Musings (okay, a rant) on health care.

Everyone knows that the health care system in this country leaves much to be desired. Lately, I've been dealing with some of the reasons why.


Here is the picture:
A while back I had an admitted Mommy meltdown and took Isaac to the ER because there was a slight chance that he had ingested some Tylenol. I asked to have his blood tested for acetaminophen. One test. Just for the Tylenol.


When we got the invoice, I was surprised to see five items for "Laboratory" and charges totaling almost $1000. Intriguing. Numerous phone calls later, it was revealed that Isaac had been tested for Tylenol and aspirin and alcohol and to make sure various internal organs were still functioning. And anyway, what kind of mother would NOT want her child to get tested for all of these substances if given the chance? The last person I spoke to summed up the situation nicely: "We would NEVER make a medical decision based on monetary considerations." Me: "So this is about liability, then?" Administrator, with some shock: "No, this is about the health of a child." Me: "Grrrr....."

I can spot about five things wrong with this picture. How about you?
1) I asked for one test and ended up with many more. The given reason for this was "standard practice." Apparently, if a child is exposed to one medication he is likely to have been exposed to others. Really? In every circumstance? Even in our particular circumstance, where even the ER doc agreed that it was unlikely he had consumed any Tylenol let alone another substance? I don't think so.
So let's do a thought experiment: If patients were allowed to pay less for every test that came back negative, do you think all of these tests would still be "standard practice?"
I'm not saying that anyone is consciously trying to milk money from patients. But surely when income is dependent on the number and complexity of medical tests given, it must influence, to some extent, decision-making at many levels of the administrative tree.

2) I asked for one test and ended up with many more. Repeating myself on purpose, here. I do have a vague memory that the doctor mentioned something about testing Isaac's blood for other things. At 11:00 p.m. When I was trying to keep Isaac happy, and feeling guilty about being there in the first place. I'm not sure that counts as full disclosure. Regardless, subsequent conversations made clear that any protests about extraneous testing would have been met with a decent amount of resistance.

3) Five charges for "Laboratory." I should point out that these five charges were listed on the initial invoice we got from our insurance company. The actual bill just lumped everything together. Of course, even if it had divided the amount into five Laboratory charges, so what? It took at at least three phone calls to figure out what each charge meant. I want to know exactly what I'm paying for - in plain written English.

4) Shock and awe. Medical bills are always scary because you never know what to expect. Why not? Why don't I know what's coming? In other words, not only do I want my medical bills to be itemized, I want to have a sense of how much the total is going to be before I open up that mean white envelope. If Isaac's ER doc had ascribed a dollar amount to each one - even an approximated amount - it would have solved many problems. First, it would have saved me some time later on as I tried to figure out for what I was being billed. Second, it might have clarified the procedures being done. Third, it may have motivated me enough to speak up and at least engage the doctor as to why certain tests were administered. Obviously, upfront cost disclosure isn't practical in all situations. Often, medical decisions need to be fast and furious and sometimes there are no options. But such preventable things have happened to us before. For example, mere minutes before getting a third trimester (i.e., too late to do anything about it now) ultrasound I had to sign a form saying that I would pay for it if the insurance company didn't. No mention of how much it was going to cost (turns out my insurance didn't cover most of it). And I never did find out what they were looking for, or why it was important.

5) We would NEVER make a medical decision based on monetary considerations. Well how terribly convenient, since you are not paying for that medical decision. I am. And as lovely as it would be to think that all of our decisions occur in a monetary black hole, they just don't. Permit me another example: I had a CAT scan administered via the ER since the main medical offices had closed for the day. It was my choice whether to have the scan then, or wait until Monday. If I had known the cost, I would have waited until Monday. Risky? Maybe. But at least a more informed decision.

*End Rant*

I am worried about coming across as feeling negative about doctors and the job they do. This is not so. Some of the people I admire most are in the health care business and they're just concerned with making their patients better. But I do think there is a detrimental disconnect among the money and the medical decisions and the information imparted to the patient. And the whole thing just looks like a black box to the patient - a box shut so tight it seems useless to try and open it. I'm a trusting sort, and I generally go with whatever a medical doctor recommends. I know I should take more control of my health care - ask more questions, and so forth - and I think knowing about cost might provide a bit more motivation to do so. Perhaps it would also motivate other people.
Finally, I'm enough of a navel-gazer to realize that some of my annoyance comes from being in this situation in the first place. No doubt, I'm projecting some of my guilt about taking Isaac to the ER (for nothing!) onto the health care system. But it's such a behemoth, surely it won't even notice. I guess that's part of the problem, too.