Long before my life was turned upside down-or rather, sideways-from my illness, I knew that I wanted to go into public policy or law to focus on health care reform. I've been interested in the ethical and public interest components of medicine since taking a freshman seminar called Ethics of Globalized Medicine. I suppose, since I signed up for the course eagerly, my interest may have started even before then.
Since then, I have taken several other classes that delved into the inner workings of health care and medical law. While we often debated the legitimacy and ideology surrounding the Affordable Care Act, more often than not, our discussions surrounded the shortcomings of the American Health care system that no one could deny: our wasteful spending, the gaps in coverage, the profit margins within the industries. As much as I have learned in the classroom about these issues, I have learned and witnessed far more in the last month.
As I have mentioned, I am very very lucky because my mother is a government employee, a school teacher. She has fairly inclusive coverage and, since I'm her dependent and only 20 years old, I can remain on her plan. If this hadn't been the case, if I had found myself in the same position as one of the 40 million uninsured Americans (that's what it was in 2014, I'm not sure of the current rate), I probably wouldn't have gone to the doctor in April, when I started fainting. I probably wouldn't have gone to the ER when I did. I probably wouldn't have taken the medicine that has gotten me to the slightly more functional point I have reached. And I probably would have only gotten sicker. When would I have finally done something? Probably when I fainted and cracked my head open, or crashed my car, or fell down the steps and broke my neck. Eventually, one way or another, this tumor and this dysautonomia, would have landed me in the hospital.
I was in the hospital for 11 days. I had several rounds of blood work, a CT scan, a tilt table test, IV fluids, three different medications, 2 sessions with OT, 2 sessions with PT. I never had surgery. My fluids were basic saline fluids. I was on a general floor with renal and oncology. My total bill? $18,272.55.
As we've seen, my experience was riddled with unnecessary and inefficiently delivered services, including labs, tests, and an extended stay. Since I'm no hospital administrator, I can't speak directly on the topic of excessive administrative costs (though, I have many thoughts about the pricing of OT and PT considering the time and attention they gave me). While it isn't included in my hospital bill, my MRIs cost $7,500. I'm no economist (yet) but that might fall under "prices that are too high." Did fraud have a role in the waste of my medical experience? I don't know, since I'm looking at it from outside eyes.
I don't pay any of this. But if I had to pay even a fraction, I would be crippled. Post hospital discharge, I would be crippled again and again with every physical therapy appointment and dose of fludrocortisone. I wouldn't be able to maintain the regiment prescribed to me by my doctors, so I would have to make sacrifices, sacrifices that would once again put my health and safety in jeopardy. Would I end up back in the hospital? Or worse?
When we discuss what is wrong with the American health care system, people bring up various aspects, but after my experience at Johns Hopkins Bayview, I'd like to speak on the most apparent to me: waste.
When I arrived at the Bayview ER, I had a binder with 3 different workups of blood labs, images from 5 different MRIs, referrals from several specialists, a diagnosis, a tentative treatment plan, graphed vitals from the previous two months, results from 3 EKGs, and results from 2 rounds of a Holter monitor. The ER triage team and my doctors in Med B looked at one blood test. They claimed they reviewed the MRIs (after losing the first two sets of discs) but when we read my discharge papers, it clearly said that they did not report on the images. Triage in the ER conducted their own EKG. They had no interest in my diagnostic notes or recorded vitals.
During my first day in the hospital they did one blood test. We never saw the results and they didn't report any conclusion from the test until a week later. A week. (Today, I had the same test done as a follow up, LabCorps said the results would reach my doctor by tomorrow morning) While I came in with 4 months of syncope, it took my doctors 5 days to get me on a tilt table. So the first 5 days of my hospital stay consisted of 1 test.
After a week, my doctors said that I could be discharged as soon as I could build up more orthostatic tolerance. They said that the best way to do this was working with occupational and physical therapy. That was Friday, I did not see a therapist until Tuesday. During those four days I sat idly, being charged $1000 a day, taking up a bed and wasting valuable resources. During my stay I saw OT 2 times and PT 3 times. With OT I practiced bathing and dressing myself once, which took about 30 minutes. The next session consisted of a 5 minute walk down the hallway. 35 minute = $1,271. My total time with PT amounted to about 2 hours and cost $1,832. While I understand that the time and expertise of these professionals are valuable, there is something seriously wrong with an industry that charges it's patients over $36 a minute for its services.
My labs cost $961. They ran a general blood work up (even though I had results from the same tests that were less than a week old), a cortisol test (results of which, were never reported), and a work up of potassium and magnesium levels (another repeated test). Two of these tests were redundant and, in my opinion, therefore unnecessary and wasteful. The third test, was lost and therefore unhelpful. Do I even have to explain how wasteful this is?
Had my medical team been more attentive to my need for PT and OT, my already established medical records, the status of my lab work, and my overall care, I could have been in the hospital for 4 or 5 days. Did my healthcare plan incentivize them to keep my case at a low priority, as they tried to care for and discharge uninsured patients faster? It's possible. Do uninsured patients drive up medical costs in general? It's likely. But the sources of waste in the American healthcare industry originate from other areas, and my experience at Bayview exemplified each and every one of them.
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| Soure:http://www.pnhp.org/news/2014/september/8-facts-that-explain-what%E2%80%99s-wrong-with-american-health-care |
Here's where we get back on the topic of the uninsured. Had I been one of the 12% of Americans without health insurance, I wouldn't have taken the necessary steps to get care before a major accident or injury. I would have sacrificed every opportunity of preventative care because I couldn't afford it. Where would that have left me? In the hospital with more serious injuries and ailments, a longer stay, and a higher bill that I couldn't pay. Not only do these missed opportunities for preventative care burden me and my health, they burden the whole system by driving up costs and creating large amounts of waste.
While we treat health as a luxury, the rest of the world knows that it is a right, specifically, a human right. So whether you are looking at the high levels of uninsured Americans who are burdened by medical bills or the many sources of waste that drive up prices to cause those burdens (even on the insured population, why do you think your premiums are so high?), there needs to be some change in the way America looks at health.
In other words...
So tell me, have you had similar experiences with your trips to doctors, hospitals, and specialists? Where do you see the most wasteful parts of health care? Where do we go from here?
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