Category: Medicine

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The $1,200 Hockey Stick

“Total bill: $42,156.50, covering emergency surgery, scans, laboratory testing, and three hours in a recovery room. His insurer has said it will pay him about $8,184 (7,260.40 in Swiss francs), which is double the procedure’s price in Switzerland. This left him to cover the remaining roughly $34,000.” NPR

Presidential Candidate Tim Scott says America has the greatest healthcare system in the world. Yet this same procedure would cost about 1/7th the price in Switzerland, which is not exactly a backwater. Wait– no, it’s 1/10th (the insurance company voluntarily paid double). This is Switzerland- not Thailand or the Philippines (not that there’s anything deficient about health care in those countries).

If you took anything produced in some other country and gave an American company 10 times what it cost in that country and said see if you can produce one that’s better, well, heck, yeah, I think they probably could. They could certainly equal it. So if an American company could produce, say, a hockey stick for $1,200, I guess they could say it was the greatest hockey stick in the world and they might be right. If you want hockey sticks to cost $1,200.

Does that make the American company “the greatest”? I would argue that if it cost that much to make a hockey stick when everyone else knows how to make one for 1/10 the cost, they might be the worst.

And I’ll bet those sticks would break just as quickly as the $120 Canadian sticks. In terms of health care results, that is demonstrably true (life expectancy in the U.S. is lower than most other developed countries, including Canada).

The most depressing part of the story is the long list of itemized charges on this guy’s bill. It’s like this giant mechanical octopus with 100 arms wrapping itself around you and sucking as much blood out of you as it can. You’ll live, but those suction cup marks will be around for a long time.

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Vampires of the Health Care System

The New York Times reports on a woman named Kim Little who had a tiny thread-like spot on her cheek and asked her doctor to check it out. The doctor thought it was harmless but an assistant at her dermatologist’s office thought it might be cancerous. She had a biopsy done: it was indeed cancerous, but it was the kind of cancer that is easily, routinely treated, with complete success. Except that she fell into the hands of the AMERICAN MEDICAL SYSTEM, which seizes those with insurance or money or assets with powerful stainless-steel talons and bleeds them drier than Dick Cheney’s heart.

She went in for treatment. The spot was removed! Success! Except that it wasn’t. All that was required was the removal of the spot and a few stitches. Local anesthesia. And then her grandmother could have stitched her up. Ms. Little told her doctor that she was not concerned about a scar. Tough luck. The doctor who removed the spot refused to do the stitches and sent her over to a specialist in a different building in the same complex. The specialist ordered nurses to prepare the patient to be bled dry: she was undressed and put in a bed and given an IV bag, which undoubtedly cost $600 or so. An anesthesiologist put her under, for $1,000. The plastic surgeon robbed her of $14,000 but left a scar anyway. The hospital fanged her for $8,774.

Now, a vet could very well have performed the entire procedure almost as well– if not better– for a hundred bucks or so. Wait a minute– that’s silly. Really, it should have cost about $50, given the effort and skill required. All right– $75. We’re talking about two or three stitches here on a patient who made it clear she was not concerned about a possible scar.

You’re thinking: you would trust a vet with cancer? On a human being?

I’m thinking: you would trust the three or more medical personnel who charged her thousands of dollars for a medically simple procedure that should not have required more than ten minutes to perform?

Yes, I would trust the vet. Maybe not with liver cancer, or a brain tumor, but with this spot? Yes, I would. Just as I would trust the cancer drugs that cost about 1% of the cost to humans when used on an animal. Same drug.

But dogs don’t carry health insurance.  Maybe that is why treating a dog’s illness is so much more economical than treating a human’s illness.  (On the other hand, the vets seem to be catching on.)

It is interesting that a perfectly competent individual with appropriate training and equipment could easily have performed this procedure just as well as the doctor did. It is in the nature of the American health care system, however, that nobody is going to start a business that performs this service cheaper than hospitals. Nobody is going to be allowed to train in the specific skills needed without also having to be sucked into an entire program of training which has the desired collateral result: complete absorption into this profit-generating system. Even a nurse or doctor who trained in the existing system could never get away with opening a practice that advertises low, low prices.

Why not? What would happen? He or she would not have any customers. The customers come from Health Care Plans, Groups, Employers, Government. They start out with connections to labs and clinics, all of whom refer to each other, and none of whom will refer a patient to a cheap, alternative clinic, if there were any. Ms. Little was undoubtedly presented with numerous forms which entrust the key monetary aspects of her treatment to a blind and unfeeling bureaucracy which then proceeds to bleed her dry and expunge any trace of real accountability from the system.

