Outsource Your Facelift
July 21st, 2009Pina Coladas Can be Considered Painkillers
It looks like Obamacare is dead. Thank God. In order for the plan to live, lots of Americans would have had to die. So the way I see it, it was aborted to save lives. That’s pro-choice, isn’t it? And if you believe, as I do, that Obama got elected by accepting money from China and Muslim nations, then the pregnancy was also the result of rape.
It’s odd, but I can’t remember anyone suggesting that caregivers just charge the poor and uninsured less. As it stands now, the poor get all the treatment they need, but then they get charged huge bills they can’t or won’t pay, and the rest of us (the ones who take bills seriously) end up subsidizing them. Why not just admit that we overtreat and overcharge people? Let’s give the poor and uninsured good but not excessive treatment, and let’s charge what the treatment is actually worth. Maybe some of them would actually pay, and that would bring prices down for the rest of us. And the poor would be more likely to go to doctors.
Whenever I think about health care prices, I think about my first kidney stone. Like all medical emergencies, it happened on a weekend night, so I had to go to the ER. They gave me a totally unnecessary scan that cost several thousand dollars. They doped me up and kept me on a Gurney all night, and then they sent me home on Saturday morning–still containing a stone–with enough Percocet to get me through one day. Because clearly, I was a drug-seeking patient, and I had magically generated a kidney stone in order to get enough pills to last until Monday.
In the end, they charged me around six grand. That includes a few hundred bucks for my urologist, who actually provided useful treatment.
What did I really need? I’m not a doctor, but I know what doctors have done with millions of other people with tiny kidney stones. They x-rayed their abdomens (or not), gave them painkillers, and waited for them to pee the stones out. You can do this, including drugs and a follow-up x-ray, for maybe six hundred bucks. Apart from the pointless scan, this is the treatment I received.
The second time I got a stone, I called my urologist’s office, and I got his unbelievably nasty receptionist, and I was so offended, I decided not to get treatment. And a couple of days later, I was fine. Total cost: $0.
Now I lay off the calcium antacids, and I go easy on tea. And I definitely don’t take calcium antacids WITH tea. No more stones.
Apologists can say, “You could have had cancer! You could have been on the verge of death! You should thank God you got that scan!” And my response is that you could say the same thing about someone who went in to get a pimple squeezed. You can mistake cancer for a pimple. Or for hemorrhoids, or for any of a huge number of other trivial ailments. The fact is, the odds that I had a serious problem were incredibly low, and if I had turned out to be seriously ill, it would have become obvious with or without a scan.
The purpose of the scan was to make money. And it worked.
Have you ever gotten sick overseas? It’s a very different experience. The care you get is likely to be nearly as good as the care you get here, but it costs much, much less, and it comes with fewer bells and whistles. For example, I knew a kibbutz volunteer whose appendix went crazy while he was visiting Jerusalem. The same day, he went to a charity hospital in the Old City, and they yanked his appendix out, and they sent him back to the kibbutz when he was ready to travel. Didn’t cost him a thing, because the Catholics paid for it. But if he had been charged, it would still have cost much less than American care, because they didn’t generate 3,000 pages of documentation and give him fifty things he didn’t need, and he didn’t get a private room with cable.
I sliced my finger open in the Bahamas. Did a real number on it. There was no doctor on the island, unless you count the vacationing Americans who were lying drunk on their yachts. I went to the local nurse, and she ran a giant needle up through my fingertip and out of the nail, and she tied it up and bandaged it and sent me home. I was fine. In an American ER, they would have given me a bone scan, an EKG, three caviar enemas, and a grief counselor. I didn’t pay her a dime, but even if she had charged, it would have been dirt cheap.
I’ll bet this would have been a $500 injury in the US. If you’ve paid to have a minor cut stitched, leave a comment and tell me what they charged.
The other big excuse is that lawyers force doctors to overtreat. Yes, I’m sure the added profit is no incentive at all. Because nobody ever went into medicine to make money. Everyone knows lawyers screw life up, but they’re not the whole explanation for our medical costs. Doctors proactively look for ways to charge more. My dentist now has a racket where he tries to charge you for an oral cancer exam, and if you don’t buy it, you have to sign a release. That’s so blatant, it’s nearly a scam. And the obvious inference is that if you don’t pay, and he sees a lesion anyway, he’s not going to tell you. I hope that isn’t the case.
