My Drug Problem, and Yours
I've spent the past seven days lying around the house in a drug-fueled haze. Sort of like Charlie Sheen, except in my case the house is occupied by only one female (my dog) and the drug in question is Levaquin, a powerful antibiotic they only give out for the really nasty stuff.
I'd been fighting a recurring fever for weeks -- I know, I know -- and last week, driving into Greenville, SC for a meeting, I just couldn't go any further. I pulled into the hospital, staggered to the ER, and they took one look at me and admitted me, instantly began running an alarming series of tests, and hooked me up to an IV.
The IV, I'm here to tell you, was like a wonder drug itself. I instantly felt better. I could easily get used to having one a day -- what I like to call the Michael Jackson Lifestyle.
So, five hours and many many terrifying tests later, I walked out with a quasi-diagnosis -- massive bacterial infection of some kind -- and a scrip for Levaquin.
As of today, I have no idea -- zero -- what the whole thing cost. (My insurance is good, for which I'm grateful.) I do know what Levaquin costs -- about $40 per pill, which for a 10 pill scrip is a lot of money. I paid $15 for the whole bottle, which is another reason I'm pleased with my insurance.
And yet.
This is a perfect example of the problem with the American health care system. I was treated -- essentially for free -- in an emergency room, but only because I left it until it was too awful. In other words, I created the emergency. For which I was penalized not a jot.
Had I left my grocery shopping, say, to 3AM, I'd have to go to the all-night grocery store. And I'd pay a little more for the privilege.
Look, there are two ways to reduce the costs of anything. One way, the Obamacare way, is to create a price-management authority and set prices from a central office. That hasn't worked, ever, in the entire sad pageant of human history. Potatoes in Poland, rents in Manhattan, health care in America -- control the price of something and you get less of it, at a higher cost.
The solution is for more of us -- especially people like me -- to pay more out of pocket, to be price-sensitive, to create a market. The market creates lower prices for everyone, even idiots like me who leave it all until it's too serious for regular office hours and the el cheapo antibiotics.
What I mean to say is, I should have to pay more, and I should have had the incentive to get this all dealt with in a less urgent fashion. Instead, without a financial incentive, I did it all the most expensive way possible, an expensive way shared and subsidized by everyone else in the Blue Cross system, for which my total cost is about $15.
This is no way to run a health care system.
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May '10
Re: My Drug Problem, and Yours
My husband definitely sees this behavior first hand in the ORs. They are always slower early in the year when people start over with their deductible and then they get slammed from October on. It's around the time many people have paid their deductibles, so they're all scrambling to get their surgeries in before the end of the year. The demand is completely insane and my husband and the other physicians work around the clock for several months trying to accommodate it. So, they're gasping for air in January (and sleep). It's all about incentive.
May '10
Re: My Drug Problem, and Yours
Our man Steyn tackled the idea of preventative medicine a while back at NRO.
LINK
May '10
Re: My Drug Problem, and Yours
LIKE! I hope you feel better soon, too!
Jun '10
Re: My Drug Problem, and Yours
I hope you get well soon.
The system is broken is well known, what to do about it less so. Hospital emergency rooms constantly complain about non-emergency patients overcrowding ERs. Parents know children don't get sick on schedule, people wait as long as they can to hold off the expense of seeing a doctor, especially when they have no insurance, the list goes on.
Despite the complaints there has been no incentive to change the system, yet useful change is possible. The local military base I go to has created an acute care clinic that runs in conjunction with their ER and sees those who's illnesses do not require the resources and expense of an ER. I don't know the percentage of people they see vice the ER, but I'd guess it was high. Last time I had occasion to visit the ER for my heart problem the Acute Care clinic was full, but the ER was empty except for me.
Changing the system would change the expense, and this is a change that makes good sense.
Feb '11
Re: My Drug Problem, and Yours
EJHill
Exactly. Then the health care providers would lower what they charge since fewer people would come in. That's the demand in supply and demand. · Apr 18 at 7:17pm
Agreed, but Rob's point was that if he were more sensitive to costs, he would have gone to the doctor earlier in order to avoid the ER and Levaquin expenses. That doesn't seem likely to me. A greater sensitivity to costs would have, at least in Rob's case, probably resulted in the same outcome--putting off seeking care until he absolutely couldn't wait anymore and stumbled into the nearest ER.