If she sued, or refused to pay, the system would turn her over to a collection agency, which is empowered by legislation to annihilate her credit rating, her assets, and, ultimately, her freedom.

Addendum

How is this story different from a story about a man who takes a gun and walks into a corner store and demands money?

The difference is that you don’t have any money to give the robber, he can’t turn you over to a collection agency to get it.

The difference is that institutional medicine in the United States has developed very sophisticated and culturally rich methods of kicking you in the teeth with documents and forms instead of a gun or a crowbar. The attitude is exactly the same. The greed is the same. The ruthlessness is the same.

Well– wait a minute. I don’t think it is. I think a robber with a gun might actually care if you die during the robbery because he would receive a stiffer sentence if caught.

The doctor and the hospital do not care. They will get paid regardless.

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Repealing Obamacare

It may not matter much in a real election with real people who watch reality TV, believe they are getting a good deal with the Super Jumbo Sized Soft Drink, and hope to win the lottery some day, but the question in mind, for the coming Congressional elections in the fall, is this: which parts of Obamacare are you going to repeal?

I don’t know how most Republican candidates will answer that. They won’t want to. They will not want to go on the record declaring that they will take away insurance for the 5 or 10 million people who now have it who did not have it before. They certainly will try to make it sound like they have a better alternative but even Fox News might occasionally ask a question: what? The answer will be magical thinking: we will find imaginary efficiencies that will produce imaginary care and provide imaginary cost savings for an imaginary future. But, hey, have you seen my new, larger flag lapel pin?

As polls have shown, if you ask the average American if he likes Obamacare, only about 45% say yes. But if you ask them if people should be dropped from their insurance coverage because they develop a serious, expensive illness, or should be denied coverage because they had an illness previously, or if children should be dropped from their parents’ insurance while they are in college or university, a large majority say no. Can the Democrats run on that paradox? If I were a campaign advisor, I’d suggest they start early and hammer their Republican opponents with that question: which provisions of Obamacare will you repeal?

 

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A Parable of How America got Obamacare

You want to go on a trip. You think Hawaii would be great. It’s beautiful and sunny and warm. Lots of people go there.

Your wife says no, no, no, it’s too expensive, and you’ll never get a hotel room. You say, I need a vacation. She says, you do not. Vacations are stupid.

Finally she says, okay, you need a vacation? Let’s go to Alaska. I really want to go to Alaska. I LOVE Alaska.

You book your trip to Alaska, really glad that she finally agreed.  You really didn’t want to go to Alaska, but you compromised, like a good husband.  You put up the money, which is non-refundable, and anticipate your trip.

Then she leaves you.

You go to Alaska by yourself. You think, so what if that b—- left me! I’m gonna have a good time.

Your ship gets locked into the ice and starts to sink. You tell the Captain, are you kidding me?!

He says, what kind of idiot would book a trip to Alaska anyway?

And that is how America got Obamacare.

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The Disappointment of Free Enterprise Healthcare

What an unfortunate result! The Americans, alone in the Western World, decided to boldly embrace an alternative model of health care: free enterprise. There is no government plan, and very little government regulation. In theory, we were told, this would reduce the costs of health care because competition among doctors and hospitals would drive costs down.

It has had the opposite effect. The U.S. has the most expensive health care system in the Western World, and the worst results.

I am genuinely disappointed.  Look at the computer industry, and related technologies:  the bang for your buck has grown astronomically since the first PCs entered the market in 1981.  Today, you get fabulous technology, lavish memory, incredible capabilities, for a fraction of the cost.

Medical care, on the other hand, is absolutely through the roof.

It is also, to be fair, more effective– look at cancer deaths.

Doctors and hospitals, of course, don’t compete.  Just imagine if you had to take your broken computer somewhere and nobody would tell you what it was going to cost to repair, and may not even tell you what repairs are going to be done.  You will get a bill for $40,000.

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No Historians

There are seven members of the conservative bloc on the board, but they are often joined by one of the other three Republicans on crucial votes. There were no historians, sociologists or economists consulted at the meetings, though some members of the conservative bloc held themselves out as experts on certain topics.

NY Times, March 12, 2010.

