Well, I just got my bill for getting my knee scoped in March. I was amazed to how they screw insurance and me, only $5400. People think their LBS’s have pricing issues. The hospital is charging me $16 for an ace bandage that can be purchased at Walmart for like $4. Plus, $47 for a guy from therapy to spend 5 minutes with me to watch me walk up and down stairs safely on crutches. What a crock of shit. I think these people need their heads examined.
Man, don’t even talk to me about the incredible ineptitude at hospitals. When I know more medicine (especially emergency medecine) than the pimply-faced junior intern on his 36th hour of a rotation then it is scary.
And that says nothing about the insurane/billing debacle, which (as you point out) is another matter all together.
When I hear these US medical horror stories I’m glad I’m in Canada. Our government health care system, while it has it’s flaws, beats your private for profit system any day.
As one of those pimply faced interns (not quite so pimply faced anymore), I have to take issue with a few of these things.
To Tom: I respectfully suggest that unless you have been through medical school, and most of an internship and/or residency, you can have no idea how much you don’t know about medicine. I am not saying this to toot my own horn or anything, as there are numerous interns and more senior physicians who know oodles more than I do. I am sure from your military background you have a sufficient knowledge of field emergency medicine and triage to have a good idea of what to do in the immediate aftermath of a serious injury. But seriously consider what you are writing. That is like me saying that because of my background in hunting and riflery, I could field strip an M-16 as well as you could. Obviously, that is nonsense. When one of your riding buddies crashes, has major internal bleeding and god knows what else, do you want to take care of him or do you want one of us? You want one of us, because we have given up any hope of a normal life to study medicine and know just what needs to be done to send him home next week.
Number 2: Working in a hospital over 80 hours a week, I see medicine from the inside. It is like sausage…you like it, but you don’t want to see it being made. I am fortunate enough to work at a hospital that runs in the black. The average hospital in this country runs at a profit margin of around 0.5%. Is it disgusting what administrators make? (Especially when my fellow interns and I make 10 bucks an hour, not to mention the nurses.) Absolutely. There is certainly some fat to be trimmed there. And certainly, there is waste in the hospital that could be avoided. And the $5 aspirin borders on the bizzare. But let’s think about the operating costs of a hospital for a moment. Let’s ask ourselves WHY there is a 15 dollar ace bandage or 5 dollar aspirin.
Fact: In the greater chicagoland area, a general internist can expect to pay $35,000 a year in malpractice insurance. In fact, a general internist can no longer purchase a solo policy at ANY price in much of Illinois. Either you join a practice and get under their policy at that price, or you look elsewhere to hang your shingle. Now, multiply that cost times all the physicians in the hospital
Fact: When you crash your bike and get a bleed in your head, you want a neurosurgeon to take care of you. Guess what? Most have left chicago, and illinois in general. My hospital needs a couple of them, since we are a trauma center. We pay $400,000 in insurance a year EACH for our neurosurgeons. My hospital can afford to. You crash your bike at a tri in an outlying area, it is a LONG helicopter ride to chicago, because there are no more neurosurgeons at most other hospitals in the state. While you are hanging around an er someplace, that pressure is building in your head and probably causing damage that will NEVER be fixed.
Hospitals overcharge for EVERYTHING so that they can get some reimbursement that is close to what is fair. Consider this: When a medicare patient comes in, the hospital gets a flat fee…I belive it is between 5 and 6 thousand bucks. That is about all we get, no matter how long the stay is or what tests are needed (I am not sure of all the ins and outs, but we are talking ballpark here). The operating costs for the hopsital bed are about 1200 dollars a day when you factor in nursing, diet, basic prophylactic measures, paying the secretaries. Now maybe we think the person has a stroke, so we order an MRI. $2000. You get the idea here. This is most of what comes through the door. In my hospital, a 700 bed major teritiary care center and trauma center, 4/5 of my patients are older than age 75. Every fourth night I work all night (the 36 hour (actually, 30 hour) shift)). Most of the perople I see are medicare patients or older folks that cannot afford insurance. We take care of them because they are human beings and deserve to be cared for, no matter what they can or can’t pay. To keep the doors open as a practical matter, the money has to come from somewhere. So the rest of us who DO have insurance that we pay our our asses for foot the bill.
For the gentleman who complained about the therapist and the safetey eval, you can thank the insurance industry and the ridiculous litigious nature of america for that. We have been sued for MILLIONS (yes, millions) for people who have fallen with crutches because they claimed their PT eval was insufficient to prepare them for the hazards of walking with crutches. It is insane.