My point is that Rob didn't go to his GP for a fever because
Adding cost sensitivity to that list doesn't make it more likely he'd go to his GP, but less.
Edited on April 19, 2011 at 5:31amRe: My Drug Problem, and Yours
I'm afraid you're right. I'll keep you all posted. Still, though, I'll bet it's not much considering the CT scan, the nuclear medicine, and the ultrasound.
(It was a long, long night......)
Re: My Drug Problem, and Yours
common_sense_and_good_judgment
EJHill
Exactly. Then the health care providers would lower what they charge since fewer people would come in. That's the demand in supply and demand. · Apr 18 at 7:17pm
Agreed, but Rob's point was that if he were more sensitive to costs, he would have gone to the doctor earlier in order to avoid the ER and Levaquin expenses. That doesn't seem likely to me. A greater sensitivity to costs would have, at least in Rob's case, probably resulted in the same outcome--putting off seeking care until he absolutely couldn't wait anymore and stumbled into the nearest ER.
My point is that Rob didn't go to his GP for a fever because
You've got me pegged. But I still think there should be a financial penalty for my bad judgement.
May '10
Re: My Drug Problem, and Yours
Rob, I'm glad you revisited the subject as I wanted to "Beau Gest" you in the podcast thread and got derailed.
Now, I gotta get some liberals to take on the gang over at Hoover and really start the rumble...
Hope you feel better.
Re: My Drug Problem, and Yours
Hey Rob. I'm more than happy to subsidize a friend...really. And your situation doesn't even begin to budge the Stupid Visit Meter for this here ex-ER doc.
But next time you have a 102F fever for, like, weeks, drop me an email, okay?
I'm here to help.
Mar '11
Re: My Drug Problem, and Yours
It is the folks who visit the ER for everything from colds to delerium tremens that is costing us. My wife is a nurse (albeit not in the ER, but her team consults with the ER) at one of the inner city hospitals in town. The place fills up, especially in the evening, with these people, who aren't able (or won't) pay, using the ER as a GP. They chalk up all these charges just to get prescribed two aspirin and Robitussin. It is crazy. And it isn't like this town is lacking in the free clinic department.
Jun '10
Re: My Drug Problem, and Yours
Fat Dave knows the score. ERs used as GPs are an enormous drain on our medical resources. So is end of life care --- what Sarah Palin referred to as "death panels," where octagenarians with chronic, painful illnesses have family members insisting on end-stage heroic attempts to keep them on the planet for another week or two. The hospice movement should be embraced and we should educate all citizens about the futility and waste when for whatever reason, death with dignity is not granted to our seniors.
My daughter just pulled a Rob last week. She ignored sinus/wicked cold symptoms for a few busy, crazy days because the campus health office closes at 5PM. She texted me at 10PM saying she was crying in pain from a splitting headache and a stiff neck. I was texting her like mad --- get to the ER -- possible meningitis !!!!! Over 12 hours in one of the nation's finest hospitals, with CAT scan, IV fluids, extensive blood work & cultures. Diagnosis: mono. Treatment: rest, rest, rest and plenty of fuids. Over the counter decongestants for sinus pressure. Tylenol for the pain of golfball sized lymph nodes.
I dread this bill.......
Jun '10
Re: My Drug Problem, and Yours
Delerium tremens are a medical emergency and it is appropriate to be in the ER. But there are so many Medicaid patients who would rather go to the ER than buy a bottle of Tylenol from their own pocket it is astounding.
Same with vaccinations. They are free in America to anyone who wants them. You just need to pay attention to clinic hours and schedule an appointment. I worked a bit in a free clinic during nursing school & was so sick to death of moms demanding the full course of vaccines be administered to their five year old kid at once so he could start school. They had abdicated their parental responsibility, which would have cost them nothing but time, for years, & were quite testy when told no.