This is the Texas Board of Education making decisions about text books for millions of students. This is an important decision: these men are entrusted with a serious responsibility. What should our children study in school? How will their perspectives on life be shaped for years to come? How should their education as citizens be guided?

Well, whatever we do, let’s not get an expert on any of the subject areas were are establishing guidelines for. Heavens no.

I wonder if any citizens of Texas realize how close they have come to the 18th century? The only things missing are signs and wonders. Then I wonder if any of them care about how the state is perceived by outsiders. Well, we know the true believers in this movement certainly don’t care. The question is, does Mr. & Mrs. Mainstream care, as they travel through Europe, and identify themselves, and watch people nod and go, “Oh, you’re from there.” Tell me, have you seen any flying saucers lately? Mr. And Mrs. Mainstream reply, “no. Have you tried to open a business lately. Notice how many restrictions there are? How many permits you need? How long it takes to get approvals from the various bureaucracies?”

And the European says, “and how’s your health care?”

 

 

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No Health Care for You!

Health Care
When will Americans finally begin to realize that there is not a single component of the health care industry that benefits from preventing illness? Are you listening, America? THE MEDICAL INDUSTRY DOES NOT BENEFIT BY KEEPING YOU WELL. This is the fundamental, inevitable flaw in a for-profit health care system: the system profits by keeping you ill.

So it is in the interests of the health care system that you are obese, that you don’t exercise, that you smoke, that you drink, that you watch television, that you biggie-size your meals, that you don’t know what’s in the food you eat, that there is radiation and asbestos, that there are wars and civil disturbances, accidents and sickness.

Sure, the health care reforms just passed by Congress will help lots of people. But some Republicans– not very many of them, obviously– and many Democrats are also right that real reform has to start with the entire system which currently focuses on treatment rather than prevention.

Just one example: the makers of Crestor, a cholesterol medication, are crowing that a recent study concluded that healthy people who take Crestor every day (at more than $3.50 a pop) are 50% less likely to have a heart attack than healthy people taking a placebo. Wow. Let’s get all the healthy people on this drug! Now!

A well-paid doctor who received money from AstraZeneca, says, would you let your patient walk out of your office without signing up? Hell no! The only problem: well, only a very small number of healthy people have heart attacks. Only about 1 in 500. So a 50% reduction translates into a difference of 1 in a 1000, of which a large majority will survive the heart attack anyway. But the cost of providing 1000 people with Crestor for a year is over $1 million. Good deal? Then add in the fact that some cholesterol drugs have now been implicated in causing type 2 diabetes. They know that at the time they signed everyone up to a drug you will never be able to stop taking once you get started on it.

The alternative: walk more, eat more vegetables and less fatty foods.

Thinking of treating somebody like an object? Don’t do it. It sends a bad message that will not be quickly forgotten.

The drug cartels are battling it out in Mexico for… what? For routes into the U.S. In theory, of course, there are no routes. The U.S. government spends $13 billion a year ensuring that there are no routes. Actually it’s more than that: think of all the people incarcerated for drug offenses, or offenses related to drug use.

The idea that America cannot “afford” the health care bill is ridiculous. To believe it, you have to assume that all or most uncovered medical conditions are not treated. That, of course, is not true. They are often treated in emergency wards, and they may be treated– in a different form– later in life in a chronic care facility, but there will be treatment and it will cost somebody and it will have an impact on the economy.

What universal health care coverage does is apply some rationality to the cost of health care. When you think about it, insurance is a marvelous concept. Since nobody knows who will ever get a disease or serious illness, why not commit, in advance, to pool our resources and treat everyone? When John McCain insists that the Republicans will campaign in November on repealing it– he’s dreaming. Since the Republicans have no alternative, his campaign will consist of “we will take away your health care”. About that for a slogan!

Even the Republicans are probably not that stupid. They will probably have to come up with some kind of weird alternative plan. The problem is, there is no alternative. They will come up with something that sounds like an alternative, but is really a variation of what the Democrats just passed, but with something that looks more “free enterprise” in it.

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Pandemic!

You would think we all would have learned about hysterical over-reactions from the hysteria surrounding SARS in in 2003, and the even more over the top hysteria over Avian flu in 2006.

But then, many people don’t think it was an over-reaction. Many people believe we were almost swept by a deadly virus that could have killed … well…. I have no idea. I have no idea how many people many people think it might have killed. Nobody will say. Nobody will say because if they did say, they would quoted frequently when we find out that the real numbers are not quite anything like the predicted numbers, or the monumental solemnity with which Peter Mansbridge intones the phrase “pandemic”.

