Health-Care Reform

March 22, 2010

So, the gargantuan health-care reform legislation passed a little while ago, and the President is expected to sign it into law as early as Tuesday. I do applaud the sentiment in creating landmark legislation to address critical issues currently facing our health-care industry. Or rather, facing those who must interface with our health-care industry.

I don’t care what your political persuasion or views are on the current debate, but reform has been necessary since the 1980’s, when itemized hospital bills first revealed that an aspirin or Tylenol tablet costs $7.00.

I had to accompany a family member to the hospital last year. Included in the bill was an electrocardiogram. I know how to perform them and read them, that’s bread and butter to an EMT/Intermediate or Paramedic. Your entire cost of the ambulance ride, including the ECG, will run about $900 if no other complications present.

So why does the ED charge over $2,000 for a single ECG? Simple answer, because they can. The leads are hooked up exactly the same, the machine uses the same software to read and interpret the signals, there isn’t any mystery to how it all works. It is old technology, and has been around since the Korean War or perhaps even before then. I’m not entirely sure when the first ones came into being. But it’s not new. Not by a long shot.

Three words come into play here: Exaggerated Price Environment. And that is precisely what the medical profession is all about. Exaggerated pricing.

I’m sure there are other procedures, diagnostics and equipment that are very new, and yes, some inflated cost of old technology is going to pay for the new stuff. To me, though, that’s akin to having a $250 test (my guess for the true value of a typical ECG) run about $400. All right, I can live with that. $250 pays for the ECG, $150 goes for research and development, or applied to newer diagnostic and treatment technologies. That would make reasonable sense. But $2,000 for the test? Not including the interpretation by the cardiologist? It’s simply not workable, and hasn’t been for a long time.

The hospital administrator would also chime in here: “Well, eliminating that would also make us go broke.”

In this environment, I hope so. The hospitals and clinics NEED to go broke in the current medical economy, and start from scratch. I can’t fathom any other business model that encourages such rampant inflation and indeed, courts it. With the possible exception of movie theaters and the $5.00 boxes of popcorn.

Yes, there are the uninsured who mooch off the system. Yes there are hospitals, doctor’s offices and clinics who charge incredibly high amounts to insurance companies just because they can. And yes unscrupulous lawyers encourage frivolous lawsuits to further bilk the system. But all of us pay the bottom line through our elevated insurance premiums, co-pays and uncovered tests. In many cases the premiums are now higher than the cost of a home. That is unnacceptable.

Is this legislation the answer? I doubt it. I do have one anecdote to share, though. I had an ambulance transport from Duke Hospital to the airport one time. The patient was visiting family in the US, and he was from Germany. He broke his hip and was treated here. About to collect his insurance information, the nurse told me not to worry about it; the hospital was paying for the transport. I raised an eyebrow but she shook her head. No, he wasn’t uninsured. His insurance, so efficient and prompt, had already paid his entire bill, including transport. His daughter explained on the way to the airport. Everyone in Germany has insurance, it’s required by law. And because everyone has it, the costs are lower.

It does make sense, but the key is in how it is managed and developed. If we are going to revamp the health-care system, it needs to be done from top to bottom. Leave out the pork and don’t make exceptions. To leave certain things as business as usual and revamp others because it is easy and convenient to do so is wrong, and won’t bear scrutiny over the long haul. If this is to work at all, every hospital, clinic, doctor, ED, dialysis center, etc., must adapt a new model and price schedule or we will have only a piecemeal approach to managed care.

My hope is that they will do it right, or not at all.

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3 Responses to “Health-Care Reform”

  1. Patti Says:

    AMEN!!

  2. Laura HC Says:

    Without my insurance, last year’s heart attack would have literally bankrupted us. The final total for everything came in at right around the amount we still owe on the house. I lost count of how many EKGs I got during the week; there were also two echocardiograms, the two caths, and an abdominal CT. 4 of the 6 nights were in the cardiac ICU.

  3. ThermoRaz Says:

    Greetings! Very helpful advice within this post!
    It’s the little changes that produce the most significant changes. Thanks a lot for sharing!

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