Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.
Friday, April 27, 2012
Why is Medical Care So Expensive?
By Rod Moser, PA, PhD
The day before my shoulder surgery, I was pondering how much it will cost. My cost will be a hundred dollar co-pay, but what is my group charging the insurance company, and how much of that cost is really “fluff”? My last surgery in November cost more than my first house. My MRI alone cost more than my first car. If I had to take a wild guess, I would say it is going to be in the $40,000 range, perhaps more. I guess I shouldn’t care, since I am not paying it, but I do care.
I grew up in the 1950’s. Even adjusted for inflation and the fact that I was in a rural Appalachian town, our office visits were $3. A house call was $5, and that included any medications (usually a painful penicillin shot). That was sixty years ago, when a house cost about $14,000, a car cost $1500, and gasoline was a whopping 18-25 cents per gallon (including complimentary windshield washing, and checking oil/tire pressures). My family, like many families that I care for in my practice, did not have health insurance. Of course, at those bargain prices, they just paid for it.
There were few, if any, health insurance companies in the 1950’s, but they were starting. The federal government had a commitment to care for the poor and elderly through welfare. Hospital prices doubled. By the 1960’s, there were 700 private insurance companies, and President Johnson signed the Medicare and Medicaid bills. Prices continued to climb. In 1969, I had my appendix removed. I suspect Medicaid paid for it, since our family income was around $5,000 a year at that time.
America was in a health crisis, of sorts, but nothing like what was to come. The largest problem was doctor shortages, especially in primary care. Now that insurance companies were paying the bills, doctors migrated into the more lucrative specialty areas. Over 69% of the doctors at that time were specialists, so the federal government and private institutions funded grants and scholarships to train more general practitioners (renamed, family practice physician), and of course, PAs and nurse practitioners. I received one of the healthcare shortage grants from the Commonwealth Fund.
We are now in a real crisis, since the cost of medical care and insurance has seriously outpaced inflation. It is out of control. Nearly 50 million Americans do not have health insurance, and those that do often discover their insurance policies cover less and less. I have patients in my practice who have a $5,000 to $10,000 deductable before their policy even kicks in. The out-of-pocket expenses and higher premium costs are crippling small companies and hard-working families. The Medicaid and Medicare programs are costing our country more than any other industrial country on this planet – soon to approach $4.3 trillion dollars a year, or about $13,100 per person. Unbelievable, yet it is happening.
Who do we blame? We can blame the high cost of malpractice insurance and those astronomical lawsuits against doctors for mistakes. We can blame those money-grabbing insurance companies. We can blame the CEOs of large hospital groups as some of the highest paid businessmen in the world. We can blame pharmaceutical companies for high-priced drugs, or technology for inventing new ways to diagnose and treat patients more expensively and help us live longer. We can blame old people for living longer and spending more health care dollars. We can blame the economy for putting people out of work and on Medicaid, if they can get it. We can blame the emergency rooms for charging $2,000 for treating an ear infection, or the person without insurance who feels going to the ER for an ear infection is an appropriate course of action. Or, we can blame ourselves for being too fat, too self-indulgent, and living unhealthy lifestyles. You pick.
In the 1950’s, we actually hospitalized patients to treat middle-ear infections. We did not insert tubes, but we did lance the eardrums. We did not have the armada of antibiotics to treat them, and now we find that antibiotics are probably not even needed in most cases. The most frequent surgery done in the United States is the insertion of tubes in children for middle ear infections. This is a procedure that takes less than ten minutes in most cases, and cost about $3,000. There is a profit margin in there somewhere, so I wonder who is getting the cash? It isn’t me.
Before someone accuses me of being a hypocrite by being a part of this shady profession, I have to inform you that I am on a salary that is not commensurate with my three university degrees and four decades of experience. I make about a third of what my physician counterparts earn, since I am not a partner, and I generate eight-times my salary in charges. I work for the “man” and not a day goes by where I am not embarrassed to circle that billing code. I do a lot of apologies in advance since I have little or no control over those charges. Why do I do it? I need a job and health insurance, just like everyone else. We are truly caught in a never-ending loop.
Many times, I thought about opening a drive-through medical clinic (McMoser? Doc in the Box?, Jiffy Care?) and charge cash at the window. I would cut out the insurance companies, charge a fraction of the current office visit charges, and send people away happier. I would likely get run out of town.
It is no wonder why people are jumping on airplanes to go to India, Thailand, or Singapore for elective surgeries. People should not have to spend their life savings and sell their homes, assuming they still have one, to pay for a new hip or knee replacement.
Obama-care or whatever they call it is not the answer, but it may be a step in the right direction. As a country, we must get control of this “patient” by providing affordable health care, no matter who pays for it. I am not a big fan of the government, with its over-spending reputation, taking charge of medical care, but someone needs to step in before it’s too late.
We need a medical messiah.
We need a miracle.
The “patient” is dying.
Photo: Creatas
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