Yesterday I had the opportunity to participate in the harlequinade that we Americans choose to call “health care”. A woman with top-of-the-line insurance had an infection and, before prescribing an antibiotic, her doctor wanted an ultrasound to rule out a 1 in 1000 chance that there was an abscess. The doctor suggested that she visit the emergency room at Emerson Hospital in Concord, Massachusetts, though in practice any clinic with a machine and a radiologist on-site or connected via the Internet could have done the scan. She arrived at the E.R. at 2:00 pm, was seen about 7:00 pm, and was discharged around 8:00 pm (I delivered emergency supplies of food at 5:30 and stayed until 7:30). Had she gone to a veterinarian, her odyssey in the health care system would have been complete, but hospitals and doctors aren’t generally able to send patients home with the required medications. So our exhausted patient had to make a trip to a separate pharmacy a few miles away.
One complicating factor yesterday was Patriot’s Day, a holiday for some folks in Massachusetts. Most personal service industries add staff during holidays. If a customer came into a restaurant on a weekend or holiday, he or she would not likely have to wait 5 hours for service “because it is a holiday and our waiters and cooks wanted to stay home with their families”.
The most painful knowledge for me was that there was almost surely an ultrasound machine and radiologist waiting idle somewhere in eastern Massachusetts but there is no Web-based system for finding facilities with short waiting times. This is presumably because customers’ time has no value in our health care system, but I reflected that even the Massachusetts Registry of Motor Vehicles took mercy on its victims and posted facility waiting times on the Web starting in the 1990s.
So… by spending a greater percentage of working hours paying for health care than any group of humans in the history of the world we Americans have managed to create an industry that is less customer-friendly than the DMV.
One exciting positive: Thanks to the heroic efforts of Barack Obama, a gay couple can pay the same $17,000 per year and wait the same 6 hours for a 20-minute procedure as a straight couple. Egalitarianism seems already to have been implemented at Emerson. I was not asked to explain my sexual orientation (if any) when visiting.
More: my own health care reform plan
[How would this have played out in countries that spend less than our $8500/year per person on health care? She would have gone to a pharmacist rather than a doctor, described her symptoms, and been handed the antibiotic 5 minutes later at a cost of between $5 and $50. Had there been an abscess she would have gone to a doctor a couple of weeks later.]
One can easily find walk-in x-ray/ultrasound clinics in Mexico. A pity Massachusetts hasn’t caught up.
Plus, by having an ultrasound so early before she was really sick, she’d have been given a false assurance that there was no abscess when in fact any collection is likely to be too small to visualise on ultrasound (your account makes it sound like she wasn’t particularly sick and so unlikely to be bacteremic).
If you have are middle class or better and live in Manila, Philippines, this would have taken perhaps 45 minutes – 15 to see the doctor and get a prescription, 30 minutes to get the ultrasound. Cost would have been $50 to $100 total.
Plus a pharmacist in Mexico would most likely be able to prescribe the medicine needed.
Philip –
I would love to see you innovate in health care as you have in software. When will you be starting a venture to tie together medical equipment, practictioners, and patients with telepresence, at low cost and with fast response time?
Or get this: A family member had minor, routine surgery at a famous local hospital. She stayed one night in a non-private room. So what’s the fee for the use of the OR, recovery room, and a one night stay?
Well, the “insurance negotiated rate” for these services is $3,900
The original hospital bill was $63,281
(Note the surgeon’s fee is not included in either figure, that’s billed separately)
Kabauze: Thanks for the vote of confidence. Unfortunately I don’t think that starting a health care provider in the U.S. is a sensible idea. Your customer isn’t the patient. The customer is the insurance company. So there is no direct connection between doing a better job (making people healthier with less pain, suffering, and time for them) and making larger profits. The insurance company certainly does not care if the patient is made to wait for hours or even if the patient dies (as long as the death is cheap).
There also isn’t an obvious way to succeed by being more efficient and offering lower prices. Consumers will drive to New Hampshire to avoid the 6 percent Massachusetts sales tax on a piece of furniture or a set of tires. They wouldn’t drive to New Hampshire to save $10,000 on a medical procedure, though, because their insurance company or Medicare/Medicaid is paying.