I avoid doctors for the same reason I avoid mechanics. You can’t trust them. You go in for a trivial problem, and while you’re there, they look for other things that can make them money. And unless you’re Superman, they can always find something. Actually, that might not be enough to make you safe. “Hmm…I can’t get this needle into your Kryptonian vein. I better give you an expensive yet inconclusive test for scleroderma. And some type of scan, as soon as Steve gets out of the machine. He has a very ominous pimple.”
If I trusted doctors–if I had not been cheated so many times already–I would be more likely to visit them regularly. It’s that simple.
Here’s another idea. Why not fly the poor overseas for treatment? I know it sounds insane, but it isn’t. You can go to Central America, pay a pittance for top-quality surgery, stay in a resort hospital on a beach, pay for your airfare, and still come out way ahead. If you don’t like arepas, you can go to India and have curry. Or Singapore.
Let’s see. Here’s how it would work. Poor person shows up at hospital. They determine he can’t pay. They diagnose him with a condition requiring expensive surgery. They send him to Belize. He recovers and doesn’t pay. The benefit? Now the hospital can cover his small foreign bill out of money received from paying patients, instead of covering his huge American bill. Sounds nutty, I know, but if it saves money, why not?
I wonder if my medical insurance would cover treatment at a ritzy beach hospital. I would greatly prefer it, wouldn’t you? You’d think they would jump at it, if it saved them money. A 2008 Time article says insurance companies are starting to take the bait.
Speaking of great foreign deals, I still have no Chaiwanese milling machine. The rigger I’m working with just emailed, and he said the shipper called yesterday to ask if he could unload the machine from a box trailer. They were looking for a flatbed and couldn’t find one. This means that as of yesterday, the machine was in…CALIFORNIA. This is amazing. I just checked, and it appears that I ordered this thing seven weeks ago. I hadn’t realized so much time had passed. Twice, I’ve been told they shipped it, and twice it has turned out to be untrue.
The seller says he has a different brand of machine he can sell me; he’ll be getting them in a week and a half. I told him to go ahead and make the switch, if the other machine was still sitting 3000 miles away.
I’ve been waiting for lathe videos from Smartflix, and they arrived yesterday. These are from ATI. I highly recommend their stuff. It’s very methodical and thorough. I guess now that I know the milling machine isn’t going to be here in the near future, I should watch the lathe videos and try to get some things done. It’s tempting to stall when you think a new machine will arrive at any minute. A milling machine would make projects much easier, so I find myself wanting to wait until it gets here. I really don’t understand the guys who claim you can do all sorts of great things with just a lathe. It’s not true. You need to be able to make straight cuts, and you can’t do that with a lathe unless you spring for an expensive milling attachment. Here’s what you can do with just a lathe: you can make a machinist’s jack and a head for a hammer. And you can thread things and cut rods in two. That about sums it up. I’m exaggerating because I’m annoyed, but what I say is true in principle.
Let me close with something useful. Heather’s mom (an actual person) just had more surgery. Stents in her urinary tract. Please offer a prayer.
She probably should have gone to Costa Rica.
July 21st, 2009 at 10:50 AM
How much cheaper was the lathe you ordered than an equivalent Grizzly?
July 21st, 2009 at 11:10 AM
My daughter (the Amazing Moo, as we call ‘er) did a Scottish Hello on our coffee table when she was three and put a 1″ split into the fat part of her forehead.
Some would say any child of mine has an all fat head, but I say: their mom is smart and pretty so it’s probably only half fat.
Anyway, we went to the emergency room around 8pm on Saturday night, waited not too terribly long (college town, early for knife, gun, and bong club), and got into see everyone necessary.
“Sir, we can use this gee-whiz-bang adhesive and there will be no stitches or scarring.”
“You want to use cynoacrylite glue on my baby girl’s face?”
“No, sir, this is a medical adhesive that dries in less than a second.”