All we know is that SARS actually killed about 774 people world wide. Avian flu? When is the last time you saw a headline on that? Right– way before Michael Jackson died.

Now you may think that 774 is a big number. And it is– by all means. That’s a lot of death. It may sound rather clinical to observe, however, that compared to a number of other causes, it’s not really a very high number. Car accidents? Cancer? Homicide? Starvation? Every year about 4,000-5000 people die from seasonal flu alone in Canada, and about 40,000 to 50,000 in the U.S. When is the last time you saw twenty headlines in a row about those deaths? Why? Don’t they matter?

The problem is that every few years– on schedule, it seems– the media whip us all into a frenzy over some new virus that supposedly is going to decimate the population and destroy our civilization. Do you recall Legionnaire’s Disease? SARS, of course. Avian flu. With the notable exception of the AIDS virus, none of these actually had much of impact beyond the usual seasonal swell of flu deaths. SARS is reported to have been “contained”. What on earth does that mean? Sports and other events were cancelled; anyone with a temperature was quarantined; nurses wore masks; thermal scanners were installed at airports. Did any of this actually have any effect on the spread of SARS? I don’t believe it.

I’m not sure yet about getting vaccinated myself.

Fear drives bad politics. When people are willing to wait in line for eight hours to get a flu shot, you know that they will not countenance a government that says “the media are exaggerating the problem– there’s really not much the government can or should do to prevent the spread of H1N1”. The government knows that it better look like it’s doing something. The media know that the government knows that it better look like it’s doing something. Both of them want to feel important, so we have the sober Peter Mansbridge solemnly intoning that “Canadians are concerned”– as if he had some hotline to the brains of 30 million people– that not enough vaccine is available for every Canadian.

Do Vaccinations matter? A fascinating article from the Atlantic Monthly.

And an even more fascinating article in Wired which draws the opposite conclusion.

Which is more persuasive? Right now, I lean towards the Wired article because one of it’s main points is that the public has a foolish tendency to ignore the science and go with their feelings. It was the government– not the scientists– that announced that vaccines would no longer use thimerosal even though it was safe, so that the vaccines would be safer. They might have also announced that they were making witchcraft illegal, not because there are witches, but because we will all be less likely to suffer from magic spells.

Bill on SARS.

Now this one tops them all: the CBC is doing an online poll to ask viewers what story Wendy Mesley should cover tonight. One of her possible topics is this: can the public be trusted in a pandemic? I am not kidding. (Unfortunately, it is winning.)

What the hell is that supposed to mean? That the government should not compel people to get vaccinated?

 

The contemptible CBC: my wife and I have watched the CBC national news for about 15 years now. I used to think they were reasonably sober and serious and comprehensive, aside from occasional hysterics about SARS or Princess Diana… I don’t know– maybe they never were. We want some Canadian news, so I was reluctant to switch exclusively to McNeil-Lehrer but maybe it’s time. I was disgusted with their coverage of the SARS crisis back in 2003 and I am even more disgusted with their coverage of H1N1 now. The CBC has gone absolutely hysterically over the top this time.

From Wikipedia: As of 22 April, all Canadian SARS cases were believed to be directly or indirectly traceable to the originally identified carriers. SARS was not loose in the community at large in Canada, although a few infected persons had broken quarantine and moved among the general population. No new cases had originated outside hospitals for 20 days

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The Cost of Death

From the Washington Post, June 11, 2009

In the final two years of a patient’s life, for example, they found that Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Some differences can be explained by big-city prices, acknowledged Elliott Fisher, principal investigator for the Dartmouth Atlas Project, “but the differences that are really important are due to the differences in utilization rates.”

Much of the evidence suggests that the more doctors, more drugs, more tests and more therapies given to patients, the worse they fare — and the unhappier they become, said Donald Berwick, president of the independent research group Institute of Quality Improvement.

The kicker here is that there is evidence that the more treatment a patient receives late in life, the less happy he or she is.

I believe it. Anyone who has spent time in a hospital or nursing home can’t help but believe it.

Billions of dollars of health care spending in the United States is guided by a very simple and pernicious logic: don’t you love your mother? (Or father, or grandparent, or…). And if you love your mother, don’t you want to do everything possible to extend her life? Everything? Even if the odds of the treatment actually extending her life or improving her quality of life are not very good?