As far as the cost of healthcare, take a doc in the outpatient clinic. You come in for a physical, blood work, etc. It is your first visit with me, so we schedule an hour. What is my time worth? According to most insurance plans, maybe a hundred bucks. Probably less. Most people on this board drop more than that on a bike fit. Consider that for a minute. I went to 4 years of college, three years of grad school, 4 years of med school, and will have finished 4 years of a residency before I am done. I am not suggesting that there is not a large amount of know how that goes into a PROPER bike fit (i.e. what Demerly would do)…I have been fit by a professional and I paid what it was worth, and I didn’t complain because i was paying for someone professional opinion and expertise. That is how it is supposed to work. What I am saying is that how many people complain about the $20 copay, or think it is ridiculous that the doctor billed a hundred bucks for a ten minute visit? You are paying for the doctors expertise. You are paying for his knowledge of how to determine your headache is a strange variant of migraine, and NOT a brain tumor that is going to kill you. You are paying for the risk he assumes when he says your leg pain is a strain, and not a blood clot that might go to your lung and kill you before you even hit the floor. Think about it for a minute.
Ok, rant over.
Philbert
I work in a hospital in Hawaii, and I ask if the medicine in Canada is so good why are about 20% of our staff expats of Canada?
They all left because they think the state of medicine is horrible in Canada. We seem to be filling our nursing shortage from the Western Provinces In the last ten years Hawaii has recruited x-ray techs, nurses, physicians, and lab people by the bunches. They all complain about over worked underpaid and having people go to the States to get medical care at any price because the wait is so long in the Great White.
I know American medicine is in the toilet and we will probably have socalized medicine pretty soon, As the system is going broke,but I am not too sure the system in Canada is in any better shape than ours. G
''I work in a hospital in Hawaii, and I ask if the medicine in Canada is so good why are about 20% of our staff expats of Canada?
They all left because they think the state of medicine is horrible in Canada."
And you really believed them !! They left for the money.
Francois
“I was asked if I was going to sue the hospital for the mistake…”
You should have no - I’m not going to sue for making a mistake… but, I am going to sue you for being stupid.
Perhaps, they would of had a better understanding about the predicament.
FWIW Joe Moya
What happened to you ALMOST happened to me once… (long story)… but, luckily I had enough where with all to stop that non-sense - only I wasn’t that nice about it!
Since then, I have always thought it would be smart to wear a medic alert tag with my normal HR noted. I try not to ever assume anything…
FWIW Joe Moya
"if the medicine in Canada is so good why are about 20% of our staff expats of Canada? "
Ever occur to you the weather could have something to do with it? Winter in Hawaii or Alberta. Now that’s a no brainer IMO.
It’s also actually supply on demand. When you have government supported health system there are limits on nursing/tech jobs. Consequently more nurses and techs have been graduating recently than there are jobs for. Hence, they have been absorbed by US employers.
There is a lot of problems with the Canadian system for sure, but we don’t have a situation as in the USA where you have 40 million Americans without health care and a further 29 million with inadequate coverage. That’s about 25% of your population (CNN statitistics BTW).
No system is perfect. If you’re in the US and have a CEO health care plan then you’ve got terrific coverage, but if not, you’re likely not getting it as good a coverage as you might in Canada.
Philbert, absolutely exceptional rant (your word)/explanation. One fact of life is that service varies widely. I can’t think of any service we receive (ie, store, auto, etc) that is as critical as medical service. Unfortunately long hours on the job can reduce the performance of even the best of us. Thanks for your service. Bill
It seems to me that the US will ineventably be heading to a Canandian/US type health care system… Or, a more modified HMO/PPO health care system.
By modified I mean… those without an economic advantage will have a Canandian health care structure… while those with wealth will seek a Health Insurance (i.e., less regulated/socialized) structure for care. Whether this will result in a two tier heath care system… I’m not sure. But, it does seem that we have a two tier system now.
just my .02 worth… Joe Moya
Philbert:
I applaud your comments. I too am a physician (respiratory and critical care) and a ironman triathlete. As you are aware, both hospitals and physicians are lucky if they collect 60% of what they bill and the patient only sees what is charged, not what is paid. This then doesn’t count the overhead incurred in running a practice to include malpractice insurance. In my clinic, our overhead is around 60%. Therefore if we “distill it down” for every one dollar I charge, I am lucky if I get 35 cents! Counting college, I have 15 years of training since high school and I am sure your situation is similar. Had we been interested in making the “big bucks” we certainly would not have chosen medicine as the route to do so. I must say that even though I have enjoyed Tom D.'s posts in the past, his most recent comment was moronic and I will predict that he likely would not have had the GPA to get into medical school. Lastly, I find it interesting how some of these guys slam the medical profession and people like myself however when they get hit by a car and have multiple trauma in the ICU, I become their best friend!
