called a "boil" in one of the hair follicles along my neck. This runs in my family. My father frequently had them. My brother frequently has them. In the last few years, I've gotten one or two a year. Warm water, antibiotic cream, a few days of pain and they are gone. It is basically like having an atomic zit.
Well in June, I got a really bad one and it abscessed. It grew in the matter of three days to be the size of a golf ball (4cm x 4 cm) and it was hard as a rock and not showing any signs of healing. The placement was right at the base of the neck, which basically meant right on a bunch of nerves that went throughout my body. I was in tremendous pain. So I went to my doctor. He sent me directly to the emergency room and 5 hours later I was on morphine and ativan having my neck operated on.
I bring all this up because what happens next is what is wrong with the US. Because of the nature of the infection and its proximity to my brain and my spine, it was important to rid myself of it as quickly as possible. It was also important that I not have the wound seal over the infection before it drained completely. So not only did I have to go to the hospital to have it removed, I had to return to the burn unit twice to have it dressed. The burn unit was the best place because preventing infection in severe burn wounds is extremely important so they have the right tools and techniques.
Cost for this? Well I don't think I have all the bills yet, but so far it is $3500.
Now I know there are some unusual costs involved, but lets face it, with the exception of the drugs, most of what was done was a sophisticated version of what mom's do all the time. $500 I could accept, but $3500 is outrageous.
Why so high?
I have some speculations.
1. I'm not going to be able to pay this amount, so it is a high charge to cover people like me who can't pay. The next person with an atomic zit will have an insurance company pay the atomic price and it will cover my costs as well.
2. Because they can. There is no regulation of costs only some negotiations with Medicare and HMOs. If you are going into negotiations on price, you put your bid high so that the resultant final offer is higher.
3. Technological necessity. My guess is that there were instruments at the doctor's office that could have accomplished pretty much the same effect but the fancier stuff was at the hospital. Okay, this may not be as pertinent in this case as it often is, but I still think this was a little bit of overkill.
4. Regulation by the threat of malpractice suits. My doctor would not touch the thing, other than to measure it. His stated reason: potential infection means someone more qualified than him needed to address the wound. Translation: "I'm afraid if I open it up and treat it and you get a more severe infection of the brain or spine, I will be sued." In fact, when I called and asked if I could avoid the $230 per visit follow-up to the burn unit (yes you read right, I am being billed nearly $500 for having my wound redressed twice -- this was a clean it out, drain it and re-bandage it procedure that took 10 minutes. Of course, it was 3 hours of my time because I had to admitted to the hospital.)
This is a mess and a $3500 bill for this minor problem is a perfect example of why it is a mess. US emergency rooms are the current health care program in the United States. My problem was only one of dozens of people who didn't have emergencies but had problems that a local clinic would have taken care of in Canada in less time, for less money with probably better results because the 5 hours of exposure to other people's diseases would not be part of the bargain.
I'm so tired of the damn "debate" going on in Washington.
The opposition says that we should have choices. There were no choices for most of the people in that room. Even the ones with insurance were stuck with being exposed to every respiratory ailment prevelant in the city.
The opposition says that we should not have to supplement other people's health care. The bills are high because those who are insured or on Medicare are supplementing those of us who are not insured and will either be a deadbeat, file bankruptcy or turn to a charity that will only be required to cover a fifth of the bill.
The opposition says that it is a question of quality. This is not high quality care. This is care by fear. Fear of the HMO. Fear of the deadbeat. Fear of the lawsuit. Quantity is not quality. US emergency rooms are full of people who cannot afford to go to a doctor and full of people who are sent there because doctors are afraid to practice. Hospitals are not the best place for health care. A large amount of sick people in small places equals breeding ground for major communicable diseases. We are one major flu epidemic away from breaking down the US health care system and the ER will be a primary place for that epidemic to spread.
The only thing that is keeping US healthcare from being universal and being of the highest quality is greed.
HR676 has been introduced in the US House of Representatives every year since 2005, including Jan 2009. It is an elegant bill that is only 30 some odd pages long (current debates are over a bill that is around 870 pages long), but it would revolutionize our health and well-being. AND it will never pass unless our politicians find political will because its passage would get rid of insurance companies and HMOs and would curtail the obscene profits of pharmaceuticals. The reason that the bill that will be considered is so much longer than HR676 is simple: the bigger bill is hiding greed in the form of political compromises.
HR676 would turn the Federal government into a single payer of health care for all Americans, including anyone living in the United States at a given time. Instead of having 25% of phyisician's practices and hospital administration being devoted to sorting out all the different plans that patients use to pay for health care, the billing process will be streamlined. Huge savings would be seen on a system level. One system of payment = one process to administrate.
Current versions of "healthcare reform" are trying to set up "also payers," making the government a player in the market place. This is inefficient and expensive. Efforts to not step on the profitable toes of HMOs will lesson opposition to the bill, but it will be doomed to fail. It will be one more system that every doctor's office and hospital adminstration will have to learn to bill. It is doomed to add expense.
The problem is that health care has to be addressed as a public issue. But it is thought of as personal choice in the United States with little regard for the big picture. This is a spiraling mess and 870 pages of more spiraling mess is not going to fix it.
Only a radical change of heart will make this mess go away. I'm not sure I'm going to live to see that day in the United States.