“So it’s model glue at a bazillion dollars an ounce?”
“No, but it works the exact same way. And there is no plastic surgeon necessary.”
“Ok, go for it.”
I got a $125 copayment for the general emergency room visit – fair enough as that is what my insurance says it should be. And then a few bucks, less than 20, for this-and-that.
And then a month later we got a bill for $1,900 dollars for a guy to walk in and apply glue to my kids face. From a non-hospital entity with no willingness or desire to play ball with my insurance company, who promptly paid $100 of it because that is what they’ll pay for stitches. Fair enough as well.
After arguing with them for 90 days they sicc’d the process servers on us, so I paid. No government cheese here.
However, that university hospital is part of my alma mater and they haven’t seen a dime from me or my wife (also a graduate) for 8+ years.
My story, YMMV, but no reason to hand over 8% of our GNP to the gubbmit.
Oh, and my daughter has no scar. If I’d known how beautiful she’d grow up I’d probably have rubbed dirt in the cut and planted radishes in it.
-XC
July 21st, 2009 at 11:15 AM
sliced my hand open badly in canada once, prooject paperclip german md stinking of vodka stitched me up while smoking. stitching was so bad i had to have the desk clerk at the hotel re-stitch me. Cost around $300 for horrible treatment by a drunk. Wondrous canadian healthcare!
upside, desk clerk now my wife of 15 years.
July 21st, 2009 at 11:21 AM
Note to self – don’t buy anything from the place you bought your mill….
July 21st, 2009 at 11:34 AM
The seller isn’t the problem. It’s the importer.
July 21st, 2009 at 11:36 AM
XC, my home remedy for cuts needing stitches is to cut a piece out of a plastic grocery bag and superglue it across the cut. Grocery bags are strong, and they don’t stretch. Did this with a 3/4″ cut on my finger, completely through the skin (playing with new pocket knife), and to this day, I can’t see where the knife went in.
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The guy who was NOT a plastic surgeon charged $1900? Wonder who it was. Maybe it was Lloyd Bridges, the week before he quit sniffing glue.
July 21st, 2009 at 11:47 AM
Everyone should go to Costa Rica. Costa Rica is beautiful, safe-ish, and affordable. It’s the Canada of South America.
July 21st, 2009 at 11:48 AM
Only with good medical care.
July 21st, 2009 at 12:20 PM
My 14 year old daughter had to be taken to the ER by ambulance because of an allergic reaction to an antibiotic. Her treatment consisted of Benadryl and Epinephrine to deal with the reaction as well as a bunch of blood tests. Part of the ER “protocol” was a pregnancy test which cost us $120! The kid hasn’t even dated yet!!
Total bill $2058.99 plus a $980.94 ambulance ride. The really sad part is we had managed to get an appointment with her doctor later in the afternoon, but she started passing out which prompted the call to 911. Yes, we really appreciate the excellent care she received and how quickly it was administered, but the difference between a $150.00 doctor bill and a $3000.00 ER bill is hard to stomach.
July 21st, 2009 at 2:12 PM
Regarding visits to the ER, the old engineering maxim applies: Fast, cheap and good (good should ead comprehensive): pick two.
July 21st, 2009 at 2:14 PM
Obvious overtreatment isn’t “good.” And the choice is false. It doesn’t have to be “cheap.” It can be “reasonable.”
July 21st, 2009 at 2:23 PM
The problem is ambulance-chasing lawyers. Got hurt/sick, had a bad outcome? SUE!!
Malpractice insurance is the – THE – number one expense for Doctors.
If he misses something, and also didn’t run every possible test/scan/etc. then he’ll get raped in court.
So, he runs every stupid test to CYA – that way he won’t be facing a hostile Atty saying “Why didn’t you do a whozzamahooey scan?”
FIRST thing to do to fix medicine is reform our judicial mess…
DD
July 21st, 2009 at 2:46 PM
I don’t have health insurance. I sprained my ankle severely about a month ago. I went to an urgent-care clinic. I waited three hours. I was seen by a DOCTOR, not a nurse-practitioner or a janitor like they do in England. The doctor took her time with me (as she apparently had with previous patients). Since I was out-of-pocket, she didn’t order an MRI, but just did a manual assessment. She gave me lots of good advice. Cost of the visit was about $60, which was less than it cost to get crutches and a brace at the drugstore. My ankle got better. If it hadn’t, I’d have known what to do next.
