Surgery at Seven, Conga Line at Three
June 2nd, 2009If it Moves, Outsource It
I am loving this. Reader Sally V. sent a link to a hilarious story indicating that outsourcing may be part of the solution to our health-care problems. In other words, as we have seen in other industries, when Americans charge too much, somebody else undercuts them and provides something better and cheaper.
Let’s see. Cars. Tech support. Machine tools. Electronics. Appliances. Cement. Can you believe we import cement? If we can profitably import something that heavy and cheap, we are in deep trouble.
What does that leave? Lap dances? Government? I guess you could say Barack Obama is outsourcing government to Tehran and Gaza, but the decisions are still filtered down through a lot of overpriced dead wood here in the States. It would be cheaper to have Abbas and Ahmedinejad run the country directly. No more $50,000 dinner dates for Obama and his wife.
Here’s the story. Guatemala has hospitals as good as our own, staffed by doctors trained in the US and Europe. They don’t have our Democrat-supported, parasitic tort problem. They are more efficient, because efficiency is too much to ask from the richest country in the world. And they need our business, and they are not taking our fees and dividing them up among strangers who don’t pay their bills. Or maybe they are, but the bite is much smaller.
You can fly there and live like a king while you get top-notch treatment, and when you come home with a nice tan, you’ll still be ahead by thousands of dollars. It’s cheap, even if they overcharge. What’s not to like?
I checked out medical tourism back when I was having gall bladder pains. I am not actually cheap, but I do resent paying more than I should. And American medical costs are obscene and unfair. Overseas treatment is a very good deal. You can go to places like India, for example. That may sound scary to you, but before you judge, maybe you should ask yourself how many turbans and dots you’ve seen at your local hospital. The Indians are not stupid, nor are they lazy or ignorant.
I guess medical people who read this will post self-serving comments, claiming I’m unpatriotic or that I need to support our ailing system with my dollars or that overseas care is risky. But the fact is, American doctors and hospitals charge much more than they’re worth, and they are not really better than foreign providers. I didn’t cause this problem. They did. Why should I put up with it? Buy your Mercedes honestly, if you want to keep me coming back.
I’ll give you an example which I have mentioned before. I had a kidney stone in 2003. I went to the emergency room. They gave me either an MRI or a CAT scan; I can’t recall which. I was there for maybe twelve hours. Cost? Over five thousand dollars. Treatment? None. They treated the pain (incompetently) and sent me home. I had to get leftover pills from someone else’s old prescription in order to get through the weekend.
Now, you can say I’m not a doctor, and that I don’t know what I needed. But that’s a stupid argument. Sometimes you have to be a doctor to know whether medical tests are justified, and sometimes you don’t. If I sprain my finger and someone tries to biopsy my liver, I am perfectly qualified to say he’s a crook or an idiot.
You don’t need expensive scans to diagnose kidney stones. Many, many thousands of patients have been sent home without even an x-ray. Doctors told them to wait and see if their stones passed. When they didn’t pass, the patients got surgery. In the meantime, they got antibiotics and painkillers. Today, they can give you an abdominal x-ray known as a KUB. Kidney stones show up on x-rays. I had a KUB in 2003, and it cost $250.
Where did the decision to get a KUB come from? A know-nothing disgruntled patient with no MD? No. It came from my urologist. After my hospital visit, I followed up with him. He gave me Percocet and Levaquin, and he told me to go home and pass the stone. After that happened, a lab looked at it for $40. He looked at the result and suggested a second expensive scan to make sure I was okay. I asked if that was absolutely necessary. He said a KUB would also be okay. The message was, “You can have a $5000 test or a $250 test. Either will work. Gosh, which would you rather have?”
If I hadn’t asked about the necessity of the scan, guess what would have happened? Five grand, down the toilet. For no reason whatsoever. I probably didn’t need the KUB, for that matter.
The urologist ended up charging something like $300, total. He even gave me sample antibiotics, for nothing. The hospital and drugstore got all the rest. And the hospital did very little for me. They even did the KUB. Maybe he got a kickback, but the fee went to the hospital.
