Miller: The machine that goes ‘ping!’
September 24, 2009
Hospital administrator: Aah! I see you have the machine that goes ‘ping’. This is my favorite. You see, we lease this back from the company we sold it to, and that way, it comes under the monthly current budget and not the capital account. [applause]
-Monty Python: The Meaning of Life
What a simple time it must’ve been when doctors needed only to make a cursory diagnosis of some imaginary disease (“Marthambles!” “Brain fever!”) and prescribe one of just a few cure-alls. Relieving a patient of a few ounces of blood was one; trepanning (boring a hole in the skull) was another favorite. If the cure didn’t kill you, you might just walk away feeling better. At the very least, the payment to the sawbones (a chicken, perhaps a few shillings) wasn’t going to keep you up at night.
Nowadays, hearing the phrase “We need to run a few tests …” can send shivers up one’s spine as the potential costs make those cash-register sounds almost audible in the exam room. No doubt, many such tests make perfect sense and can identify problems that need correcting. Other times, it’s hard not to wonder if some of those CAT scans, MRIs and the like are ordered with tenuous connection to anticipated outcome. Perhaps it’s simply doctors and hospitals covering their rears; other times it seems the simple fact that the facility has the “machine that goes ‘ping'” encourages its use with greater frequency. Either way, when facing illness or injury, it’s not easy for patients in the hot seat to question the doctor’s suggestion – or, heaven forbid, ask something as simple as “Hey, how much is that going to cost?”
It’s tough to think of another industry where consumers are expected to make what can be quite large purchasing decisions without knowing the pricetag. One colleague of mine told me when she asked how much a certain test was going to cost, she was told they simply didn’t know. Talk about legislation being a sausage factory: Oftentimes in health care, there’s no telling what that super-fancy test will cost until it goes through the labyrnthine process of billing, co-pays, discounts, etc. and comes out the other end in one of those odious “Explanation of Benefits” forms we get from the insurance company. Consider yourself lucky if you’re able, eventually, to reconcile all those EOBs with the confetti of statements received from the providers and come out with your sanity intact.
Leaving the whole health care debate about who pays – and how – aside, today’s “system” reminds me of the kind of byzantine dystopia imagined by the likes of Kafka and Orwell. When the maze of rules, forms and procedures become so dense and the source of all the decisions that made them so becomes ever more remote, we end up feeling like dupes – numbers on a spreadsheet or an actuarial table with little or no recourse for protest.
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In Wednesday’s “Daily Mail” section, we published a letter from Bud Hill of Frisco, who had the great courage to detail his own experience with super-sized medical bills. Like Bud, I don’t blame individual doctors or providers but, rather, decry a system that’s gotten so out of hand that no one seems to know how to fix it – or even begin. It’s a system so firmly entrenched, though, that to even suggest specific fixes for it has created a great rift in our nation.
I don’t think Bud’s solution of never again entering a hospital ER is a good one, but I understand where he’s coming from. Even with coverage, I would just about operate on myself before paying 20 percent of whatever it costs to even walk in the door of an ER. I hope it never comes to that, but if all else fails, no doubt there’s an online tutorial somewhere about trepanning and bloodletting.
Editor Alex Miller can be reached at firstname.lastname@example.org or (970) 668-4618.