April 2, 1999 (Ira Pilgrim)

Medical Care

As medicine becomes more commercialized, what was defined as unscrupulous behavior is redefined as normal business. Where once we took pride in institutions that served the public and served it well, we now measure status by the bottom line.

Keith Schneider, 1986

The problems with the quality and price of medical care has spawned an alphabet soup of acronyms of organization whose purpose is to improve medical care.

The major problem has to do with medical insurance. The term health insurance is a misnomer because no one, no way, can insure health. In our country, the rich can afford anything that they might need or want. Those people who are employed by organizations that provide medical insurance for their employees are fairly well covered for almost all medical problems. The poor are covered by federal and state programs, which vary from state to state, for basic medical care. Some programs are fairly good and others are close to worthless.

There are, however, a substantial number of people who are not covered at all. This is in contrast to most of the industrial nations, which have state-sponsored medical programs that are tax supported.

Right now, health maintenance organizations(HMOs) are the whipping boys and are catching quite a bit of deserved flack for putting profits above service. This can be expected of any profit making company; that is, until their service becomes so poor that no one will buy them any more.

It would be hard to match hospitals for undisguised greed. Anyone who has had a hospital stay and examined his bill may find it heavily padded. For example, during a recent stay at a local hospital(which shall remain nameless), the charge for tablets of the antibiotic Cipro(ciprofloxin) was $110 per pill. The same pills are available at Rite Aid pharmacy for $10 per pill. Obviously, they settled the whole bill with Blue Shield for a lot less than what they billed. This is routine procedure when hospitals deal with medical insurance or Medicare.

Another example is with blood. Before the surgery, I gave two units of blood which were kept in storage in case I needed it. I did not need it, but that did not stop the hospital from doing a blood type and cross match to find out if my own blood was compatible with my own blood; a totally unnecessary procedure. That procedure cost in the neighborhood of $400.

Then there is the perpetual problem of medical competence by the physicians and staff of hospitals. It is obvious that your chances of leaving a hospital in better shape than when you entered it depends on the hospital. Large teaching hospitals do better by their patients than small ones. Much of this difference is a function of the skill of the physicians staffing them.

With complicated and specialized procedures such as hip replacement, heart or eye surgery, a person is much better off going to a center that specializes in those procedures.

I guess that I should be thankful that I was able to walk away from the hospital and that I was in better shape when I left than when I entered it. There are many places where your chances of walking away are much worse than this one was.

A thousand years from now we will probably have the same problems and the best that can be done would be to achieve some form of compromise on a variety of issues. While the system itself is complicated, the major problems relate to the fact that the system is run by people. I doubt that it would be much better if it were run by chimpanzees, but it might not be very much worse.

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