I had a second kidney stone later, because I stupidly insisted on drinking huge amounts of tea in combination with dairy products. This time I called the urologist first, because it happened on a weekday, and I didn’t have to go to the ER. He has a receptionist who is so nasty she probably needs therapy. After thirty seconds on the phone with her, I decided not to get treatment. And I was fine. Saved six grand. Risked absolutely nothing except a little discomfort.
The purpose of the scan was to make money for the hospital, pure and simple. And it’s very typical.
Here’s a fun story. The brother of one of my college buddies became an ENT, and early in his practice, he learned he shouldn’t tell people not to get surgery. People came in for second opinions, and he told them they didn’t need to be cut up. The local doctors sat him down and told him he was not going to continue interfering with their cash flow. After that, he changed his ways. He’s not the only doctor in the US who has colleagues like that.
Medical care is too expensive. That’s the plain truth. It could be cheaper, but providers don’t care enough to make their prices fair. So if I can get better treatment in Guatemala, for less money, I’ll do it. Contrary to what gadget-crazy doctors may say, you don’t always need The Most Expensive Machine in the Hospital or The Machine That Goes “PING” to cure your constipation or warts or strep throat. They overtreat us because it makes them more money. If they can’t spend my money wisely, I may as well go to a nice hospital on the beach and recuperate with a pina colada in each hand.
The great thing about this plan is that liberals can’t interfere with it. They are not allowed to meddle with anything that makes health care cheap, even when it goes against their agenda in some fundamental way. Example: they won’t touch Canadian pharmacies. The excess money drug companies charge here in the states presumably goes to subsidize the lower prices they charge in places like Mexico and Bangladesh; it’s welfare, which liberals love. But if they try to explain that to greedy retirees who want cheap pills, they’ll get absolutely nowhere. Medical tourism is probably unstoppable, and it’s a great thing. It could destroy the monopoly that makes American health care overpriced, and it will probably improve the quality of care. Competition has a way of making things better. Look at the difference between a 2009 Ford and a 2009 Toyota, and compare it to the same difference in 1980. Ford still loses, but the margin is much smaller.
America is in a steep decline, but the free market is as strong as it has ever been. It is an eternal, fundamental principle of the universe. Like thermodynamics, it has an existence independent of our own. It existed before we did, and it will exist after the earth disappears. In the end, it always wins. If it sends me to sunny Guatemala instead of the Miami Heart Institute, so be it. I will manage to cope.
June 2nd, 2009 at 11:04 AM
take a look at a hospital. A drs office. A drs house. The medical profession makes the UAW look like a bunch of pikers. And the efficiency is as good as the US mail. But hey, we’re going to make it better, we’ll put the GOVERNMENT in control. That way the theft will be gummint sponsored. dirtbags.
June 2nd, 2009 at 11:56 AM
I’ve seen my mother’s house. And her office, before she had to retire, due to health problems, at 84. If she’d made as much as a UAW member she’d have been better off.
June 2nd, 2009 at 12:00 PM
Waiting for Obama to promise a machine that goes “PING!” to every patient. It’s my favorite. http://www.youtube.com/watch?v=arCITMfxvEc Pay attention to the Obamaworldesque reply by Chapman to the mother’s inquiry if the baby is a boy or girl.
June 2nd, 2009 at 1:09 PM
I certainly don’t deny the profit motive behind tests, but at least in part needless tests are ordered to “lawyer-proof” the doc and hospital, since they are the deepest of deep pockets.
If the ER had sent you home w/o a scan, and a few days or weeks later you’d come back with a honking big kidney tumor and a terminal diagnosis, guess what the plaitiff’s laywer is going to say in his negligence suit?
All this crap feeds back into itself to truly ball things up. Hospitals waste incredible amounts of time and money- a significant amount of it to attempt to insulate themeselves from lawsuits.