Carrying the restaurant staffing metaphor a few steps further:
Everyone in the country is seated at the same table, with the bill divided arbitrarily between only the solvent diners under 62. The menu has no prices, the staff is unaware of what they might be, and the topic never came up in their 10 years of training. 50 pc of the diners are obese and eat like it. In order to scramble an egg the kitchen staff must have studied for 5 years in a distinguished school of cuisine that rejects 2/3 of its overqualified applicants. The wait for a meal is from .5 to 5 hours. Several hundred thousand Americans per year die of food poisoning from this restaurant, but the staff is somewhat offended by the suggestion they consider washing their hands more often, an no one is about to make them.
I’m an uneployed uninsured customer. Two weeks ago I practically severed a finger tip while cleaning a bicycle chain. I put it on ice rushed to ER, waited two hours for four stitches which were completed in less than 10 minutes. I just received a bill for $628 which had been discounted due to my being uninsured from $1,048. When talking about my options with the doctors I requested cost information and was told they didn’t know and it was not readily available. Had I known the cost, I would have left after the doctors recommended stitches because of tradition but could not explain whether stitching, suture tape, or minimized movement of an open air scab offered significant medical advantages (I informed them I as not concerned about cosmetic scarring).
Health care is obviously horribly broken and Massachusetts is showing the probable future for the rest of the US as healthcare is promised to all. I think the coming system is like giving everyone in town free bus passes but there are only two busses running so get ready to fight for a seat!
I do like the restaurant analogy but would add the chef (someone like myself- an Internal Medicine specialist) spends little time actually cooking for the gymnasium sized dining room, instead whiling away the hours calling suppliers confirming the carrots and pepper can indeed be placed in a stew. The trained chef then calls the owner of the restaurant (who has an MBA and the culinary training gleaned from watching an hour of the food network every week) to confirm the choices. Unfortunately, the fresh carrots were replaced by frozen and a pepper substitute was approved. I agree many of the simpler dishes- i.e. a hamburger, can be made by just about anyone but complicated dishes do require a bit more knowledge to get just right.
Never fear- 2 tier health is just a step away! Many of my friends are jumping on the wagon but I got little satisfaction out of my days when I used to take care of the local rich and famous. I especially like the comparison to airline travel.
http://www.msnbc.msn.com/id/34024233/ns/health-health_care/
Chefs may get help from fast order cooks soon
http://www.newsweek.com/id/234218
Chefs are tired and don’t receive much joy from the process of dispensing yet another plate of cold gruel to hungry, frustrated patrons.
http://www.msnbc.msn.com/id/35545561/ns/health-health_care/
Personally this chef is winding down the kitchen and will be closing shop in 6 months. I plan to keep current in medicine as I expect to take care of myself as medical anarchy arrives. Perhaps I will work as a vet tech for my veterinarian sister who has double my income and feels great about what she does all day.
Here are two short articles by a medical school professor about dealing with the medical system as a patient or outsider. She has plenty of problems, too.
The articles are PDFs, but they open in frames.
A Tale of Two Patients
http://www.annals.org/content/140/11/929.full.pdf+html
I Can’t Be Bothered
http://www.annals.org/content/148/4/317.full.pdf+html
I had a peritonsilar abscess in February and made 2 visits to the ER and had 3 follow-up visits to the doctor. I must have been to a better ER because they were blazingly fast (this is in Denver, not Massachusetts). But the bills are still coming in and it looks like it’s going to add up to about $5000. (My insurance policy has a $10,000 deductible, so I pay the whole thing.).
Wayne: Congrats on not having been killed due to medical mistakes after all of those visits to the hospital and the doc! I didn’t say that the ER in Massachusetts was “bad” nor do I think that your Denver ER is “better” because you happened to get through quickly. My point was that hospital ERs are all subject to a lot of random demand, which makes it inevitable that some will have longer waits than others and that only an industry completely indifferent to customers would fail to come up with a system of steering customers to the ERs with the shortest wait times at any particular moment.