The real problem with US Health Care

As of this writing the new Health Care Reform Bill has just passed the Senate Finance Committee. As is typical of legislation in the modern era, this bill is long, complicated and contains everything but the kitchen sink. For this article, I will include a summary

This is the House Democrats’ big health care reform bill. Broadly, it seeks to expand health care coverage to the approximately 40 million Americans who are currently uninsured by lowering the cost of health care and making the system more efficient. To that end, it includes a new government-run insurance plan (a.k.a. a public option) to compete with the private companies, a requirement that all Americans have health insurance, a prohibition on denying coverage because of pre-existing conditions and, to pay for it all, a surtax on households with an income above $350,000.

The bill focuses on ‘insurance’ for everyone, but this avoids the whole issue. The real problem with health care in this country doesn’t revolve around insurance, it revolves around cost. I know this for a fact due to a recent experience of mine.

Two weeks ago I awoke on a Saturday morning with an abdominal pain in the lower right quadrant (the area where the appendix is). By Sunday evening it hadn’t subsided, and appendicitis can cause an appendix to burst after 48 hours, so my family and I decided I should go to the hospital.

We arrived at 8:30. I saw a nurse and a doctor. The doctor examined me, didn’t think it was the appendix, but sent me for a CT scan just in case. The CT technician came and got me and took ‘two short pictures’. The whole scan took about 10 minutes.

After the scan I waited for it to be ‘read’ and the doctor reading it to fax his results (indicating he wasn’t even on site). The results came back, and the problem was not appendicitis. There was a ‘finger of fat’ that got wrapped around something internally, coincidentally right where the appendix is. It wasn’t dangerous and should go away in another day. The doctor (who I must say had a great bedside manner) offered pain medication, but I refused. I was then released. During checkout I notified the staff that I didn’t have any insurance. I was then presented with a form that said if I didn’t have insurance and made less than $125,000/year the hospital would automatically deduct 50% from my bill. 50%? Of course, I signed this and went on my merry way. It was 11:30, I had spent 3 hours in the hospital.

Yesterday I received the bill for this little check. $4200. I was billed $4200 for a 3 hour visit in which the determined that there was nothing wrong with my appendix. The average American household income is $50,000, which translates into a takehome wage of around $2700 a month. It would cost the average American almost two months salary just to find out there was nothing wrong with him. I shudder to think what the bill would have been if they had to remove my appendix.

If this wasn’t bad enough, the hospital would have charged the insurance company twice this, over $8000. Everyone accuses the insurers of being greedy, but premiums have to be high just to cover expenses like this.

Interestingly, CT scans aren’t this expensive everywhere in the world as illustrated by this excerpt from an article entitled Why does a CT scan cost so much in the USA?

A basic MDCT scanner (6 or 8 detector rows) costs about 2 to 2.5 crore rupees here in India (INR 20 to 25 million = US $ 500,000 to 630,000). I learnt from a source in the industry that the cost of the scanner is about 40% subsidized for the Indian market (compared to its cost in the North American & European markets). So the same basic multislice CT scanner would cost about $ 900,000 in the US.

We have a basic four-slice MDCT scanner in our hospital. A patient would be charged Rs. 3500 ($ 90, yes ninety dollars) for a plain CT scan or Rs. 4500 ($ 115) for a contrast CT scan of the whole abdomen. Ours is a small city. The charges are likely to be as high as Rs. 8000 or Rs. 9000 ($ 200 to 230) in the bigger metros like Chennai, Mumbai or Delhi.

Why is there such a discrepancy in the prices between the US and India? Honestly, a patient could FLY to India to get the scan cheaper than having it done here. Experts will point to a variety of reasons for these outrageous charges, malpractice insurance, coverage for patients that don’t pay for ER visits, the high cost of purchasing and maintaining CT machines, etc…

The real question in my mind is why are congress and the Obama administration ignoring the real problem here. US health care costs are increasing annually by 5.6%, but no one seems concerned about that. Instead of finding the reasons for these outrageous costs and working to control them, some members of Congress are trying to spend $829 billion over the next 10 years just to provide insurance coverage to those who don’t have it.

President Obama is about change, so let’s have some change. Rather than one massive bill that just tries to provide coverage for all uninsured Americans with an $8 billion/year price tag, lets break this down and pass bills like the
Health Insurance Industry Antitrust Enforcement Act of 2009 that most of us agree will help the whole situation.

Update 11/04/2009 The hospital’s financial assistance program scheduled and appointment and met with me. First off, I was incorrect about the bill. The original $4,200 bill was not discounted by 1/2, that was the full bill, I was only liable for about $2,500. Second, I did qualify for some state assistance due to my current income level, so this bill isn’t quite as devastating as I originally feared. In spite of both of these, I still believe the underlying problem with healthcare has more to do with the costs than the availability of insurance.