Tuesday, April 28, 2009

Because they can.

In 2002 I had an abdominal cat scan. It cost 900.00.

In 2006 I had the exact same scan. (I'm fine. The conclusion is arthritis in my hip joint.) This time it cost 3600.

Why? Because they can. Pricing is not based on what the market will bear. No, wait, it is, actually, but when you are faced with a threat to your life, what price, exactly, will you not "bear"?

And that's if they let you go into debt to pay it.

Our older daughter, who has Crohn's disease, needs 16 pills a day to keep her stable and able to lead a fairly normal life. Because she has been on low hourly wages, and in fact is currently unemployed, we pay the 500 or so per month to keep her on them. Without that medication her colon will ulcerate. She will become infected, anemic, dehydrated, malnourished. Untreated, she will die.

Ulceration happens within days of interrupting the meds. Once the disease flares up, that does not simply end when she resumes meds. Instead, a course of steroids is needed to transition her back onto the regular meds, and a lengthy healing of the damage must be accommodated with more medication and nutritional help. And that's if the ulceration does not require hospitalization.

A year ago, her medication refills ran out and she phoned her doctor. His appointment staff informed her that he could not renew her prescriptions unless she came in for an office visit. This is the responsible practice of medicine -- the patient should be seen so that adjustments to treatment can be made. The right regimen last year may need tweaking this year. She asked to make an appointment.

No, she was told. She had an outstanding balance of about 500.00, and he would not see her until it was paid. No one knew better than he that this would put her in crisis within days.

She was paying Long Island rent of 1200 a month on an hourly-wage job. She did not have 500.00. She had visited the office several times for lab work, which she paid each time, and had never been told of this balance or given a chance to pay it over time. Now, unless she made a single full payment, she could not make the appointment. Without the appointment, she could not have the meds.

Without the meds she would become dangerously ill quite fast. We took it out of our account, along with the Overnight Express fee.

So do I want some silly government that can't even make its own form fit into its own return envelope running my health care system?

Such questions are an outrage. Lose your insurance, and then have a serious illness or an accident. Watch the doors slam: Medicaid, no; partner's employer, no; Disability, no. Watch your provider refuse care. Does National Health look a whole lot better now?

Like many things, it would be better than our daughter's situation, and worse than the situation that the people who still have good plans are in. If we were a sane nation, we'd be finding a good solution under which nobody would get lousy care or no care at all. Waiting until crisis mode creates emotion-fueled, hasty implementation of flawed cures. Didn't we learn squat about the dangers of that in the past? But again we're keeping the status quo on life support, again we're delaying.

And conservative bloggers are helping that happen with their affectedly precious garbage about how government can't do anything but screw up folding questionnaires and build Bridges To Nowhere.

Those of us for whom health care horror stories aren't just newspaper feature articles but living realities will be, I think, forgiven by humorous bloggers for not having much sense of humor about it, but mocking extremes is a time-honored humor tradition and even I really do understand that.

My problem is that I know, and am surprised that more people do not know, that it's not just benign humor. It's unpaid labor on behalf of BigProfitHealth.

BigProfitHealth needs for the status quo to go on as long as possible. They make sure that only the extreme scenarios of health care reform get talked about. If you want a particular answer, then make sure you control the question:

Do you want no-choice totalitarianism? Delays while tumors grow? Forced abortions? Politicians will set your leg, bureaucrats will cut you open, pharmacists will no longer know the difference between benedryl and belladonna!

Am I being just as silly and over-the-top as the conservatives? Sure, paper-pushers will create a bureaucratic mess, but no one has explained why doctors won't know medicine as well, or why pharmacists will be more likely to make mistakes.

Does anybody really have such a naïve lollipops-and-gumdrops view of for-profit health care as to think it doesn't exert plenty of pressure for fewer people to do more work on longer shifts, to pander to the Sacred Bottom Line? Causing nasty mistakes? Could anyone not know what a blind-maze runaround of bureaucracy people get thrown into right now, to get into programs for which they're technically eligible?

But sincere, good people become convinced that Big Socialism is coming and is a danger to their loved ones. And then those sincere, good people work for BigProfitHealth for free, circulating the cute memes for them, which helps keep the general public wary of change and slows reasoned reform to a crawl.

The other thing they don't know is that BigProfitHealth does not give a tinker's damn about them. A simple change in life circumstances is all it takes. BigProfitHealth will pulp its beloved blogger supporters into Soylent Green the day they can't get any more pecuniary benefit out of them. Seriously, lose your job. Sit in that miserable desert with your sick child and strike that goddamned rock till you're blue in the face, and see if BigProfitHealth issues you one crapping drop of water from it. You've defended BigProfitHealth, even if you thought you were only questioning total socialism, and now they. do. not. care.