TriMD
Wow, the responses have been quite entertaining. Now let me take a minute to get some of your responses straight. It is okay for the government to take my new wetsuit in taxes, but now the hospital wants to take my Trek time trial too. Don’t get me wrong, I am very greatful for the treatment I recieved in this instance and when I had viral encephalitis. However, is it right for someone to stiff you just because they can? The answer is no.
Hey Tom,
Did you get my email about the Cervelo TT skinsuit?
Well, I just got my bill for getting my knee scoped in March. I was amazed to how they screw insurance and me, only $5400. People think their LBS’s have pricing issues. The hospital is charging me $16 for an ace bandage that can be purchased at Walmart for like $4. Plus, $47 for a guy from therapy to spend 5 minutes with me to watch me walk up and down stairs safely on crutches. What a crock of shit. I think these people need their heads examined.
hansoa,
I share your pain, but where have you been?
In 1997 my wife was taken to the ER at a local and reputable hospital for diagnosis and treatment for what turned out to be a kidney stone. When we saw the bill for the services rendered, we discovered that she was charged $13.00 for each ibuprofen tablet! And $70.00 for the use of a blanket while she was cold and shivering while an anesthetic wore off. We didn’t even get to take the blanket home! It was simply laundered and used again to permit charging another suffering soul $70.00 again.
But wait, it gets worse. Even at these outrageous price levels, the hospital administration maintained, with a straight face, that they were losing money! This seemed totally unbelievable. They call this management. I bet the hospital administrators even got bonuses.
I wish I had some advice for you from my experience that would help you, but I do not. I can only empathize with you.
Where have I been?
I am only 26 and just 3 years out of college. It is the first time that I have actually had money, and the first time I have had to pay for major medical bills under my current work insurance. Here is my analogy and see what you guys think: the hospital is currently running and dictating fees like our good buddies in the middle east that run OPEC. Please feel sorry for us when we are driving around in our BMW’s/Hummer. Here is something: kiss my ass. Don’t be a hater when I pass you on my Trek time trial in a race sometime.
The other reason I am pissed lately is my piece of shit knee is not going the best. I got hurt while playing hockey in December, and the jerk off intern gave me some pills and told me to come in to my real doctor in 2 weeks if not better. I ended up finally getting something done in mid March. Now the season is starting and it is still not well enough to ride or run on. Plus, I had to pay the hospital $220 to see the intern. Wow, get jerked around by an intern or buy some new cervelo skinsuits. It was a really tough call, but in this case, I think the skinsuits would have been more productive.
As one of those pimply faced interns (not quite so pimply faced anymore), I have to take issue with a few of these things.
To Tom: I respectfully suggest that unless you have been through medical school, and most of an internship and/or residency, you can have no idea how much you don’t know about medicine. I am not saying this to toot my own horn or anything, as there are numerous interns and more senior physicians who know oodles more than I do. I am sure from your military background you have a sufficient knowledge of field emergency medicine and triage to have a good idea of what to do in the immediate aftermath of a serious injury. But seriously consider what you are writing. That is like me saying that because of my background in hunting and riflery, I could field strip an M-16 as well as you could. Obviously, that is nonsense. When one of your riding buddies crashes, has major internal bleeding and god knows what else, do you want to take care of him or do you want one of us? You want one of us, because we have given up any hope of a normal life to study medicine and know just what needs to be done to send him home next week.
Number 2: Working in a hospital over 80 hours a week, I see medicine from the inside. It is like sausage…you like it, but you don’t want to see it being made. I am fortunate enough to work at a hospital that runs in the black. The average hospital in this country runs at a profit margin of around 0.5%. Is it disgusting what administrators make? (Especially when my fellow interns and I make 10 bucks an hour, not to mention the nurses.) Absolutely. There is certainly some fat to be trimmed there. And certainly, there is waste in the hospital that could be avoided. And the $5 aspirin borders on the bizzare. But let’s think about the operating costs of a hospital for a moment. Let’s ask ourselves WHY there is a 15 dollar ace bandage or 5 dollar aspirin.
