Some of the treatment I received was clearly unnecessary. I went to the doctor with chest pain and received an ECG at the surgery. After arguing with the doctor who wanted to call me an ambulance, without again, being prepared to discuss the likely financial implications, I arrived at the hospital in a cab, and walked in, looking I imagine reasonably well. There were several receptionists waiting to check someone in and other health professionals standing chatting, and generally giving the impression of not having enough to do.
They insisted on giving me a second ECG. I explained I had already had one and that it wasn’t too bad, but they didn’t seem interested in this news or in making a phone call to the surgery to chase up the results. The second and unnecessary ECG appears on my bill at a cost of $277.
At no point did they discuss with me any financial implications that their medical choices would have for me. It was a bit like being in a McDonalds where instead of offering you a choice the server says: “You MUST go large, you WILL have the fries with that.” They offered me a wheelchair which I again declined saying that I didn’t feel that unwell. I saw a doctor and then was sent from place to place to receive an intimidating battery of tests which rather added to my anxiety as I was convinced by this time that what I suspected was a yoga injury must be something much graver.
After all the tests were concluded, I went to grab a coffee and a sandwich – further signs I suspect that I was not having a heart attack – and then went to await the results. After half an hour I was handed a report detailing the tests and saying that I had a slight pleural effusion which would in all likelihood go away by itself. Which it did.
We have health insurance but it seems that excesses can be billed individually for everything. My hospital visit when I was given a CT scan, chest X ray, ECG and an aspirin(1) (which appears on the bill as $400 under pharmacy) costs the insurance firm $6330.35. I have to pay $300. The medical involvement in analysing the test results cost the insurance firm $952, of which I have to pay $271.55. My visit to the doctor totals a further $280 of insurance cost of which I have to pay $25.
I will put my brush with American health care down to experience. But I think it is a terrible way to run a healthcare system. It doesn’t encourage people to seek help, and when you do nobody is honest with you. People don’t offer you choices. When I refused the ambulance the doctor appeared to become quite terrified. He became defensive and almost tearful and urged me on arrival at the hospital to explain that I was acting against medical advice. This was not motivated by compassion, I suspect, but by fear of litigation. He seemed to have lawyer phobia the way some people have hospital phobia.
American health professionals are not well served by the system they work in. It turns them into the obsequious toadies of the rich and the enemies of the poor. They are powerless to help those who most need it and forced to pander to the imaginary ailments of the well-insured.
American Health Care is sick and it is about to get worse with President Trump’s appalling health care act which will remove health insurance from 23 million people on the way. Being right wing in America, it appears, means believing that if you can’t afford health insurance and you get sick, you should die. But as well as this immoral basis for care, there is a general issue of efficiency. America’s health care spending is vast. Lots of unnecessary treatment is given out – there is no mechanism to reduce this. The motivating fear of litigation means that colonoscopies and Caesarians are routine, despite the fact that most people don’t need them. America’s health care spending is now 17% of GDP, and projected to keep rising, hitting 20% in 2025. It is way out of line with other developed countries, as this world bank table shows – and yet life expectancy appears to be in decline. My “world’s most expensive aspirin” is a case in point. If you weren’t having a heart attack when you got to the hospital, just wait until you get the bill…
1. I remembered after writing this I also got a dose of nitroglycerin before my CAT scan, but that is also an inexpensive and easily available drug.