My $0.02, YMMV
June 2nd, 2009 at 1:10 PM
aelfheld:Yes, of course, I see the error of my ways now. All doctors are overworked, underpaid wage slaves.
Oh, wait. thats utter bullshit. For every dedicated doctor or teacher or auto worker, there are thousands of scumbags. I feel for your mom, but she is an obvious exception.
June 2nd, 2009 at 1:23 PM
There is no doubt that lawsuits motivate stupid tests, but they are also used as an excuse for just about every unnecessary treatment, and it doesn’t wash. Lawyers cause a lot of problems, but they don’t cause every problem.
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I very much doubt that a healthy man with sudden kidney pain is a likely candidate for cancer, and if it had been cancer, in all likelihood, by the time it started causing this kind of pain, my goose would have been cooked. I’ve known a fair number of cancer patients. I don’t know any whose first symptom was sudden and intense pain. Maybe such people exist, but it sounds unlikely.
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My urologist knows I’m a lawyer, and he knows my dad is a lawyer. If he thought a lawsuit was a serious possibility, he would not have suggested the cheaper test.
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One more thing. No lawyer I worked for ever asked me to do anything that was not necessary, just to pad a bill. It’s unethical.
June 2nd, 2009 at 1:24 PM
“Look at the difference between a 2009 Ford and a 2009 Toyota, and compare it to the same difference in 1980. Ford still loses, but the margin is much smaller.”
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Aside from losing at “most boring car design of the year” competition, how does the Ford lose? The Ford Fusion is a world beater.
June 2nd, 2009 at 1:25 PM
I wanted to be sure, so I looked at the 2010 Corolla. Funny thing – it looks a lot like a 2006 Chevy Cobalt.
June 2nd, 2009 at 1:26 PM
It’s amazing that a car company employee would say something like that! I am shocked!
June 2nd, 2009 at 1:54 PM
actually europeans love ford, and the eurofords like the mondeo are what helped keep ford from having to participate in the bailout. So far.
June 2nd, 2009 at 5:29 PM
2008 JD Powers winner: Compact Car Honda Civic
2008 JD Powers winner: Mid-size Car Chevy Malibu
2008 JD Powers winner: Large Car Pontiac Grand Prix
2008 JD Powers winner: Mid Size Pickup Dodge Dakota
2008 JD Powers winner: Large Pickup Chevy Silverado
2008 JD Powers winner: Van Ford E-series
Yeah, I work for an auto supplier too.
And we’re good at what we do, too.
June 2nd, 2009 at 5:33 PM
Okay, but:
DETROIT — Automakers cling to such surveys, ready to trumpet any positive press they can squeeze out of surveys like J.D. Power and Associates’ initial quality reports. J.D. Powers’ top 10 nameplates for 2008, based on problems per 100 vehicles are Porsche (87 per 100), Infiniti (98), Lexus (99), Mercedes-Benz (104), Toyota (104), Mercury (109), Honda (110), Ford (112), Jaguar (112) and Audi (113). Cadillac and Chevrolet are ranked 11th and 12th, and each are listed with 113 problems per 100 vehicles — J.D. Power rounds the numbers.
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I should also add that there is more to a car than the number of problems per year. Things like mileage, performance, and looks.
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Here is a blurb about the 2008 Vehicle Dependability Survey:
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Lexus earns six model awards and Toyota earns five, combining to capture more than half of the segment awards. Lexus is also the highest-ranked nameplate in the study, and has ranked highest each year since becoming eligible for the VDS in 1990.
June 2nd, 2009 at 7:08 PM
Og, I never said all doctors were overworked or underpaid. Nor did I say they were wage slaves – no slave was ever treated with the disdain Medicare and Medicaid dishes out to its ‘valued providers’. I know of some doctors who’ve done quite well, and others who, like the majority of Americans, get by.
Are there bad and/or greedy doctors? Yes. Is the percentage of scumbags higher than in other fields? No.
June 2nd, 2009 at 9:02 PM
“Is the percentage of scumbags higher than in other fields? No.”
