How Do We Get Off This Thing?

By Edward Shanahan

During a trip this winter, I came up lame. The pain in my left leg was so excruciating I could barely walk for several days and could not sleep because of the discomfort.

Returning home, I checked in with my primary-care or family doctor, who suspecting a possible blood clot, did all the right things, including sending me to the hospital for an anticoagulant injection and an ultra sound test, which, happily, indicated no clot.
Still, there was discomfort and a weakness in the leg, so he sent me to a neurologist, who practices locally. That visit resulted in another trip to the hospital for an MRI and another ultra sound, for an unrelated matter.
With a round of physical therapy and the subsequent passage of time the pain diminished and the sense of renewed strength seemed to return to the leg.
But that’s not the important issue; it is rather the impenetrable paperwork and the astonishing charges by the medical professionals that arose out of this one slightly bad leg.
I can’t imagine what the treatment of serious illness costs in this country, but I can clearly understand that some medical professionals are making out like bandits and the rest of us are completely in the dark about how and why the health-care system functions as it does.
It is impossible for the consumer of medical
treatment to actually determine what specific treatments or visits cost, and how much the provider of the treatment gets, and who pays the balance if there is one.
For example, the information sent to me by Medicare about my late night visit to the Cooley Dickinson Hospital emergency room indicates that total charges of $493 were incurred for the visit and anti-coagulant shot, of which $41.77 represented “deductible and co-insurance” (whatever that means), and I might be billed $41.77, with the additional notation that payment of this bill “is included in another service received on the same day.” Huh?
There was also a charge of $466 for an “extracranial,” maybe the ultra sound, of which amount I might be billed $63.81, but in this case the notation stated: “The amount Medicare paid the provider for this claim is $78.00.” What about the difference? Who knows.
Now let’s turn to my two encounters with the neurologist. The first visit was billed at $440 for perhaps half an hour’s time, when I was asked various questions about my medical history and a routine examination that confirmed weakness in the leg. Medicare approved $233.33, with the notation that “this information is being sent to your private insurer(s), in my case Blue Cross/Blue Shield.
The neurologist ordered an MRI and an ultra sound for the unrelated matter, for which CDH charged a total of $2,7974, but the Medicare paperwork indicates that “Medicare paid the provider $281.12. Big difference there – about $2500.
Then, of course, a radiologist had to read these two diagnostic tests – and he charged $237 and $118 respectively, and this time “Medicare paid the provider” $8.48. I still don’t get it.
Meanwhile, at my return visit to the neurologist, fully a month after my first visit and almost as long since my MRI and ultra-sound about which I had received no report, I spent a total of less than 10 minutes with the doctor who said the month-old tests were normal and I might want to undertake a regime of regular Vitamin B pills.
Medicare reported that the doctor’s charge for that visit was $275 with the notation “this information is being sent to your private insurer(s).”
I may be not be very bright, but during this whole time, except for the visit and conversations with my family doctor, I understood very little of what was going on, certainly the neurologist was as much in the dark as I was, and Medicare’s reports to me only plunged my entire medical experience and its cost into ever deeper mystery.
How much does any medical consultation or procedure cost? Who knows. It’s is impossible to tell, so ultimately the consumer of health care is operating in total ignorance. Thus, the average citizen simply allows the system continue to spin further and further out of control.
Admittedly, it is easier for me to be outraged about the system now that my leg no longer is killing me. But still, this small example illustrates for me the elaborate, perilously fragile and stunningly expensive house of cards that seems to be on the verge of total collapse at any moment.
Nice going, greatest country in the world, marvel of capitalist innovation, democratic accountability and individual freedom. Your health-care system is a wreck.