I'm Part of the Problem
Yesterday, I inadvertently squandered $4000 plus worth of medical resources during a lunch break. That I could do this, gain no benefit, and not even see the bills, is what's right and wrong with American medical care.
I'll tell the story in moment but first consider that none of the politically active reform proposals being debated deal with the absence of market pricing for medical care, that system-wide problem that there is a disconnect between the supplier and the consumer, and this problem is absolutely pervasive. You rarely know the prices of what you are getting, and even when you do, the prices are an abstraction: something to know but not act on, since they don't really affect your premiums as with other forms of insurance.
The result is hardly surprising. End-user costs soar higher and higher and resource use lacks that essential component of economizing by priority. The American system just assumes that there is no such thing as too much technology, too many drugs, too much service, too much care. The consumer, in the end, isn't really a consumer but a passive conduit of an unchecked contractual relationship between producer and third-party payers who are heavily subsidized by taxpayers.
So now my slightly goofy story of how I spent probably $4000 yesterday without knowing it. I had a chest cold of some sort that was getting on my nerves, so I finally decided to see the doctor at a walk-in clinic. I complained of tightness in my chest that wouldn't go away. Within minutes, an EKG machine was hooked up to my heart and x-rays were being taken of my chest. Fifteen minutes later, the doctor came back to tell me that he found a big black spot on my lungs. He inquired about my past smoking.
Of course at this point, I'm ashen and woozy and worrying about who will update my Facebook page after I'm dead. The doctor orders a cat scan: "stat!" Suddenly, I felt like I was in a television show. I make my way to a medical specialist company, a place that looks like an industrial castle. I'm greeted by receptionists, hooked up to an IV by nurse practitioners, and slapped down on the scanning machine, which whirls and buzzes wildly all over my chest. The staff gathers around the pictures I could not see but I can see all these people's faces through a glass. They are staring and pointing with looks of intense seriousness. Meanwhile, the scans are sent to a radiologist in Tennessee, who is also examining them.
In my mind, I've already divided up my property among heirs and I'm hoping that I have time to train someone to do stuff that I do. My final wishes for world peace and prosperity will be written in my last message to the world, read to all those gathered at my funeral.
Thirty minutes later, they gather to tell me the news. Nothing. No one can see anything at all. My lungs are pink, my heart is working away, and I'm healthy as can be. The nurse suggests that the walk-in clinic needs to fix their x-ray machine, which is evidently throwing blacks spots around the images. Maybe it is a filter. Maybe someone bumped the machine. Regardless, my life was back and I appreciated all things anew.
Oh but wait. I pointed out to them that I never received anything for my chest cold. The lady said: "oh that. Take some Mucinex."
And that's what $4000 bought yesterday between the hours of 1 and 5pm. Maybe it was more. Maybe it was less. I don't really know.
On the one hand, the whole process was amazing. The speed! The efficiency! The miraculous technology! On the other hand, it was all wholly unnecessary. Now, you might say, hey, don't complain: at least you know. That's true enough. But if there were really a concern about costs, I'm not entirely sure this would have happened. And can there be any doubt that the scan was ordered over liability concerns mainly?
Lots of people benefit in this system. You could say that I benefited. But at what cost? And is the cost proportional to the benefit? This is what the system doesn't seem to address. And the reform proposals, so far as I can tell, are designed to make what I went through a universal feature of American medicine. It's wishful thinking, and while the attempt might last a while, eventually it will go the same way all such attempts go: skyrocketing costs and universal stagnation.