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  • About this “curmudgeon” guy…

    Armchair philosopher, politically-incorrect political commentator, raconteur, retired air traffic controller, dilettante truck driver, US Army veteran, recluse, sometime-writer, redneck convert neè Buckeye, ne'er-do-well, bon vivant, unrepentant libertine, unapologetic libertarian, and (of course) curmudgeon…

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It’s enough to make you sick (if you can afford it)

Posted by The Curmudgeon on January 25, 2010

There’s gold in them there ills—but who’s raking it in?

While taking my daily walk several months ago, I was bitten by a neighbor’s dog. The injuries weren’t severe, but the skin was punctured in a few places. I approached the neighbor and confirmed that the dog had been properly vaccinated (and reassured him that I had no intention of suing him into oblivion), and made arrangements to have the overly-exuberant canine quarantined for observation. Upon returning home, I thoroughly cleansed the wounds per medical advice. No big deal.

After doing a little research, however, I was reminded of the routine practice of obtaining a tetanus (or booster) shot. The outstanding risk seemed minimal, but the potential consequence of inaction is sobering, to say the least (lockjaw isn’t a pleasant prospect). The following day, I telephoned my regular physician. Unfortunately, his office was closed for the next several days; waiting for his return was not an option, as the delay would exceed the prescribed window for obtaining the vaccine. His practice is located in a small local hospital, so I called the emergency room. After explaining the situation, I asked about the possibility of dropping in for an injection. The nice lady was only too happy to accommodate me, but pointed out that I’d “have to be seen by the doctor on duty.”

As an indication of the nature of the times, it can be stated that scarier words are rarely heard.

That afternoon, I spent about an hour and forty-five minutes at the aforementioned emergency room (one wonders what the term “emergency” is intended to convey). The physician on duty spent less than a minute (literally) in the treatment room with me—just long enough to tell me that the vaccination was probably unnecessary, statistically speaking…and that a nurse would be along shortly to give me the injection.

My business concluded, I was presented with a bill that proved a microcosm of today’s burgeoning budget numbers.

An injection that might be reasonably expected to cost (I’ve been told) something on the order of $15-$50 was in fact a few bucks short of $1000. An “itemized” bill that explained little listed various charges (e.g., physican fee, ER fee, triage fee) that all appeared to me to be inflated. I contacted my insurance carrier.

Long story short: the insurance carrier did whatever it does, I received a refund of my deductible (in fact, the actual cost to me ended up to be nothing), and whatever method or formula the carrier and its preferred providers (this hospital is one) use to find common ground brought down the overall charge substantially (I never did see the final figure).

My question is this: How does a $15 charge get to be a $1000 charge in the first place?

Some of you might recall a similar question I posed in an earlier entry about health-care reform, noting that the emphasis has been on throwing huge sums of money at the symptom of rising health care costs without identifying the reason(s) for the rise.

I think I now know why no one’s ever clarified that.

Try doing a few online searches on physician income, malpractice insurance cost, malpractice lawsuit payouts, drug costs, lawsuits against pharmaceutical companies, indigent health care, and “defensive” medicine. Care to know beforehand how it’ll turn out? Think about one of those TV ads for Bing; you’re immediately awash in contradictory data that’ll take you years to sift through.

We all know that malpractice lawsuits have increased logarithmically for years—right? Odd. There are many studies that suggest a decrease. We all know that malpractice judgments and settlements have caused malpractice insurance rates to soar—right? Not if you sift long enough; you’ll find just as many surveys and studies claiming that litigation isn’t the issue…insurance carrier profit-taking is to blame. But without a doubt doctors have had to pass along the cost of insurance coverage to their patients—right? Yep. That one’s not much in dispute—but how much effect it’s had is pretty much impossible to determine. For that matter, try determining how much doctors earn (or should). Unless you ask each one personally or hack your way into IRS databases, you’ll probably never be able to figure that one out, either. “Defensive medicine” (e.g., ordering expensive tests that probably aren’t necessary—but you might get sued for malpractice if you don’t) is an oft-cited culprit; this argument loses a bit of validity, though, when one considers that many physicians’ incomes are directly tied to the number of such procedures they perform. Health care for illegal immigrants is also a popular scapegoat; however, confidentiality issues and the practice of ultimately charging indigent health care to Medicare blur the picture considerably (indeed, this is also part of the reason Medicare itself is in trouble—but we still don’t know the extent of its impact).

How many times have you seen television ads sponsored by law firms chumming for cases urging users of one drug or another to contact them? It has become a common cycle: Big Pharma comes out with a new wonder drug…doctors prescribe the drug (earning huge sums for Big Pharma)…law firms recruit clients to sue Big Pharma over the side effects of the drug (earning them huge sums)…Big Pharma comes out with another new drug…

…and so it goes.

The problem with that scenario is that Big Pharma exists to make big money; after paying-out huge sums to settle lawsuits, they factor that into the cost of the next drug they produce—and the spiraling cost of health care simply goes higher. Moreover, having already been burned in previous lawsuits, they take a preventive approach—driving costs even higher, and delaying the new drug’s availability.

Here’s another sobering thought: how many local hospitals have been taken over by corporate operators? And why (back to Economics 101) do these corporate entities exist? To make money. With that in mind, what incentive do they have to hold the line on costs? In simple point of fact, they make more by having ICU beds full, regular beds full, and a humming ER business.

Now that the Obama regime’s quest for health-care reform seems to be stalled, it’s time to step back and re-assess the situation. Obama’s claim is that people want affordable health-care insurance. He’s wrong. What people want is ready access to affordable health care they can have confidence in. To be able to obtain that care will no doubt require insurance—which, yes, they axiomatically want to be likewise affordable. However, they also want for it to remain affordable—a provision destined to remain unachievable as long as the reasons for the costs getting out of hand in the first place remain undetermined.

Good luck trying to unravel that one.



4 Responses to “It’s enough to make you sick (if you can afford it)”

  1. Kay said

    I agree about the medical costs. I have insurance and my bills are negotiates down by 80%. I feel sorry for people without insurance who have to pay full price. There has to be a better way.

  2. Jim Seeber said


    Call me crazy (you wouldn’t be the first), but I got the distinct impression from the insurance rep I spoke with that this was neither unusual nor unexpected (though she did seem a bit irritated by it). I’ve been told that certain common procedures have already been negotiated and the health care providers know before the charges are submitted that they’ll be reduced.

    I wondered why they do it and came up with an on-the-fly theory: it might be an accounting thing, perhaps a way to write-off as a loss the difference between submitted charges and allowable charges paid by the carrier.

  3. Larry Z said

    A reply to a previous thread applies here also: “greed on one end…entitlement on the other ,and most of us somewhere awash in between”

  4. Lynne Z said

    It’s all insane. Just the hospital (physician owned) charges for neck surgery & one overnight stay came to $50,000. and look at these edifices with 20 foot ceilings in the lobbies and cherry wood cabinets in the maternity wards … all just to sell bonds on Wall Street. I have no answers but tort reform (yes, defensive medicine DOES cost us), portable insurance and cessation of free care for illegals would go long way to reduction of medical costs. But, given that most of our Dear Leaders are lawyers, I doubt and action on tort reform will be taken. And do try to remember … doctors “practice” on their patients.

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