The world is particularly scary right now, with jobs evaporating and the possibility of losing everything far too much on the minds of people who should be secure, whose hard work and responsible living should pay off in a decent well-earned life.

In a scary world we get overwhelmed and focus on the bad-enough problems on our own plates. We want to make easy choices between either/or scenarios.

The reality on the ground is that those of us who watch suffering and death happen at the hands of medical price gougers don't want stupidity, inefficiency, "rationing" or any other alternative that will merely hurt different people. And believe it or not, we know that to oppose universal or government subsidized care doesn't mean someone wants us and our children harmed either.

The free market is a good thing. It works pretty well for almost any commodity that gives consumers choices. They can choose among competitors, they can say no. And the value of a commodity or a service can find its level that way.

Health care may be the one and the only commodity that can't be free-marketed. How do you value health care?

The question is, how do you value your own, or your child's life? Because THAT is the "commodity" that they are selling to you. Is there any amount that they cannot ask? They price it all the way they can. Because they can.

What exactly are the choices? In a case in which you must have the money in a lump sum, do you even have a choice?

If you have the choice and can get treated with a resulting debt that will bankrupt you, should you "choose" to say no and die?

Do. not. ever. tell me that there's anything remotely humane or decent, much less "Christian" about the idea that any provider is entitled to immense wealth -- I'm not talking fair profit, I'm talking obscene riches -- and to let someone who can't fork over die when that provider has the knowledge to save them. If anything besides Big Government can stop the price-gouging, let's hear about it, but don't tell me that health care pricing right now is one whit different from selling disaster victims 50 dollar gallons of water.


Catherine said...


ronnie said...

I find it so upsetting and frustrating when I read my American friends' healthcare horror stories.

We who live in countries with single-payer health care systems watch this debate in the US and feel like we're the kids in the back of the class waving our hands in the air and yelling, "Ask me! Ask me! I know the answer!"

And the teacher never calls on us, and if we do shout out the right answer, he ignores us.

Mike said...

As someone facing unemployment, the only "good" news is that the economic recovery package includes allowing me to extend (COBRA) my health insurance for roughly what I have been paying at work -- until now, I would have had to pay the entire price and I simply wouldn't be able to.

But my small-business policy comes with a $2500 deductible, so I still need to remain healthy -- a fair amount of stuff is covered, but certainly not everything.

I think much of the toothpaste is out of the tube. To start with, I don't think physicians in Canada or the UK have the lifestyle they achieve here, and it would be hard to persuade them to scale back.

In fact, at my last job, I mentioned to the PR director at the local medical center that it might be a nice gesture for the doctors to put Sports Illustrated and Redbook in their waiting rooms instead of rubbing it in by stocking the tables with their back issues of yachting and resort magazines.

They really, really don't get it.

Christy said...

Ouch, Ruth. I don't think I'm wrong in not wanting the government to be involved in my health care. That does not mean I want your daughter unable to obtain her meds. What it does mean is we Christians need to do a better job of helping those around us in situations like your daughter's.

My church has an active deacons' board that helps people with needs like this. Did she go to her church and talk with the deacons? Does she have a good church body who can come alongside and support her through this with physical and financial assistance?

I know that seems like a small, impossible answer, but individuals will always do a better job at helping other individuals than the government.

I am more than sorry to hear your daughter is suffering. Which ultimately means you are.

ronnie said...

Mike, I dated a doctor for 4 years. You're right, the lifestyles are not comparable to doctors working in the same areas of medicine in the US. My boyfriend and his friends often mused about moving to the States, where they could double or triple their income. One major drawback in their view was that they would have to deal with insurance companies which could veto their care decisions, which essentially doesn't happen in Canada with provincial Health Depts.

I laughed when I read your comment about the yachting magazines in the waiting rooms. The reason they're there is that physicians get free subscriptions to dozens of "lifestyle" magazines subsidized by advertisers looking for a chunk of that larger-than-average income. Some are actually targeted: my ex used to get unsolicited copies of two called "Yachting Doctor" and "Doctor Sommelier", a travel magazine targeted exclusively at MDs - and one, I kid you not, called "Doctor's Wife", full of ads for trinkets and bling, a copy of which I see is available on Ebay.

Nostalgic for the Pleistocene said...

Thanks for the good wishes, Christy - i always hesitate to use her story for fear that it becomes an individual plea for sympathy. We are actually incredibly incredibly lucky, in a much better position than are thousands of other people, like the young cancer patient in the article i linked.

