THE $20 ASPIRIN
People often ask, " Why is medicine so expensive in the United States?" This simple question requires a complicated series of answers.
As recently as 60 or 70 years ago, if you were sick, there was relatively little the medical profession could do to diagnose and treat your ailment. Beyond some simple x-rays, a few antibiotics, and some rudimentary blood and urine tests, the armamentarium of the physician was relatively bare compared to what it is today. Our science has developed noninvasive ways of looking inside your body such as ultrasound, CT scan, MRI scan, and PET scan. The cost of each of these machines runs from $100,000 to several million dollars. Each require technicians with specialized training to run them, and physicians with specialized training to interpret the results. As expensive as these machines are, they quickly become obsolescent and require replacement due to the demands of the public as well as the newly minted doctors trained in their use.
While we are a long ways away from finding the cure for cancer, there are number of cancers today that actually can be cured with a combination of available treatments. For many others, there are treatments which can slow down the progression of the disease. Unfortunately, the cost of these therapies runs into the hundreds of thousands of dollars and more.
The public appears to have an insatiable appetite for news regarding health care. Newspapers, magazines, television, books, and the Internet have combined to provide a prodigious amount of information regarding health and disease. Unfortunately, the media approach is often sensationalistic, and designed more to generate fear leading to more media consumption than to the dissemination of the real facts. For those without medical or scientific background it becomes difficult to separate the wheat from the chaff. Nonetheless, most doctors will readily tell you that their offices routinely have to deal with the worried well. These patients consume significant health care dollars in their recurring need for more tests to reassure them they are not suffering from an as yet undiscovered malady.
The ever-looming threat of malpractice motivates doctors to order more and more tests from an ever-growing armamentarium. Because there are few studies that can be considered 100% conclusive, there is continued escalation of tests driven both by patient demand and malpractice worries. The growing intrusion of both courts and legislatures into the practice of medicine fuel this process.
We have both a mobile society as well as an insurance system that forces patients to frequently change doctors. Since we lack a system of readily available health records, and because patients are often ignorant of what tests they already had done nor the name of the facility which has performed them, there often results duplication of studies.
We as a society have done a very poor job of accepting the reality of death, and have failed to parse the distinction between the prolongation of life and the prolongation of death. There’s a poor understanding of the hospice movement not only by the general public but also by many physicians. Despite the fact that it has been around for over 30 years, and that 98% of families have given high marks to hospice and would recommend it to their friends and family members, the program remains underutilized. This is a topic that deserves its own discussion, and the one that I will address in a following piece.
People are justifiably outraged when they receive a hospital bill showing a $20.00 charge for an aspirin. The fault, however, lies within the arcane system of charges forced upon hospitals by the bureaucracy of insurance companies and the government. There are a large number of unfunded mandates such as laws requiring hospitals and doctors to provide care to any one walking through the doors regardless of their ability to pay; state mandated staffing ratios; state and federally mandated utilization review programs, infection control programs, quality control programs with increasing number and complexity of reporting requirements – all of which require significant expenditure of staff time and effort. As there exists no direct means by which hospitals and physicians can bill for these services, the costs of these unfunded mandates get bundled into other allowable charges. Hence, the $20.00 aspirin. If grocery stores were required by law to provide food for any one who was hungry regardless of their ability to pay, if hotels were required by law to provide shelter to any one unable to afford it, then the cost of these services would rise exponentially, or it’s providers would go bankrupt. With 40% of the population having no health insurance, we are seeing evidence of both of these consequences.
If the picture I am painting looks bleak, indeed it is. I sit on the financial committee of the board of a nonprofit three-hospital system in a reasonably affluent area. For four years we have lost considerable amounts of money, and only in the last two years following staff and program cutbacks have we been able to eke out a 1% margin. Unfortunately, while this is an improvement over our past performance, it does not allow us to even replace worn out equipment and infrastructure, much less build for the needs of the future. Based on the experience of other facilities near us that have been forced into bankruptcy, there’s no one in the public or private sector who will take over our operations should we fail. If we close our doors, we can expect that 150 to 200,000 people in our geographic area will have to find healthcare much further away. The domino effect of such an influx on the already strained resources of our neighbor hospitals is all too predictable. While the crisis in our community is perhaps slightly greater than the rest of the country, we all face the same challenges.
In my next several offerings on this topic I will endeavor to give you a better insight into the physician side of this problem, as well as talk about some potential solutions we need to consider if we are to avert a total melt down of our healthcare system.
I hope you\’re warmer now 🙂
We have had several hospitals close their doors and my neighbor is an emergency room nurse. Shetells me how htey send indigent heart attach victims home after stabilizing them knowing the will not do well but the hospitals cannot afford the continue providing care for free.
Jorge, This is a very good and timley post. I was just stopping by to give you a hello and thank you for visiting the Painting Studio. Friends were trying to get me on MSN Windows Live Messenger and I nearly burnt my dinner because I had to read your post. As Maitre d\’ in the finest restaurant in Peoria and as a fine arts painter I have many friends that are Doctors. I have the VA for my primary care and am most pleased with the quality of service I have thus received. In the past ten years or so the VA Hospitals have done away with paper work and improvements are a model for the private sector. The profits of multinational pharma giants, corporate hospitals, and insurance companies. It gets my goat. How many insurance companies own hospitals? I wonder. On a lighter note………Sassene got into my computer again and Simpsonized my profile picture. I hope it gives you a smile as it did me. As ever be well, my friend. Stephen Craig Rowe
Thanks so much for giving us a physician\’s perspective. It really is a wide-span issue and very complex. I really think our healthcare system needs a re-working and that it would be very helpful to have the viewpoints of doctors and patients in the process of planning for it.