Hm. That sounds like a challenge. You are, of course, wrong, and I am absolutely prepared to prove that. I can do so merely using the medical history of my family alone, while I will be pleased to allow you the rest of the population of the continental United States. The medical profession in the United States is a wasteland of greed, mismanagement, bad business practice, and- did I mention greed? I was recently charged $900 for a three minute visit with an anesthesiologist who spoke almost no english. For all I know, the woman I spoke with was the janitor. Another person did the anesthesia for my surgery, and I was billed $560 for that. I had to fight for almost six months to keep this bill from being sent to collections. They finally adjusted the charge to $43. I probably spent a hundred hours all told dealing with it. And this is the least egregious example I can cite in my own medical history alone. If I started speaking about the family member who was nearly killed by allergic reactions to drugs prescribed by the same doctor who discovered the allergy in the first place, or the family members who died, literally, of neglect, in hospital beds, we would barely be scratching the surface. And every single person i know who does not live in a bunker has a handful of similar stories.
I have a good doctor, thank God. I have also had some great experiences with individuals in the medical profession. but demonstrably, provably, the profession and the framework of it are by definition a cluster. Medicare and Medicaid AND the insurance industry are not separate from but an integral part of that cluster.
Again, sorry if your mother doesn’t fit into this category. This is not directed at people who actually do their jobs. Trust me, whether you believe it or not, most do not. MOST.
June 2nd, 2009 at 9:03 PM
Having watched ER treatment change over the last 20 years I can assure you, Steve that the fear of lawsuits drives a lot of things that get ordered.
There is this “It ain’t gonna be me who gets caught with his butt in the wind” attitude. Turn on the TV during the afternoon. Every other commercial is a lawyer. Way to many dirtbags look at it as a lotto. Nothing to lose so go ahead and sue.
But hospitals do charge way to much for stuff. I call the ER the “Home of the $10 dollar Tylenol”. Reimbursement rates are another part of that cost drive.
ER’s have traditionally averaged about 50% return. People just don’t pay anything. This has dropped into the 40% range in the last few years. I think they overcharge hoping to get something back from those who do have insurance.
Basically, health care is a big mess in this country. There’s a lot of reasons why and the government is a lot of it. So expect it to get worse when they do nationalize health care.
Every one will get the same shitty treatment then. You won’t be able to get a CAT scan even if you really need it then.
Traveling to get a break on care makes perfect sense if you can do it.
Even with decent insurance, I’ve had my finances tore up with medical bills in the last year. I’m sinking and it ain’t gonna get any better anytime soon. The wife had surgery today. There’s another couple grand to add to the pile of medical bills.
Yep, I can see this one from both ends and don’t like it one bit.
June 3rd, 2009 at 10:51 AM
Steve I am so glad you read this and put your unique touch on it. I have a recent story of my own… almost died from a burst appendix back in December… the 3 hour super duper scan for inflamed gall bladder nearly killed me. And a sick, pasty faced woman barked at me to keep still through the whole pointless event, as the peritonitis was gradually poisoning me to death. When I finally FINALLY got to the ER after two days of useless scanning based on my “typical” female-fortysomething-farting profile, a simple blood test showing my EXTREMELY elevated white count put me into the emergency surgery pipeline on the spot.
Bottom line: one simple & quick blood test would have put me into the pipeline *before* the appendix infected all my lower organs, especially the colon, and I’d have been home within 3 days, healed in 2 weeks. Instead, the surgery was very long, involved a lot of tissue handling and the removal of a section of colon, and I spent 11 days in the hospital. Nearly six months later I am finally feeling back to par. My digestive issues will go on indefinitely. Total cost: $235,000. But I have the satisfaction of knowing I was able to help beef up many revenue ledgers along the way… and live to talk about it.
June 3rd, 2009 at 12:35 PM
For every illegal alien the hospital has to treat for free, it must wring out the cost of the service from a paying customer. The ratio of free to paying customers determines the level of overcharging needed.
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An unneeded MRI for $5000 pays for some illegal’s treatment.