Getting on the train

Okay, so we did the whole hospital thing for the first time.  It’s going to be incredibly expensive, this is certain, but it’s also going to be substantially more expensive than it has to be, because of the way the entire process works.  Once you board the train, you cannot get off without serious belligerence.  This results in a whole host of procedures and expenses that would ordinarily be optional – and often opted out of – that are instead all-but-compulsory.  Here are some examples from our recent experience:

  • We started the process at the ER in American Fork Hospital.  We knew before we got there that Gabriel’s leg was broken, or very likely broken, and would need to be casted.  We explained this to the staff there.  But even though AF Hospital CANNOT TREAT a child this young for an injury of that type, they admitted him anyway.
  • The first thing they did there was give him morphine for pain.  This they did through an IV inserted in his hand.  Once they gave him morphine, however, he was under a kind of treatment that necessitated his being transported by ambulance to the facility where he could actually be treated.  This was never explained to us until approximately the time the ambulance pulled up.  Even then, there were no options given.  He was going to be given the second-most expensive taxi ride in the universe, and there was nothing we could do about it.
  • Everything that happens, from the minute you walk in the door, costs money.  The needles are one use, and sterile, and expensive.  The line for the IV, the hanging of the bag, the bag itself, the liquid in the bag, all of this stuff is disposable, meaning that it is going to be paid for by you.  Everything they touch you with, except, I guess, the stethoscope and the gurney, you are buying.  No one explains this.  Ever.  Well, no, I take that back.  I bet they ARE going to explain it to me when the bill shows up.
  • In a restaurant, when they ask me if I want more food, I know that they’re charging me money for it if I say yes.  That’s true in the hospital, too, only they don’t ask.  They bring in juice, and that’s going on the tab.  They bring in graham crackers, and those are going on the tab, whether my son eats them or not.  These are the most expensive crackers and juice in creation.

I could go on, but this serves as an illustration.  We do not have medical insurance.  I am self-employed, in the main, and I’m going to be writing a check for everything we buy.  I explained this several times.  It made absolutely no difference to the treatment we got.  Now, in one sense, this is very egalitarian and fair.  Everyone that comes onto the car lot gets a Ferrari, no matter what, and whether he has the means to buy a Ferrari or not.

Unfortunately, what this means is that we are spending a Ferrari’s worth of care on people that don’t need it, and don’t even want it.  This is true for everyone, whether they have insurance or not.  I get to see it up close and personal, because I’m going to be counting the pennies myself, but even if you have Cadillac insurance, like my mother’s, for instance (she’s a public school teacher), the money is still being spent, only in her case it’s being spent invisibly, because someone else ends up writing the check.  Ultimately, and so, so ironically, ME, because her medical care is paid for by my income and property tax.

When I complained to my mother about the railroad job I had just gotten, she said “come on.  I’m sure the nurses and doctors aren’t sitting around thinking up ways to bankrupt people.”  And I agreed.  They aren’t.  They don’t get any benefit from doing so, and in fact I must say again that I found them almost universally kind and considerate to us, very professional, and highly skilled.  But they do a fine job of bankrupting us anyway, and they do it because they are trained to.

Like this: I asked my sister, the Primary Children’s Hospital Surgical Tech, how many meetings she’d been to discussing the costs of the procedures they used, and how to weigh the necessity of those procedures against the financial strain it would cause the patient.  She said she had never had such a meeting.  No, wait.  She LAUGHED, then said she’d never been to such a meeting.  Then I asked her how many meetings she’d been to where they explained to her in no uncertain terms that if anyone ever sued the hospital because they failed to perform a test and later a complication developed, that they’d be fired and never work in the medical field again.  And she said, “two a week.”

So the medical staff has a gigantic downside to NOT ordering tests, and no downside at all to ordering them.  What are they going to do?

This is the genesis of the railroad.  AF Hospital staff surely know that they can’t treat my son the minute he comes in the door.  But if they say that, and I take him away, and he dies, I could perhaps sue them for negligence.  So they admit him, knowing that the simple process of doing so is going to cost me $6,000 to $10,000 that I already told them I probably couldn’t pay.  Perhaps a hospital lawyer could figure out where I do and do not have grounds for a suit, but the 11pm shift nurse at admitting cannot.  She has to err on the side of covering the hospital’s butt, even if it means ramming a stick up mine.

This opens up a can of ethical worms that this post isn’t going to address.  But we’re going to get there.  Stick around.

2 Responses to “Getting on the train”

  • Sandy McAvoy says:

    We have been on this train ever since our daughter was diagnosed with spina bifida 8 years ago. She is seen at the spina bifida clinic at PCMC. When we are in the clinic, we are there to see many doctors at one time. Sometimes people come in to see us, who we did not ask to see us. You can almost hear kaching kaching as they walk in. Last month the neurologist was talking to my daughter about her wheelchair. I told him she is fast and has tipped it over twice. When he left the room he informed the PT her chair tips over. We have a high deductible insurance and pay ourselves for everyone who comes in the room. So now we are paying for the PT also. PT came in and decided her chair needs altering. Even though he mentioned and we also knew this was the problem- Her chair tipped over because friends were being to helpful and pushing her to fast. Now the wheelchair specialist comes in and they go over everything that needs to be done to chair. The whole time I am hearing kaching kaching. We don’t have to pay for the wheelchair specialist visit- I am surprised. This is just one of many of our experiences. I also touched a little on our PCP office in this post on my blog Our office(after a remodel and new building at another site) started charging up a level on office visits. The cost is at $40 more than they had previously charged. We can see the cardiologist at PCMC for less and the neurosurgeon at PCMC for about the same as a sick visit to our PCP. I have asked several people at the office about the jump. They have all given me different answers. One even told me this is what the cost has always been. Funny thing is we have gone to that office for years and keep our receipts for our taxes. We know this is not true. The cost of medical really hits a nerve with me. I could go on for days about this subject.

    • chrisjones says:

      Sandy, you’re far from alone. I’m getting a lot of mail about this. I’m going to specifically address the economic side of how all this “works” in tomorrow’s post, but I can already tell you, although the system we have is broken and absolutely EVERYONE acknowledges this, the way to fix it is not clear. I’m almost to the point where I believe that since the medical system is going to collapse on its own, it might be simpler to let it do so, since the obvious fixes involve such radical measures that they are politically impossible. That’s a terrible thing to say, but I’m leaning that direction at the moment. It just might be that the best we can do is to make the patient comfortable while we wait for the end.

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