Anecdotes from a troubled healthcare system
One of the real pleasures of being a Nieman Fellow came after I discovered the morning prayer service at Memorial Chapel at Harvard. In 15 minutes I got beautiful singing, a hymn and a homily that almost always opened my mind to something new. I went at least once a week, and continue to do so.
This morning’s speaker was Ted Kennedy’s former chief of staff, Nick Littlefield, who made his points and then made them again, and again (he went on a bit too long). But he seems correct in arguing that the fee-for-service model that now dominates U.S. health care works poorly. To wit: one of my fellow Fellows had a daughter prone to falling. She fell here and she fell in Italy. Both times, she needed four stitches. Here, she went to Children’s Hospital. She was seen by multiple doctors, including a plastic surgeon, who wanted to make sure she got no scars. She received a special numbing treatment, administered by her mom, so she wouldn’t feel any pain while being stitched up. Her stitches were the kind that are invisible and dissolve on their own. She played with an iPad application while she was being stitched up. It took a few hours, but she felt no trauma. The cost: $5,000, or $1,250 a stitch.
In Italy, she went to a rural doctor. He took a needle and blue thread and went to work. The daughter screamed and cried and felt embarrassed at the blue threads on her forehead, so took to wearing hats until the stitches were removed. It wasn’t pretty, but it only took a few minutes. The cost: free, or $0 per stitch. Not only was it cheaper and faster, but all those experts at Children’s Hospital left a more visible scar than the rural Italian doctor.
Another Fellow, also based in Europe, didn’t take his anti-malarial medicine when in an African country where malaria is rampant. He came back to Cambridge and began displaying all the symptoms of malaria. He didn’t go to the doctor until he was so sick he needed an ambulance to make it the two blocks to the hospital ($1,200). He told them he probably had malaria. They tested him for everything they could think of. Then they tested him for malaria, and treated him. The cost: $8,000, much of it for all the unnecessary tests.
That’s what fee-for-service gets. It works in smaller, insidious ways as well. When my family went to Ecuador, we needed to go to a travel clinic to get some shots. While there, a doctor sat down for 10 or 15 minutes and talked with the four of us. Our insurance initially refused to pay the bills, so we got them. I looked and saw that we were charged for four consultations with that doctor, at $150 each. I called the Mt. Auburn Hospital, where the travel clinic is based, and had a lengthy discussion with a manager in accounting. He refused to tell me why we were billed jitney style for this doctor’s advice. He just kept saying they would submit it to our insurer with a different code, and we would have to pay nothing. This seems to have been true. But our insurer was effectively defrauded of $450.
The speaker this morning made a big point of telling us that the U.S. spends twice as much on health care as any other industrialized nation, with poorer results for the bulk of the population. That point can be argued. But $1,250 stitches, needless tests and jitney charges for consultations should embarrass us.