Christy said...

Using her story, though, puts a face on a problem. Without personal knowledge everything becomes "their" problem. People are more motivated to help when the need is known and it's known to be a need of a friend.

I'm thankful you told us.

Dann said...

Hi Ruth,

I trust that you aren't suprised that I'm posting a little something. A very little something as I've been thinking about a longer response.

I found this list of industry profits from 2007 that I thought might be interesting. Profits in the 5-7% range are pretty much the average for all businesses.

-Industry Rank
-2007 Profits as % of Revenues

3 Pharmaceuticals 15.8

4 Medical Products and Equipment 15.2

9 Insurance: Life, Health (stock) 10.6

28 Health Care: Insurance and Managed Care 6.2

40 Health Care: Medical Facilities 3.3

43 Health Care: Pharmacy and Other Services 2.6

47 Wholesalers: Health Care 1.1

There is a list for 2008 as well.

More later if we all get unlucky.


Nostalgic for the Pleistocene said...

Dann - Somehow i knew you'd be along. I'm perceptive that way.

But from every explanation i've googled so far, "return on revenues" is calculated by the income minus the cost of doing business. You know - costs. Materials, equipment, facilities, marketing, copy machine toner, liquid soap in the bathrooms....

.... salaries.

southernyankee said...

To Christie: Jesus provided free healthcare to the needy, should Christians do less?
To Dann: A former Health South CEO retired with a one billion dollar "golden parachute." I know it was denied him, but how many uninsured would get coverage with half a billion? Seems to me, this isn't about profit, but about greed.

I agree with Catherine and Ronnie.

Dann said...

Hi Ruth,

Believe it or not, I have a great deal of sympathy for your position WRT your daughter. One of my family has a significantly less serious....yet potentially life threatening if untreated....condition. Obtaining and maintaining health insurance coverage is a big concern.

As I've said on other occasions, health care in the US is dire need of fixing. Completely nationalizing it won't fix anything. It will make matters worse.

Looking at other western nations, those that maintain a profit/competitive component have the healthiest health care systems with lots of options for everyone. Those with national, single-payer systems invariably end up with rationing to the point where some of the most vulnerable people end up being denied service; particularly after age 65.

It isn't an easy issue. There are no easy right answers. There are some easy wrong answers.


Nostalgic for the Pleistocene said...

Hope a general response is OK.

I appreciate the compassion. The problem is that we're in a relatively good position and don't actually need much. I tell our story because it's an example of many many peoples' situation, and one i can vouch for. At our grocery store, there's a plastic donation container to provide heart surgery for a toddler. Her life depends on voluntary contributions of dollar bills. That people are doing it is beautiful. That any child's life is dependent on this is appalling beyond my powers of description. That should never happen in this nation.

There is something very wrong -- and i don't mind using words like "evil" either -- with a system that allows 10s of thousands to go untreated and even die, that necessitates more bankruptcies than any other one cause. Any compassion that ends up being about us is a massive waste. The whole problem is that it is NOT us, it's hundreds of thousands of people.

It should not be personal. Justice should never be optional, but that's what we've got going on now.

Churches and Helping Hand organizations can't do more than spit against the hurricane. They could help out with $500 bills. They couldn't possibly raise enough to take care of the sick members among the un/underinsured of their local population whose single cat scans cost $4000. Over 15% had no insurance even before the current economic squeeze, and that number doesn't include people like us who are "insured" with no practical coverage at all and would be completely bankrupted over any moderately serious medical problem. If Medicaid and other programs exist for filling the cracks, we can also vouch for the gauntlet that they put people through to keep them out. Oh, and the impossibility of getting employed when you have a chronic illness. Doors slam in every direction.

Most people i know understand that there's a problem. What concerns me is too many people not knowing the size and scope of that problem. That's what insures that the most extreme solution will be the one implemented, and then they'll all be horrified. IF it does not get solved WITH them, it will get solved without them.

So, yeah. No easy answers, but a certain percentage of people who are comfortably covered will have to enter the ranks of the bankrupted and the care-unavailable before enough will demand some change, and then, yup, total nationalization. Because that's how we "solve" problems in this country.

Dann said...

Hi Ruth,

A generic response is OK by me. After all, this is your playhouse. I assume that your rules apply. [grin]

Two things:

1) single payer systems can...and frequently do....result in the same lack of service...or worse...that you are talking about.

2) You might consider giving this a read. It is a statistical analysis of on bankruptcy and its causes.