Health care costs a lot. All of us want to lower those costs. However, not many of us know how to do that. In spite of that, we are confident that if were placed in charge, we could easily achieve that goal.
When you or your loved ones go to get a service, it’s “Do all that you can, Doc.” So CT scans are ordered, stents are placed, expensive cancer therapy meds are prescribed. As long as there is insurance coverage.
But what about the other guy? He is the problem. If you want to lower costs, cut down on fraud and abuse, meaning costs incurred in treating folks other than you and your family.
Ok, but we do have to reform our healthcare system. This system is complex, affecting about 17% of our GDP. The law of unintended consequences is very much in play when you tinker with this behemoth. Think of a balloon: you push your finger in at one end, and you might get a bulge in a different area.
So can’t we do anything about it? Should we not even try? Obviously we should. The problem is to decide who will fix this system. Who will bell the cat? Well, there is no shortage of mice stepping up to the plate. Unfortunately, they are all mice.
Look around you, and you will notice a common problem. The ability to gather a few votes and win elections is confused with the flowering of wisdom. Folks who win immediately set about fixing problems they have no knowledge about. Nowhere is it truer than in healthcare. Colorado is a prime example.
But first a little background. Human beings have an infinite capacity to consume healthcare. I could, if I so desired, go to see a doctor on most days. Doc, my head hurts. Doc, my knees are dodgy. Doc, I can’t sleep. No society has the ability to provide every service to all comers, day or night, on demand. We need some checks and balances. Who decides what checks and what balances?
Another problem. The rocket scientist who devised our system decreed that specialists be paid infinitely more for procedures than primary care doctors are for cognitive care. Don’t get me wrong. We need specialists. I was one, too. But are you saying that performing an angiogram is infinitely more valuable than being able to decide whether your kid’s fever is due to a benign viral infection versus deadly meningitis?
On to Colorado and The Comprehensive Health Care Billing Transparency Act. Competition and the free market will fix everything. Ideology rules over reality (will the free market fix bad parenting?). Anyway, if passed, the bill would require hospitals and other facilities to disclose the base fees for specific services, before any discounts, rebates, or charge adjustments. This will solve all our problems.
Oh, really? Let’s see. Joe slips on ice, and his head hits the stone pavement. Before slipping into a coma, he says to his wife, “Please call around and ask about ER fees, CT scan, and MRI fees at three hospitals within a 30-mile radius before the ambulance takes me to one of them.”
OK, so emergencies are a problem. What about routine procedures? Joe needs his gall bladder removed. “Our charges?” the lady at his local hospital asks.
“Let’s see. A thousand bucks to open you up and remove the gall bladder. You’ll obviously need sutures. Do you want absorbable or non-absorbable? Natural or synthetic? Our prices also vary based on your choice of monofilament or multifilament sutures. We have a deal going on nylon, proline and PDS. If you wait till next month, braided silk will be on sale. By the way, which surgeon do you want? We have a guy right out of residency, who’s the cheapest. And then there are three others. Their fees are determined by multiplying their years in practice by the number of operations they have done, divided by their mortality rate, and multiplied by the relative humidity on the day they operate.”
Joe’s head is spinning. “Ma’am, could you please send a list of all your charges to the Speaker of the House? I’m moving to Florida.”
* Shiv Harsh is a physician who lives in Asheboro with his wife. Contact: firstname.lastname@example.org. Twitter: @SHIVHARSH1 or his blog at www.shivharsh.com.