Sure, the politicians have bumped it over to the lit burner again. However, the pharmaceutical and insurance oligarchs are airlifting crates of cash to Washington DC to ensure that nothing too drastic happens. Of course, ol' Stevie Joe has some ideas, but I think I'll let 'em all squirm a while before I deliver up the solution.
Anywho, I have a little story that illustrates how screwy this whole deal is. A few weeks ago, ol' Stevie Joe paid a visit to the local Emergency Room ("local" being a relative term as the closest hospital, other than veterinary, is over in the next county).
Those who are frequent readers know that Stevie Joe is afflicted with migraine headaches. Now, some of you may question the medical necessity of an Emergency Room visit in the case of a headache, but let me tell you this was indeed appropriate care. If you have never experienced such an event, it can be difficult to judge just how bad it can be.
Some have compared passing a kidney stone to the pain of childbirth. I don't know about the childbirth part, but I have experienced kidney stones. I'd much rather endure one of them than a full-blown migraine headache. Plus, Stevie Joe's migraines can last a day and a half and include some mean nausea and vomiting (hope it isn't dinner hour out your way).
So, having one fierce headache, I headed on over to the Emergency Room. They started an IV and gave me the standard migraine cocktail: Toradol, Reglan, and Benadryl (Google 'em if need be). After a bit, I felt well enough to go home. The headache was still there, just a bit subdued.
A couple of weeks later, I get the bill: FOUR GRAND. Being the Smart Ass that I am, I telephoned over to their accounting department and asked for an itemized bill. Plus, having some connections in the medical world, I was able to get the cost of all the items used during my visit. So, here is how it went:
TIME IN THE EMERGENCY ROOM: 2 Hours
TOTAL COST OF ALL SUPPLIES (assuming that they bought all name brand stuff and received no volume discounts): $27.98 (really - I would not lie about this).
Here is how I was billed:
LEVEL 5 ER TREATMENT - $1300
I don't know what constitutes "Level 5" treatment. In the lobby of the hospital, they list some sample prices and show "Emergency Room Level 1" as costing $118 and "Emergency Room Level 2 - Doctor" as costing $157. Now, keep in mind that the sign made clear that these fees did not include the fee paid to the doctor. So, I guess the extra $39 between Level 1 and 2 just buys you the right to see a doctor. Presumably, in Level 1, there's no doctor.
So, maybe Level 5 includes the right to see a doctor, the right to see a nurse, and the right to sit on the edge of a bed. Level 1 includes the right to look at the ER through the window.
LEVEL 4 CARE - DR. [name deleted] - $381
Here is where the doctor gets paid. Sounds OK, I guess. He spent at least five minutes with me. Don't know why I only got Level 4 care, though.
So, where is the nurse's fee, you ask?
IV Hydration Up to 60 Minutes - $315
IV Hydration, Each Additional Hour - $69
IV Injection - $139
IV Injection, Each Additional Drug (2) - $83 (ea), $166 for both
These prices include starting the IV, letting it run for 2 hours, drawing up 3 drugs, and injecting them into the IV tubeset. They do not include the drugs or any supplies. $689 total for RN labor. I'm sure that the nurse is not getting most of this money herself. She spent maybe ten minutes with me during my visit. She was very nice (maybe that's part of Level 5 care).
1000 ml Bag of Normal Saline Solution - $130
The most expensive 1000 ml bag of saline I could find cost $3.15. The alcohol prep swabs, tape, dressing, IV tubing, and IV needle/catheter cost another $14.60.
Benadryl (diphenhydramine), 50 mg - $41.20
Actual cost = $1.98. Add in 64 cents for the syringe.
Toradol (ketorolac), 30 mg - $41.20
Actual cost = $5.44. Add in 64 cents for the syringe.
Reglan (metoclopramide), 10 mg - $41.20
Actual cost = 89 cents. Add in 64 cents for the syringe.
CT Scan, Head, w/o Contrast - $1300
Yes, they did a CT scan. For those of you who are not familiar with a CT scan, it is basically a three-dimensional x-ray. A computer takes a series of two-dimensional x-ray images to create a three-dimensional model. Contrast dye is sometimes used to highlight certain structures. Stevie Joe received no contrast dye.
Now, this sounds pretty high tech. Maybe $1300 is a fair price. I did some checking around. Not many hospitals advertise their prices, but I did find one chain of hospitals that advertised a price of $438.55 for a CT scan of the head without contrast. It was only $364.02 at their outpatient locations. This cost includes "equipment fees, staff time, and supplies." Doctor fees are not included.
An informational site about CT scans lists the average cost of a head CT scan at $200-400. The Emergency Medicine Journal lists the average insurance reimbursement for a CT scan of the head at $300.
So, where does the $1300 come from? Who knows.
The one fact that Stevie Joe does know is there was no free market at work here. I could not call around to find out what various hospitals were going to charge me. I was in no position to make an educated choice about my treatment options. I took up one ER exam room for two hours, occupied a nurse and a doctor for about ten minutes, and used up $27.98 in supplies. My bill came to $4K.
Now, I am all in favor of the doctor and nurse making a comfortable living. I know them both and know that they are not getting rich. I am also in favor of keeping the hospital running. Emergency Rooms and CT scan equipment cost some big bucks. This is a non-profit hospital, though. So, I assume that they don't need to worry about paying big dividends to the stockholders.
The irony is that the whole visit could have been made unnecessary with two Vicodin tablets that cost about 30 cents each retail. However, Vicodin is a narcotic. Oooooh! Scary! Narcotics! Bad! Bad! We can't let folks have those. Especially since there are no patents on them. Where's the profit for the drug companies?
See, the pharmaceutical companies have convinced everyone that narcotics are evil. Instead, they (and my doctor) would rather have me take a different pill that cost $30 each rather than 30 cents each. Sometimes, you need two of those pills ($60), and even then, they offer no relief at least half the time (hey - if you still hurt, just go to the hospital, right?).
This is what happens when everyone is trying to make money off of another's misfortune. Take away the cheap and easy options. Heap on the expensive medicines and machines. Everyone gets a cut!
OK, I'm tired now,
Stevie Joe Parker