With few exceptions, I have found that those who think we have a great medical system know very little about medicine, billing, and how the whole process works.  It’s not that I finished a residency in neurosurgery, but in the past 5 years, I have been around enough surgeons, internists, radiologists, residents and even medical plan owners, to have a fairly good idea on how it all works, economically speaking.

For the money, I think we have the worst medical system in the world.  When you balance how much things costs, versus what you get in return, it’s not hard to see this.  Sure, if I suffer from a rare disease with experimental treatment in the US requiring expensive equipment, then by all means, this is the place to get treated.  But routine procedures not involving rocket science?  Please…

A recent example.

My mom convinced Yanory to get an endoscopy to make sure her frequent indigestions and heartburn, weren’t something more serious.  Since we’ve already paid our yearly deductible earlier this year with Yano’s “minor” head-on collision with a bike (don’t ask), I said– screw the plan, let them pick up the entire tab.  Get every surgical procedure on the book!

For those of you in the dark, an endoscopy is a simple procedure.  They put you to sleep.  They stick a, ahem, stick with a camera down your throat, take pictures, and analyze.  Again, not rocket science, but not something for the untrained to perform.

Today I looked at the explanation of benefits from our insurance.

The gastroenterologist who did the work billed $792, however the plan decided they should only get paid $165.  This is the man who spent 4 years in medical school, 3 years in an internal medicine residency, and 2 years for a fellowship in gastro.  This is the poor schmuck with $250,000 of debt at 6% (because not all school debt is finance at 3% by the Federal government).  This is the man with a god complex paying a yearly $15,000 in debt interest alone, and possibly $20,000 in malpractice insurance, all while trying to keep up with his friend the radiologist who billed $184 for a tangentially related ultrasound, and got paid $147.

Let’s review.  MD who did all the work and stands to get sued, $165.  Radiologist who was in the office for a few minutes and pays hardly any malpractice insurance, $147.  Note to Braulio– you got suckered going into surgery.  Radiology was the residency to get into!

Now, there are still the hospital charges.  The hospital bills $6,615.  The plan, who is sometimes partially owned by the hospital, gets paid a whopping $5,300.  But wait you say, the hospital must have provided all sorts of other services.  A bed? Nope, out-patient procedure.  A meal?  Nope, that’s what the vending machines are for.  An anesthesiologist doctor?  Nope.  A nurse anesthesist making a comfortable 6 figure income instead?  Nope.  The hospital had regular nurses trained to give anesthesia.  Oh wait, that was my mom, and I know her entire wing did not make that much that day.

I have a friend who’s making a surgery clinic so he can take a bigger piece of the pie.  But while he will take in more, the insurance will estimate down his charges because he’s not an actual hospital, but a clinic– so he can’t take the $5,300 for a brief procedure.  Meanwhile, the clinic may cost millions of dollars.

You may think I’m exaggerating, that medical plans don’t make that much, but I have a (street) smarter friend, who along with other doctors, pooled in a few million dollars and bought a failing medical plan.  The result?  He said in a year, he made more money than he had in his whole career as a doctor.  And doctors don’t exactly make minimum wage.

Another example.

The gastroenterologist thought it would be a good idea to do an ultrasound of all the poop in Yano’s belly, just in case.  As we know, the radiologist made $147 for this analysis.  However, the hospital who owns the ultrasound machine made $1,200.  Wanna know how much an ultrasound machine costs?  Anywhere from 15-50 grand.  So even if it costs $50,000, the investment pays for itself in just 40 uses.  And you don’t need to go to med school to own one!  Great investment!

The reason we pay doctors so well is not because they’re so much better than in other countries (a lot of US doctors studied abroad), but because they have such high med school loans, and because we’re a lawsuit happy country.  That, and they think they should live a half a million dollar lifestyle to keep up with the dermatologists and radiologists with their high pay, low work residencies :).  Of course, it doesn’t turn out that way, because they have the high overhead of an office downtown, 2 nurses on staff, a secretary, 4 cars, two boats, a summer home, and a wife who’s a professional shopper.

I have another friend who, after he finished his residency, went to work for a hospital making a pretty penny.  No malpractice, no office overhead, no nurses’ salary out of his bottom line, virtually no overhead.  However, he was forced to work 12-14 hour days, seeing so many patients, he was only able to provide a cursory exam.  He felt bad that he couldn’t give the level of analysis and medical care he was trained for, but the hospital has strict quotas for their doctors (read, paid slaves).  Who owns the hospital in question?  You got it… an investment group who also owns a medical plan.

You may think these are hospital and doctors in Argentina, where my brother-in-law is finishing his surgical residency?  Nope.  You may even think they’re in Puerto Rico, where even though the doctors are all US certified, they’re nothing but a glorified third world country, right?  Nope.  This is all right here in the mainland, where we bitch at any attempt to throttle the medical system.

If someone comes up with an alternate health plan for the US, we poop on it, accusing it of socialism, communism, or some other ism.  But no one ever bothers to see how much the pharmaceutical and medical plans pay for lobbiers in congress, or how much they fund the different candidates’ campaigns.  I have not a clue if this Obamacare is any good, because I tuned out of the debate a long time ago, but I can tell you this much– anything is better than the alternative.  It doesn’t take nobel prize winning economists to design ANYTHING that’s better than the raping we call a medical system.

As an aside, wanna know how much an endoscopy costs in Panama, where I *know* the private medical system is not that bad?  $670.  Compare to the $6,000 bill here.  How about in Peru where $400 can pay for an endoscopy in a private hospital with a private room, and your own private nurse?  Of course, nothing can beat a friend who’s a gastroenterologist, but unfortunately my friends decided surgery and internal medicine were better residencies, so unless Yano needs her stomach taken out, I’m much better paying out of pocket for a vacation in Machu Pichu.

Sorry for the somber post.  I don’t even have any solutions.  But this system definitely sucks for anything but the most advanced, expensive procedures– and maybe not even that…

In the past 10 years, I calculate that between my employer and myself, we have paid at least $60,000 in insurance premiums.  How much have they actually paid back?  You got it… the inflated $6,000 for this endoscopy, and only because we had already paid the deductible this year.  So that’s it, I’m done with insurance.  Next year I’m signing up for Red Hat’s high deductible plan with a health savings account.  I don’t want coverage for anything more than a catastrophe (car accident or cancer).  It’ll cost me $1800 less a year, and the IRS allows me to deduct travel for health care tax free from the health savings account.  For $1800, I’m sure we can visit Braulio in Argentina for an appendicitis, or wait until my friend finishes his clinic.