Fact: In the greater chicagoland area, a general internist can expect to pay $35,000 a year in malpractice insurance. In fact, a general internist can no longer purchase a solo policy at ANY price in much of Illinois. Either you join a practice and get under their policy at that price, or you look elsewhere to hang your shingle. Now, multiply that cost times all the physicians in the hospital
Fact: When you crash your bike and get a bleed in your head, you want a neurosurgeon to take care of you. Guess what? Most have left chicago, and illinois in general. My hospital needs a couple of them, since we are a trauma center. We pay $400,000 in insurance a year EACH for our neurosurgeons. My hospital can afford to. You crash your bike at a tri in an outlying area, it is a LONG helicopter ride to chicago, because there are no more neurosurgeons at most other hospitals in the state. While you are hanging around an er someplace, that pressure is building in your head and probably causing damage that will NEVER be fixed.
Hospitals overcharge for EVERYTHING so that they can get some reimbursement that is close to what is fair. Consider this: When a medicare patient comes in, the hospital gets a flat fee…I belive it is between 5 and 6 thousand bucks. That is about all we get, no matter how long the stay is or what tests are needed (I am not sure of all the ins and outs, but we are talking ballpark here). The operating costs for the hopsital bed are about 1200 dollars a day when you factor in nursing, diet, basic prophylactic measures, paying the secretaries. Now maybe we think the person has a stroke, so we order an MRI. $2000. You get the idea here. This is most of what comes through the door. In my hospital, a 700 bed major teritiary care center and trauma center, 4/5 of my patients are older than age 75. Every fourth night I work all night (the 36 hour (actually, 30 hour) shift)). Most of the perople I see are medicare patients or older folks that cannot afford insurance. We take care of them because they are human beings and deserve to be cared for, no matter what they can or can’t pay. To keep the doors open as a practical matter, the money has to come from somewhere. So the rest of us who DO have insurance that we pay our our asses for foot the bill.
For the gentleman who complained about the therapist and the safetey eval, you can thank the insurance industry and the ridiculous litigious nature of america for that. We have been sued for MILLIONS (yes, millions) for people who have fallen with crutches because they claimed their PT eval was insufficient to prepare them for the hazards of walking with crutches. It is insane.
As far as the cost of healthcare, take a doc in the outpatient clinic. You come in for a physical, blood work, etc. It is your first visit with me, so we schedule an hour. What is my time worth? According to most insurance plans, maybe a hundred bucks. Probably less. Most people on this board drop more than that on a bike fit. Consider that for a minute. I went to 4 years of college, three years of grad school, 4 years of med school, and will have finished 4 years of a residency before I am done. I am not suggesting that there is not a large amount of know how that goes into a PROPER bike fit (i.e. what Demerly would do)…I have been fit by a professional and I paid what it was worth, and I didn’t complain because i was paying for someone professional opinion and expertise. That is how it is supposed to work. What I am saying is that how many people complain about the $20 copay, or think it is ridiculous that the doctor billed a hundred bucks for a ten minute visit? You are paying for the doctors expertise. You are paying for his knowledge of how to determine your headache is a strange variant of migraine, and NOT a brain tumor that is going to kill you. You are paying for the risk he assumes when he says your leg pain is a strain, and not a blood clot that might go to your lung and kill you before you even hit the floor. Think about it for a minute.
Ok, rant over.
Philbert
Philbert,
You begin to sound as if you are asking, “Do you have a license to practice medicine? No, then shut up! How dare you question my knowledge or expertise or desire to be a partner in your treatment! I refuse to have my judgement questioned by anyone who is less knowledgible than I am.”
The fact of the matter is that many of us have had experiences with the practice of “bad” medicine. The holier than thou attitude of some physicians just might be part of the reason why your medical malpractice insurance is so expensive!
Where do you think Lance would be today if he hadn’t insisted on educating himself regarding his illness and treatment and seeking out doctors who were experts in their fields and yet were intrigued and excited to work with such a physically gifted patient who desired to be intimately involved in his own treatment?
I suggest that you should continue your education, but learn to be less offended as well as feeling less threatened whenever your patients question your decisions and asks you to share your thought process so they can be a partner in their own treatment. I don’t think medicine is the only profession where one head is better than two. I don’t think you believe that either.
And BTW, why are physicians always reminding us patients that medicine is an art, not a science? Is this so they can get along with their hospital administrators who desire the physician to run as many tests as possible (run up the charges, more billings for hospital) (shotgun medicine) instead of suspecting a probable diagnosis, running specific tests to prove or disprove the suspected diagnosis and then proceeding to the next step(sharpshooting medicine)?