There has to be some type of connection between health care and cost/responsibility to the patient. When services are free, they are not appreciated. These same parents often had acrylic tip manicures and expensive handbags. I remember one was angry because the family was flying to DisneyWorld the next day for a vacation before school began.
Don't get me started with the condition of kids' teeth......
Jul '10
Re: My Drug Problem, and Yours
First. The problem is you don't know how much it costs.
That is, you don't know the prices of the procedures, etc. And Thomas Sowell has taught that the only thing that reflects the true cost of anything is the price. In an ideal world you'd be charged the amount. Then you would have to see how much your insurance would cover. Kind of like auto insurance. But for regular doctor visits, you'd pay out of pocket.
Second. Walmarts and some Targets are open all night. Those be some cheap groceries.
Mar '11
Re: My Drug Problem, and Yours
StickerShock,
I had debated using the term hangover, but went a little over dramatic. My wife is a vocal proponent of hospice and taking a more realistic view in end-of-life cases, whether with an octogenarian or a sixteen-year-old who's been in a horrible car wreck. She complains that while nurses are taught to ease pain, doctors are trained to do whatever they can to keep someone alive regardless of the outcome. This indoctrination leads to situations where a patient with three different fatal conditions overseen by three different departments can have surgery after surgery. This is because the doctors treating condition A won't admit that the patient will probably die during surgery, and certainly will die from conditions B and C. Same for the doctors treating conditions B and C. So each team of doctors schedule a week of surgeries that the taxpayers will pay for just so they can get their Superman kick. She mentions this situation at least once a month.
Edited on April 19, 2011 at 11:44pmJun '10
Re: My Drug Problem, and Yours
Services provided in the middle of the night usually cost extra. But with health care, we are accustomed to having the caregivers available round-the-clock & would bristle if expected to pay a premium based on time of day. Nothing about today's health care system has the slightest connection to market forces. It's nuts.
If your car starts making an awful noise at 2AM & the check engine light comes on you can just pull over, park, and call a cab with intentions to figure it all out in the morning. My daughter did not have the option of putting off medical care when she had all the symptoms of meningitis --- she could have been dead in the morning.
It's tricky, to say the least.
Jun '10
Re: My Drug Problem, and Yours
Exactly, Dave.
I am a Palin fan, but her "death panel" rhetoric was very, very unfortunate. Families don't know the real story about how their loved ones are often put through hell for questionable reasons at the end stages of life.
Another barrier to market forces working -- there are laws in place that prevent any disparity in standard of care being offered to private insurance patiients and Medicaid patients. In health care, it's all about fairness, it seems. This applies not just to medical procedures and devices and treatments, but the number of beds in a room. In otherwords, you can't pay for a private room -- it would only be available if every patient got one. So the maternity ward, which was an efficient set-up in which indigent women could give birth, no longer exists. Costs rise with decisions like these. In addition, someone who pays through the nose for Cadillac health care premiums could have meds or treatments denied at the hospital because only the Medicaid-approved items can be given to all patients.
Jan '11
Re: My Drug Problem, and Yours
Rob,
I hope your feeling better and the Levaquin takes care of the infection, if any. I know what you mean by the IV's being instant relief. When I had a serious infection I became completely dehydrated and the IV's weretotal refreshment even though they were only putting H2O back into my system. I'm praying for your quick return to health.
Nov '10
Re: My Drug Problem, and Yours
You pointed out one problem, that you weren't penalized for using the most expensive means of getting seen, the ER. I think most plans have a $50 or $100 co-pay at the ER. The fact that yours doesn't just proves you are an elite.
But my real point is that is not the only problem. I think a more significant problem is that you don't know how much it cost. And that is the real kicker. In most industries, the consumer foots the bill. Knowing what it costs forces them to shop around. I'm in desperate need of a new deck, so I'm looking at composite material. Everyone's got it for a different price. I'm trying to wheel and deal. You can't do that with health care, precisely because of insurance. Some doctors have cash discount, but most just charge what they charge. Where i live it costs about $1000 to get a crown. Thats what everyone charges. I've tried to shop around, wheel and deal, but no dice. It's $1,000 and insurance covers half. It's nuts. The way to solve healthcare is to make people pay!