I was coming out of Costco carrying a crate of oranges in front of me while wearing bifocals, which I don’t like. It was a set-up for a fall, and I did, on stepping up to a curb. I made the mistake of putting out my hand to protect the oranges.
After getting up and convincing by-standers that I didn’t have a stroke, and getting over the embarrassment, I put my oranges in the trunk and proceeded to drive home.
I astutely noted that I wasn’t holding the wheel right with my left hand. I looked down and found my pinky pointing toward the ceiling, much to my displeasure.
I figured it was dislocated, so I somewhat gently tried to pull it back to shape, but it wouldn’t go.
I acutely figured out that I needed to go to an emergency room or spend the rest of my life pointing toward the ceiling, so I called my wife for moral support and met her at St. Joseph’s E.R.
Luckily, it was around 5 p.m. so there wasn’t much of a wait. I was X-rayed and no fracture was seen and then the doctor and his assistant saw me. He yanked my finger (and it reminded me that I’m against torture).
I guess he was too busy to give me Lidocaine (a local anesthetic) or else I didn’t look demanding enough. But it straightened out, and I was pleased enough.
The “ouch” part came when I got the bill.
In my office, I would have charged $40 for my service and $40 for the X-ray. My bill came to $1,632. Ouch! And maybe more bills are coming yet.
What’s going on in medicine? My son got a tick bite in a forest known for Lyme disease and went to his nearby hospital. He saw a physician’s assistant only, received a routine prescription and was charged $850.
Is this the best care in the world, care that people can’t afford?
Let me give you my perspective after practicing medicine for 50 years, 30 years in private practice at West Paces Ferry Hospital and 15 years at Grady (I retired a year and a half ago).
Doctors don’t think about and don’t know how much things cost. I once asked my boss to post a list of drug prices in our heart clinic. She didn’t want to because, I believe, she felt the medicines were covered by insurance.
With the stroke of a pen, a doctor can order a heart scan or an MR that will cost $3,000 and $5,000, respectively.
These are great tests, but why are there not strict guidelines as to which conditions require these tests? Furthermore, why can a doctor get sued if he doesn’t order these tests?
Why do these tests cost so much? An important reason is that there are too many of these very expensive machines and consequently there is a real tendency to overuse them.
My doctor, the other day, asked me if I remembered why he ordered a bone scan on me, and I jokingly answered, “Because you have a new machine?”
But many tests are ordered on this basis. This includes programs such as rehabilitation and physiotherapy, which can be very costly.
And then there are drug costs. I see red every time I remember that Medicare is not allowed to bargain with the drug companies. They say they need the money for research, but their main research is on how to overcharge.
It’s not unusual for the price of a drug to be 20 times the cost of manufacture. A big expenditure of drug companies is promotional, including large amounts to your member of Congress to extend patents, giving the companies billions of dollars and making drugs so expensive that people often can’t afford them, even reasonably well-off people.
And then, there’s the cost of insurance administration, which is several times more than what Medicare charges. Notice the salaries of the CEOs of insurance and drug companies.
And of course there’s cancellation of insurance policies of sick people or refusal to issue policies to people with pre-existing diseases. They want only healthy people to be insured.
Well, by now you’ve got the idea of what makes me say, “Ouch!” What’s the cure? I don’t know. The national health care law, I hope, is a start. And we at least need a start. It will cost money, but health care costs are spiraling. It will cost even more not to try it, not to mention, it’s the humane thing to do.
Politically speaking, it has been easier to ask for the present plan than to try for a law that would cut costs, like for instance, controlling drug costs.
But cost cutting must come and even rationing of some type must eventually come. If in doubt, ask Greece.
Dr. Shia Elson lives in Atlanta.
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