Working 80 hour weeks at $10.00/hr may also contribute to negative attitudes on the part of physicians(overworked, underpaid, taken advantage of, and abused) that may be contributing to bad medicine. Are you a victim of this situation?
Personally, I am the victim/former patient of a foreign born ENT who could barely speak English and knew nothing of baratrauma injuries to the ear. He misdiagnosed my ruptured eardrum and mistreated the infection. Treated ear for external infection when the infection was internal, treatment was ineffective and delayed treatment of real condition. I now enjoy reduced hearing in that ear and can thank my expert holier than thou ENT specialist for his outstanding diagnosis, treatment and patient care!
While attending the University of Michigan as an undergraduate I had trouble one semester staying awake and felt very run down. My mother, an RN, suggested that I might have mononucleosis and that I should go to the University Student Health Service and have that ruled out. The physician who treated me asked me why I had come in. I explained my symptoms an that my mother who was an RN suggested I might have contracted mononucleosis. I then got the does your mother have a license to practice medicine lecture as well as his assurance that I did not have mononucleosis. Reluctantly, he finally consented to testing for that but only to prove that my mother and I were both wrong. The test came back positive, but I don’t think he ever was advised. I had to call back for the test results and was advised by a nurse.
Get off your high horse and be a human being first and a physician second instead of a physician/god first and a human being last!
Yeah call me a socialist, but I am worried about the quick and increasingly thorough conversion in the US from one that had a very strong andcompetitive non-profit component to it to one that’s more and more for-profit.
When I lived in Tennessee, the county-run and owned hospitals there were getting insane offers from the for-profit health care companies to buy out the small hospitals. (Money from the hospital sale went into the county budget) And when you’re paying $30 mil for a rural hospital, you’re going to want to turn a nice profit on it.
These days, I live in a county where 2 of the 3 hospitals are owned by Columbia HCA. (third one is in a rural area 45 miles from the coast) It’s effectively a monopoly situation for emergency care where the monopoly is controlled by a for-profit with a bad reputation. Reportedly Ft. Walton Beach Medical Center is the most expensive hospital in the Southeast. Twin Cities Hospital HCA is reportedly not far behind.
This makes it hard to get decent health insurance in the county. A lot of insurers have pulled out of the area altogether rather than try to negotiate with Columbia. In six years, we’re on our third different group plan with our second insurance company. (and we’re talking a mid-sized government employer that would normally be stable in those things) At one time Humana (previous health insurance) and Columbia’s disagreement got so bad that Humana was telling you you may have to go to the rural hospital 45 miles from the coast or over to Pensacola for emergency care. Which is a great option if you’re having chest pains. Then Humana stopped writing policies in the area.
Where have I been?
hansoa,
No offense intented, hopefully none taken.
The thought that you were so young never entered my mind. Perhaps the onset of Altzheimers. I’m 51 at the moment. Have been there(26) and done that.
I’m sorry that medicine is not advancing fast enough for you to have had a more positive experience than many of us had before you. It seems a lot like the movie, Groundhog Day. Yet it is a sad comment on medicine nonetheless.
Good luck with your recovery. Best wishes that things turn the corner for you soon.
‘’‘I work in a hospital in Hawaii, and I ask if the medicine in Canada is so good why are about 20% of our staff expats of Canada? ‘’’
I infer from the above that he thinks they left because the standard of medicine is poor. Nothing wrong with leaving for money.
But, as a matter of interest, how much of your 10 years in college did you pay for yourself. Or did France make some investment too?
I am retired from medicine and simpathize with both sides of this discussion. Having that said I have also noted both sides have holes in the arguments. I won’t go into all of them but as an example the foriegn ent that misdiagnosed and mistreated a ruptured tm may have not been a result of his being a md but a produce of his culture (values in his home country). This is something I have observed in many foriegn md’s. The language problem is a real issue both expressive and receptive on their part. This is not to say they as a group are bad for I have personally worked with some that are the finest and smartest people and md’s on earth. I have been on both sides of this problem. As a result of a surgical “accident” I have had multiple hospitalizations and proceedures so I know the patient side as well. When I was hospitalized my HR was 37 and b/p 90/50 range and it was noted and passed along every time I changed olcations in the hospital but I was not in danger of getting beta blocker .
Francois I assume you had an EPS study for WPW and did you have the ablation proceedure and if so how long did it take I have seen up to 12hrs without success. Hope yours went well or should I say glad it went well, if you had it, seeing how well your doing in tri’s