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Health Care: My Visit to the Emergency Room

I take this detour from discussing the church and medical care to talk a bit about why it is so difficult even to discuss medical care in this country, based on a recent personal experience.

I’m 50 years old, and a few weeks ago I made my first visit to the emergency room. (Just for interest, I have never been admitted to a hospital in my life for any reason.) I had pain in my upper abdomen, quite severe, and it just wouldn’t go away. I arrived there between 9:00 and 9:30 pm, and eventually left around 5:00 am. While there I underwent three scans, numerous lab tests, and a few discussions with the doctor.

I should note that it took some time to get any attention, but not really that bad as such things go. While I haven’t been to the emergency room for myself, I’ve been there with others, and I’m from a very medical family. It’s very useful to have things like an insurance card and a checkbook along on such a visit. Questions about money come up very quickly.

After all this testing, they still have no idea what was wrong with me. We’re eagerly awaiting transfer of the records to my family doctor so that he can follow up.

I got a call from my brother the cardiologist the next day, and he was very upset that they hadn’t done an EKG. He thinks that should be automatic when a 50 year old guy shows up with pain in his upper abdomen, and would like to inform the E. R. doctor that he was negligent, or something along those lines.

The bottom line is this: After the rather strong medication they gave me for pain wore off, the pain was gone and hasn’t returned. But nobody has any idea where it came from or where it went.

A couple of days ago I got the bill for all this. The initial bill for that incident was over $13,000. With the amount that is generally disallowed by the insurance company, the amount that will actually be paid to the hospital is over $10,000. My portion appears annoyingly large, but is actually blessedly small, all things considered. I have good health insurance.

Now as the son of a doctor and nurse, brother of another nurse and another doctor, and husband of a nurse, not to mention cousins and uncles and such who have pursued careers in the medical field, I have a fairly good idea what costs what. I knew the scans were expensive when I took a look at the machine they were putting me through. I also knew how annoying some of the older machines would have been, and how much better of a picture of my innards the radiologist would have to study. I had talked to my brother, and knew that he would suggest more, not less tests.

So supposing I’m an average citizen and I’ve been to the emergency room for pain that went away pretty much, I might suppose, on its own. Supposing I’m still waiting for my medical records, and haven’t been able to take care of the follow-up. What do you suppose my reaction would be to the bill? The hospital is receiving something like $1500 an hour to keep me on an uncomfortable hospital (stretcher? not-bed?), and for a couple of very short breaks, take me out to get tests.

If I’m this average person do I:

a) Say, “That’s the cost of good medical care and I’m glad to pay it?
b) Yell, “$10,000 for that?”
c) Call my lawyer
d) Vote for a politician who will provide single-payer health care
e) Get more and more frustrated with the health care system, but not know what to do

I don’t know which of those I’d do. Actually, I think a large portion of that is what we pay for some pretty good health care. Some items weren’t working perfectly in my case, but I know how much the machines cost, and I know the hospital in question isn’t rolling in money. My family and I have been very satisfied with them over all for many, many years.

The problem is that as soon as a politician starts talking about “controlling health care costs” two things happen. First, people assume that what is going to get cut out is unquestionably waste. Second, many people, especially politicians, assume they’re going to be able to cut out more than they realistically can.

There’s a constant refrain about unnecessary tests. Someone might well call my scans unnecessary. They didn’t find anything. Maybe I’m just a wimp and I can’t stand pain. As a matter of fact, I’m really not sure. I’ve never felt anything like that before in my life. The most pain I’ve undergone for any period of time was a sprain. But the difference between a necessary and unnecessary test in the eyes of the person who isn’t there is simply whether it found something. In my case, it didn’t. My guts look reasonably good when properly enhanced by computer. But the doctor didn’t know that.

On the other hand, it’s probably impossible to convince someone who hasn’t researched the various machines and their costs that the cost of that visit is at all reasonable. To be honest, I’m not certain myself whether all the tests were needed. My brother the cardiologist seems to think they were a good idea.

I guess I’m kind of beating around the bush, but it seems to me that we have a long way to go in understanding health care such as to get to the point of discussing it intelligently. I determined several months ago to study out all these health care plans, and I’ve found it pretty tough going. But the more I look the more I think that the plans are being sold optimistically. They are optimistic in terms of how much can be saved and they are optimistic in terms of the quality of health care that will result.

Perhaps the media should take up some of the time they spend trying to figure out just what Richardson said to the Clintons and when, and spend some time educating the public on the intricacies of health care. Perhaps the public should demand it. Of course, back in the real world, we’d be lucky if anyone watched it, much less demanded it!

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  1. All of this would have been free of charge under Britain’s much maligned NHS. Well, maybe not quite as many tests as you had, and maybe not with such shiny new machines, but all that are deemed necessary.

    1. In the phrase “all that are deemed necessary” you hit precisely the reason Americans are very leery of a NHS like system: deemed by whom and why?

      And we kind of like those shiny new machines.

      Whether we will manage to get a system that is at once more fair and yet still gives us those options is another question entirely.

      1. Understood. I’m not entirely defending our NHS. But it is doctors who decide what is necessary for each patient, within budget constraints, not faceless administrators. The hospitals can’t all afford all the equipment they might like, but some of them have good equipment and doctors can get you to it if it is really important.

        And there is always the option to go private and get all the treatment you can afford – although not so easy for emergencies.

        The real problem for you Americans is that you can’t have everything you want without paying for it, in one way or another. I think you might do well to move towards the kind of system we have, a centrally funded system offering basic but adequate care to all with the option to opt out and pay for your own extra treatment.

        But I am by no means an expert on this, I am just offering a few off the cuff remarks.

  2. My sympathies for your experience.

    I may be a bit cynical, but I would suggest that at least part of the reason for the abundance of tests is the CYA factor that nearly all doctors and hospitals must pay attention to. Coming from such a medical family, I’m sure you’re well aware of the cost of malpractice insurance these days.

    It’s going to take more than government to correct our healthcare system. It’s going to take a paradigm shift on a grand scale.

    All the Best,

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