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.
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.