I have to agree that many patient\’s don\’t know their own medical history and what tests have been run and where and when. When I was younger, I have an odd story from a doctor that actually did a surgery on me, without pulling up my past medical records from another hospital.
I\’ve had many, many surgeries and I did forget a past surgery so… :S when the doctor operated on me, he was surprised to find ( marlex… whatever that stuff is, some type of supportive stuff for when muscles are taken out…) Needless to say, he cut through the marlex and he called in am emergency consult during the middle of surgery to ask, WHAT IS THAT STUFF? They just sewed it back up.After surgery, we had a laugh but I imagine it was not so funny to discover something odd like that during the middle of a surgery ,right? I was very apologetic to the doctor for forgetting that surgery and he was very apologetic to me for not getting my medical records. Needless to say, he called for the medical records before he operated again and I made sure when I got home to sit down and write a medical summary stating surgeries and prescription list for every time when I went to the doctor and especially a new one.
Have a good start of the week!
sometimes we just have to accept things…
*~* :o) smiles are contagious… :o) so pass one on … :o) soon the whole world will be smiling… :o) *~*
Wow. I just stopped in to say hi & got sucked into your blog. I turned 50 this year and was treated (without co-pay!) to a wonderful procedure called the colonoscopy. The good news is that I don\’t have to have another one until I\’m 60. Aside from being a very humbling experience, I can only speculate at the cost.
I saw the doctor earlier in the year and told him that my wife complained that I hold my breath while snoring…sometimes for as long as 45 seconds. They sent me to do a sleep study. This confirmed what my wife had told me, but it was not bad enough to treat…which suits me fine because their cure to where a frightening monstrosity of a mask to keep the air passage open. So, I decided to see a doctor that specializes in somnoplasty. He removed my uvula (sp?) and tighten the skin at the back of my throat. While I think this is more practical (and seems to work well), it cost me $1600 out-of-pocket for about a 45 minute procedure. Then he sent me on my way (well, my wife had to drive me — I don\’t do well driving on 10 mg of valium.)
But if it\’s $1600 for 45 minute outpatient procedure, I\’d hate to have no health insurance if I really had to be hospitalized. It would be a nightmare, but one that many people face. Let\’s hope for some solutions. Our politicians need plans, not promises.
From my perspective, it looks like the physician\’s hands are tied on just about every level because of the HMO\’s set in place, and the procedures they must follow. It\’s quite sickening and disheartening. I pray I don\’t get anything bad healthwise… for I\’m screwed if I do.
Sigh… I don\’t know what the answer is either… do you? \’
Maybe you have already discussed this in a prior blog entry which I have never read… since we\’re fairly new blog friends and all.
Anyway, I hope you have a wonderful week ahead, and my grandbaby was FINALLY born. YAY.
this is an excellent read.. thank you.. it always amazes me of the people that I know that use the emergency room like a dr\’s office. Now, don\’t get me wrong. When an emergency happens I think that is the place one needs to go. However, I know so many people that bit** about health care but will run to the emergency room for a simple sore throat… I am looking forward to you next post.. and appreciate your candor.. hugs, mtgal
Wow. I\’ll remember to take a packet with me (£2) in the chemist, if I ever visit America, in case I get ill while I\’m there! We have similar problems here with cost of medicine. People went nuts a few years ago when they decided to charge people for the prescriptions GP\’s dispense – about £6 an item at the moment (students, old people, welfare recipients excluded), because we already fund the system through tax. The thing that annoys me though, is the way the medical companies take advantage. They have the key, and often you will pay for it beyond its value. My GP has often said "I should prescribe this – we\’ve been asked to take it on, but it will cost you about £12. Don\’t tell anyone I said this, but if you just go to the chemist and ask for \’………..\’, it will do the same job, and cost you only about £3". My parents are/were both in medicine, and became rather saddened by the decline in standards and emphasis as they saw it.
I\’ve just caught up reading your blog. Your description of your son\’s wedding was delightful. I still can\’t get over how romantic a wedding must be in the most romantic city in the world. My very best wishes to the happy couple.
Thank you for the reports on the condition of our medical system. After four years in its clutches, I can tell you it is confusing and frustrating even for one who has great medical benefits. I do, however, have only praise and gratitude for the hospice model. They are amazing!
Hope all is well.
It is a great post!!!
Medicine is very expensive all over the world, but in some countries people don\’t know the real price of the Medicine.
I hope you have a nice weekend
I just finished reading your entry on the $20. aspirin and must admit it was enlightening. Now I know why hospitals DO charge $20. for aspirins! Your exposes on medical issues have been quite interesting. Are these writings strictly for your own pleasure or are they written for a hospital newsletter? They are well written and informative at the same time – especially for the lay person.
One of our local hospitals in the Capital District area, Bellevue Woam\’s Hospital was just forced to close their doors and it still is a puzzlement. Fortunately another hospital took them over as an annex but they have had a wonderful history for serving women.
I\’m still very concerned about the lack of home health care and the inability of agencies to provide that kind of care. The availability of care should be "seamless," and the resources are just not there.
The summer is moving on fast. August and soon we\’ll be talking about Labor Day and it starts all over. I\’m already planning a barn sale for the 24th and 25th of August so you know the summer is coming to an end.
Anyway, be well and take care. P.S. I am enjoying our first garden tomatoes! And the local corn has been delightfully sweet. Bittersweet
The zoo concert and Harry Potter adventures were definitely a blast. I have to confess I\’m commenting on this blog entry without reading it, which I generally avoid like the plague. Right now though I\’m a weird combination of exhausted and unable to sleep so it\’s going to have to do. Hope all is well.