Health Care: It's Fallen and It Can't Get Up
As I noted previously, I'm a Republican. Among other things, I believe in the private enterprise system and oppose socialized health care, also known as the "single-payer-system."
At the same time, I try never to avoid reality, and the truth is our health care system is broken -- and likely to remain so. To paraphrase the old woman in the "Alert" commercial, it has fallen, and it can't get up.
Hospitals, many of them, aren't very good at what they're supposed to do: keeping people healthy.
In today's (November 21, 2006) Pittsburgh Post-Gazette, there's a story by Jerome Sherman and Joe Fahy, two very good reporters. The headline is, "Hospitals Blamed for Many Infections" and deals with three studies describing how patients contact new illnesses while supposedly receiving care.
Sherman and Fahy quote Mark Volavka, executive director of the Pennsylvania Health Care Containment Council, who said: "The simple fact is that every patient who enters a hospital in Pennsylvania and in this country is at risk for a hospital-acquired infection."
Volavka notes that as many as 150 American die each day from such infections -- roughly 55,000 people annually. He adds that hospitals lose about $26,000 per patient for certain bloodstream infections.
Who pays that $26,000 per hospital-caused bloodstream illnesses? Ultimately, you do -- unless perhaps you believe in the myth that hospitals absorb the costs out of the goodness of their hearts.
Hospital costs -- and medical costs generally -- are completely out-of-control. Only two segments of society aren't aware of this: (1) the diminishing number of people who have very good insurance; (2) the large number of impoverished people who basically get "free" care that ends up getting paid for by the government (through the Medicaid program for the poor).
Since the government essentially has no money other than what it gets from taxpayers, we pay for number 2: the impoverished in need of health care.
As the Sherman-Fahy piece demonstrates, infections contracted in hospitals add substantially to costs. But some hospital costs are mysteries.
Remember the line in "Field of Dreams" that said, "If you build it, they will come?" The hospital version is: if we charge it -- no matter how high -- someone, somehow will pay it.
Consider the following sad but true story: My brother (in his 60s with a long history of substance abuse and low wage jobs) had a stroke in Febuary, 2005 and subsequently lived with my wife and me for a year.
One day at physical therapy, he experienced faintness and low blood pressure. The ambulance came and took him the 10 miles to a University of Pittsburgh Medical Center (UPMC) hospital.
My brother had no health insurance at the time. We had been using his small Social Security payment, supplemented with our own money, to pay for his medicines ($450-plus per month) and therapy (twice a week, $110 per session).
The ten-mile trip to the hospital in the ambulance cost $850.00. Why so much? Well, like most people in health care, the ambulance service has a "don't ask, don't tell" policy when it comes to charges.
My brother spent 28 hours at UPMC (first in the emergency room and later in a regular room). He had various tests, which didn't tell the doctors much.
Then, they released him.
The first bill I saw from the hospital was $22,600, but for reasons that remained unclear, it got reduced to a mere $17,600.
When we told the hospital it might as well be $1,176,000.00, they say basically, "Not to worry." They have a retained firm that helps people get on Medicaid.
(Earlier, a social worker at the same hospital had told us my brother was not eligible for Medicaid, which he'd earlier had in New Jersey. She said PA Medicaid would disqualify him because it would factor in his small amount of income with ours.)
UPMC did help get him on Medicaid, but that agency wouldn't pay the entire amount due. It paid about $11,000, which of course comes out of tax money and goes in the hospital's pocket.
The hospital wanted him to pay an additional $4500.00, which he didn't have. At that point, irritated by the absurdly high bills, I dug my hells in and told them the money they wanted was "uncollectible."
But hadn't my brother received real services from the hospital? Judge for yourself.
After a day of medical tests, the doctors proclaimed that he had "syncope." That is med-speak for a person feeling faint and having temporary low blood pressure.
Of course that's exactly what we told them he had when he went into emergency. Don't get us wrong; we were glad to learn a new word: sycope. However . . .
The $17,600 for syncope is about the same as the cost for a small, but decent new car, or for a month in a four-star hotel in Hawaii.
No society is rich enough to pay those kinds of costs. In the next decade, one of every $5 of GDP will go to health care, with no end in sight.
Did I ever find out what caused my brother's syncope? Yes, months later I took a stress test, and I described the event to a young man with a background in nuclear medicine.
This non-doctor said it happened often with the stress tests. Essentially, fear affects the vagus nerve and cuts off -- temporarily -- the blood supply to the brain, resulting in a person's feeling faint and having his or her blood pressure go down.
He said my brother's therapist was having him do something, walk up a few steps, that caused him to be fearful. That made the vagus nerve kick in and cause the syncope.
The stress-test man gave me the diagnosis free-of-charge.
I submit that the $22,600 -- or $17,600 -- costs for someone feeling faint are unsustainable. What if he'd had something truly wrong with him?
No society can absorb this kind of costs for a multitude of patients in thousands of hospitals.
Won't the new Democratic leadership in Congress do something about this situation? Don't be on it.
Take my new congressman, Jason Altmire. His previously job was as a lobbyist for . . . UPMC.
Or what about Rep. Jack Murtha, against whom I worked so hard this year? Well, Murtha, one of Nancy Pelosi's key allies, received $100,000 from UPMC's political action committee (PAC).
Apparently, he got additional tens of thousands of personal contributions from grateful doctors and administrators at the hospital. (Go to opensecrets.org to see for yourself.)
Thus, I wouldn't look for Altmire and Murtha to be advocates for reforming the bizarre system at UPMC -- or any other hospital.
Stephen R. Maloney has worked on health care issues for Aetna, The Hartford Insurance Company, Blue Cross Blue Shield (GA & PA), Deloitte-Touche, Merck, Eli Lilly, and PhRMA.