I’m sure some elderly people simply want to live for as long as they possibly can even if it bankrupts their families, but I don’t believe most of them want that. I think most people in their 70’s and 80’s accept that life comes to an end eventually and probably hope, more fervently than for anything else, to die in peace, close to friends and family, and without unbearable pain. They don’t want to spend their last weeks or months strapped to a bed with tubes going in and out of every orifice, nauseous, drugged out. And they don’t want pallid substitutes for pain killers because the pharmaceutical industry has succeeded in establishing a monopoly over drugs.

The average American works hard all of his life, buys a house, builds up his assets, sends his children to college, saves something for retirement, spoils the grand kids, and then, just when he thinks he’s survived the economic snake-pit of American capitalism, the health care system sinks its fangs into him and sucks him dry. If you want to leave something for your grandchildren, you need to drive your car off a bridge before you become incapacitated.

Perhaps one of the most depressing facts of American life is that the medical-industrial complex has managed to convince many Americans– and almost all talk radio hosts– that the cruelest, least fair, and least efficient health-care system in the Western World is actually the best. They stand there bankrupted and ruined, dropped by their insurance companies, buried under piles of arcane incomprehensible forms, denied critical treatments because their insurance companies simply refuse to pay out… and they look at us Canadians and go, “Oh my god! You have to wait three weeks for an MRI?”

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Dear George Will: About Canadian Health Care

George, I know you strive to be fair and balanced though your basic worldview is conservative.  As a Canadian who “suffers” under our single-payer system, I would ask a very simple, very important question: having lived under a single-payer system for almost fifty years now, could you persuade a majority of Canadians to give it up, and let a “market-based” system prevail?  Do you think most of us believe that will drive down health care costs and give us more “freedom”?

George Will on Health Care

Most Canadians I know can’t even believe that there is a debate on this issue in the U.S.  We are all mightily impressed that America believes it’s system is better and everyone else is wrong even though Americans seem to know nothing about any system but the one that is failing them now.  It’s possible that everyone else is wrong.  Sometimes everyone else is wrong.  It’s also possible that the sun orbits the flat earth.

Anybody can find a few Canadians who don’t like our system, and few horror stories of delayed care and inept management.  No reasonable person can deny, however, that the U.S. system costs astronomically more to administer, and that almost all Canadians receive basic health care without the slightest impediment, and that the actual results in Canada are better than in the U.S.

Furthermore, I have no idea of where you would find any proof that Canadians do not have a choice of doctors or hospitals or treatments.

True– we can’t choose to opt out.   But Americans can’t really opt out either.  They can’t!— an American without insurance will still receive treatment at any nearby hospital.  Who pays for it?  Everyone, through taxes and astronomical charges for treatment for the insured.

Isn’t that the basic principle of insurance?  Any of us could suffer a serious illness or injury.  Why not agree to contribute to a plan that covers everyone?  Especially since we all know that those who “opt out” will still receive medical care one way or the other, but certainly less efficiently.

Finally– this is one gripe I do have about conservatives in general:  I think they are far more likely than liberals to persist in believing something long after it has become overwhelmingly clear that the results show they are wrong.  Example:  McCain actually stated at one time that Obama’s idea of talking to Castro was ridiculous because, with his long experience, he knows that it wouldn’t work.  Excuse me!  Exactly how many more years must the embargo continue before it “works”?  That is absurd.  Why not just admit that the embargo has failed and try something new?  Liberals, who have a mind-set that entertains alternative realities, are by nature more inclined to consider other possibilities.  McCain would still be in Viet Nam.  McCain will be in Iraq for 100 years (a joke really– the oil won’t last that long and then we will go back to indifference to human oppression).  And McCain will continue to believe that through some miracle, health care costs can be reduced by letting it “compete in a free market”, as if  dying of cancer is a commodity that could be sold to a hedge fund.

For the record, I’m not sure the Canadian system couldn’t stand a few modifications, and I am very interested in Obama’s hybrid ideas.  Not sure about them– but– as a liberal– I can consider the possibility that different points of view have something to contribute to our ultimate success on any issue.  Hey George, why not be the first reasonable conservative to admit that, as a family values kind of guy, you would like to see all of the nation’s children covered, and it clearly– the results show!– isn’t happening under your free market system.

Sincerely,

Bill Van Dyk