That’s about perfect, if you ask me. If I’d been insured, they’d have figured out a way to spend $1000. If I’d been insured under Obamacare, the doctor would be out of work, some administrator would be sipping fine brandy in a velvet La-Z-Boy, and I’d have seen the janitor.
July 21st, 2009 at 4:11 PM
Not quite as cut and dried as you would have it. The ER has to make money to cover the uninsured, so it soaks whoever has cash to cover itself. And to prevent the docs from being sued, yes, it will check to make sure you don’t have cancer. (So, doctor, when this patient presented with agonizing abdominal pain, why did you not screen for cancer? Uh, I thought it was a kidney stone…) That’s why costs in the ER are about 10-15 times that of your regular doctor. In other words, if you intend to pay for care, go to your regular doctor (preferably one who covers on weekends). Way cheaper, and less unnecessary care.
July 21st, 2009 at 5:22 PM
Nice effort, but they didn’t give me an scan to rule out cancer. They did it to make money. And it wasn’t because I went to the ER. My regular doctor wanted to give me a scan, too, and it was not an ER visit. It was a follow-up in his office. All I had to do to change his mind was ask if it was necessary. He admitted it was not. And he knew my father and I were both lawyers, before you start in with the malpractice stuff.
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Your argument is facially untenable. An x-ray can show the presence of a radio-opaque kidney stone as easily as an MRI or CAT scan. And it’s fast. My stone showed up just fine, and when it was gone, that was obvious, too.
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When you show up peeing blood, with pain in your ureter, and then a stone shows up on your KUB, it’s pretty obvious what the issue is. They don’t need to test you for everything from dandruff to lupus.
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I think my last point shouldn’t even have to be stated, but here it is. I was not able to avoid the ER, because that is my doctor’s weekend backstop. No one with any sense goes to the ER if they have any alternative. Here’s more information: the second time I had a stone, it was during the week, and his snotty receptionist told me to go to the ER, because he was working there that day.
July 21st, 2009 at 5:31 PM
Now that I think about it, your excuses for ER overcharges are even less credible than I realized. Here in Miami, we have clinics that handle things like injuries and vaccinations. I’ve used them. They don’t give you unnecessary tests to cover themselves against the litigation boogeyman, and they don’t overcharge. If they can do it, so can your local hospital.
July 21st, 2009 at 7:34 PM
I would much rather take advantage of modern medical technology and get a more expensive test to be certain the problem is what they think it is, rather than take a chance on “Oh, it’s probably xxx.” and end up with something much worse a month down the road that could have been treated had it been caught early by the MRI, CT, or whatever other amazing new tests they’ve come up with. But that’s me.
July 21st, 2009 at 7:36 PM
So every 14-year-old girl needs a pregnancy test when she goes in for a sprain?
July 21st, 2009 at 7:38 PM
Thanks Steve!
July 21st, 2009 at 7:52 PM
Heh, no, but if I had severe abdominal pain and was urinating blood, I’d much prefer an MRI to a plain old x-ray. 🙂
July 21st, 2009 at 7:55 PM
I guess if you broke your ankle, you’d want an MRI to make sure it wasn’t pneumonia.
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Some would say a kidney stone that clearly showed up on an x-ray, combined with classic kidney stone symptoms and a family history of kidney stones, were pretty good indications that it was a kidney stone.
July 21st, 2009 at 8:12 PM
Or, the Dr. can charge two levels of fees. I went to an orthopedist for shots to my knees. I came out after a shot in each knee to a bill of $700+. After picking my jaw off the ground, the nurse at the desk told me there was a different level of payment for the uninsured. ( The Dr. was not part of my network ) The price dropped to $291. To me, that’s still high, but the relief was worth it.
