A couple of years ago my then three year old daughter developed a very high fever and some other symptoms which upon examination by our family doctor caused him to declare that she had a urinary tract infection. He proscribed an oral anti-biotic.
My daughter who has an autism spectrum disorder was at the time communicationally challenged. At age three she had virtually no vocabulary at all and it was impossible to explain things or reason with her. We could not get her to take the anti-biotic no matter what we did. We tried for hours, literally. We nearly drowned her trying to get her to drink a crushed up pill in her milk. She was having none of it.
After hours of trying and frustration we called back to the doctor's office for further advice. By now, my daugher's temperature had risen from around 101 to the 103-104 range. The doctor's office was closed but we were able to leave a message for our doctor who was on call. He called us back in pretty short order.
We described the situation, he said it was imperitive that we get her those antibiotics post haste. He told us that if she continued with that temperature for too long it could cause kidney damage. He said the only option at this point would be an injection of anti-biotics. The drug is cheap and covered by a normal office visit (which would incur a $20 co-pay and nothing more) but the office was closed so we would have to take her to an emergency room.
On our way to the hospital we drove by a so-called urgent care center. We dropped in to see if they could help, they told us the don't give any injections, weird. So we continued to the local emergency room.
It was a slow night and we only had to wait about half an hour before we were seen. They took us to a room about the size of a doctor's exam office where a nurse took my daughter's vitals (using the same gear that our doctor uses in his office) and we explained the situation to her. She left and came back about half an hour later with the doctor who we also explained the situation to and who spent about 5 minutes examining my daughter. She ordered the shot and left.
After a while the original nurse plus a second nurse came in and gave my daughter a shot of anti-biotics in each leg. Then they sent us home.
By my estimate we consumed about 10 minutes of the doctor's time, five to examine my daugher and five more checking her chart. We consumed another 10 minutes or so of nurse time for each nurse, and in that calculation I am being very generous. A total of about 30 man minutes of time for the medical professionals and maybe another 15 minutes of time with the administrative people, just exactly as I would have in the doctor's office.
We spend a total of about an hour in the exam room, of which no more than 20 minutes were ever populated with medical staff. Most of the time was waiting.
We received no more care and consumed no more staff time than we would have in our doctor's office, yet instead of a $20 copay that we would have paid in the doctor's office, we received a hospital bill of $890 plus an attending physicians bill of about $130.
Not one cent of it was covered by my shitty Humana insurance of the time. This is one of the fundamental problems with our healthcare system. We consumed exactly the same amount of resources in that ER visit as we would have in our doctor's office, but our personal financial liability was over 50 times as much. All because of the time of day my daughter became sick. We were ripped off. There is no way to justify expenses of that magnitude given the level and type of care we received.
I realize this expenditure is peanuts as most hospital visits go, but sometimes even peanuts can be rancid. The whole scheme is a scam designed to bankrupt families and deny them the care they need. There just is no sugar coating the abuse that goes on in this system.
Now let me tell you about a similar situation we had in Colombia, a third world nation with a 70% poverty rate and 14% unemployment. Later that same year on a trip to visit my inlaws in Bogota, my daughter came down with another infection, again it was after hours. But instead of taking her to a hospital, we were able to call a mobile doctor who made a housecall. He gave my daughter the treatment she needed and gave us a bill for 250,000 pesos, about US $100. An unisured office visit there would have cost about $20, with insurance there would have been a co-pay of 13,000 pesos or about US $7.
This is at least part of the reason why Colombia enjoys a position a full 15 slots higher on the World Health Organization's healthcare access ranking list than the US does (by the way the Dominican Republic and Costa Rica also are ranked higher than the US is). Colombia has a national health insurance called EPS which is similar to medicaid or medicare and that is mandated for those who can afford it, subsidized for those who are borderline, and free to those who can't. In addition, people of means can also purchase private insurance as well. Private insurance is more widely accepted and wait times are often shorter. The combination insures that hospitals do much less cost shifting from indigent patients to insured patients than they have to do here because fewer uninsured indigent patients show up at emergency rooms. Thus the entire cost structuer is lowered across the board.
If they can get it right in a war torn third world impoverished nation like Colombia, we should be able to do it here. And if congress fails to enact a public option this year, they will have demonstrated a level of corruption and legislative incompetence that would make a South American dictator blush.
The fact is that right now we literally have a healthcare system which is inferior to several found in Latin American third world nations.