July 21st, 2009 at 8:17 PM
It always irks me when medical people say, “You can pay whatever we charge, or risk [insert horrible fate here].” They’re like funeral directors who quote obscene prices to bereaved people who are too embarrassed to complain. The truth is that they play up minuscule risks in order to get us to shut up and pay. You might as well say, “Never cross a street, because some people get run over.” Reasonable risks are part of life, and manipulating people by exaggerating risk is just a clever way of lying.
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When I was a kid, I went to the doctor for sore throats and fevers many, many times. Every time, they could have put me in intensive care and claimed I might have bubonic plague or typhus or God knows what else. But they didn’t. And they didn’t take cultures to see what I had. Because they knew that most of the time, strep symptoms mean strep, cold symptoms mean a cold, and tonsillitis symptoms mean tonsillitis. Giving me unneeded treatment would not have been caution. It would have been fraud.
July 21st, 2009 at 10:54 PM
Obamacare fanatics present with a clearly definded set of symptoms, clearly indicating the cause of their malady.
Pity, medical science hasn’t a cure for Chronic Cerebral Rectumitus.
The only known cures are Christ, being mugged and converted to conservatism, either by a real thug of a mugger, or by the IRS, or other Obamiphile functionary.
Jim
Sunk New Dawn
Galveston, TX
July 22nd, 2009 at 8:09 AM
Steve, be fair, in the old days, if it looked like strep they gave antibiotics, even if it was viral not bacterial. We went to the doctor for antibiotics because they were miracle drugs and one must not feel ill with such good things around. The fact was (is) people were (are) lazy and did not take the full course of meds. The bugs got resistant to more and stronger antibiotics. Now a culture must be run so and appropriate anitbiotic, or perhaps no antibiotic at all, can be prescribed. This is a direct result from those times. We are really at fault for a lot of this particular situation.
July 22nd, 2009 at 8:52 AM
That doesn’t have much relationship to the discussion of overtreatment. A kid with a fever (and mine used to top 103) could conceivably have a life-threatening disease that merits a trip to the ICU, and that was true when I was a kid, just as it is now. A greedy doctor could have persuaded my nervous mother to foot the bill for a boondoggle like that, but none of them ever did.
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Also, I suspect that you don’t really know if what you say is true. I doubt that it is. I’ve been treated with antibiotics during the last 10 years. They never took a culture before prescribing. In fact, a doctor gave me penicillin for a pus-filled boil that turned out to contain no bacteria at all. It was probably a reaction to a spider bite.
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That happened to me twice, and each time, the same doctor refrained from assuming I had a horrible disease, and I was not overtreated, and here I am, alive and well. She knew I was a law student. I guess the fear of litigation is not all it’s cracked up to be.
July 22nd, 2009 at 9:07 AM
Steve, You are right about overtreatment. My point is your simplistic statement about the “Antibiotic Regimin” used when you were a kid (BTW, I experienced the same treatment) and not needing cultures had undesirable consequences on treatment today.
Just a few:
http://www.mayoclinic.com/health/antibiotics/FL00075
http://origin.cdc.gov/ncidod/eid/vol10no3/03-0252.htm
https://www.stfm.org/Fullpdf/Jan00/Sa2.pdf
July 22nd, 2009 at 9:13 AM
I don’t see where I mentioned antibiotics. They didn’t always give me antibiotics, for that matter. They weren’t witch doctors; this was the Sixties and Seventies. We had electricity and everything. Sometimes they actually knew whether antibiotics were needed. It wasn’t like the Middle Ages. They weren’t feeding me worm tea and putting manure on my sores.
July 22nd, 2009 at 9:28 AM
Steve, perhaps I was projecting my experiences on your statement, I apologise, but still stand my my overall comment.
July 23rd, 2009 at 1:29 PM
A few years back my son slipped on the ice and got a couple of gashes above his eyebrow. While on the way to the ER, my friend the ENT surgeon called to see if we were okay (it was a big ice storm) and said to take my son to his office instead. He said it would cost a ton less than the ER and take way less time.
He did an amazing job. He managed to rearrange the tears into a single very smooth line that almost blended in with the eyebrow and you can barely see it. Absolutely top notch work. $1200.
And I’m pretty sure that was a discounted rate for us. He said the ER would be at least two or three times his normal rate.