He had the flu and visited an urgent care center. They told him over the phone that it would cost around $100. His bill? $450 for a 5 minute visit with the doc, who told him he had the flu and sent him home. David is more than willing to pay the quoted fee of $100, but they want the whole $450.
I happen to agree with David. He was quoted a fee over the phone that seemed reasonable for a service that was not above what he told them he was coming on for, and he is willing to pay it. The hospital should take his money and be happy. I know my office would have.
But David’s story is about so much more than the fee. It’s emblematic of everything that is wrong with our healthcare system.
Let’s see just how many of America’s healthcare’s problems we can find in his story. I found five – how many others can you find?
1. He does not have a primary MD
So he went to a hospital urgent care center for something his family doc could have handled. As a result, he got socked with a facilities fee that was more than twice the doctor’s fee.
Lesson learned (and it’s an expensive lesson) – Establish a relationship with a primary doctor. That first visit you make to get that relationship going is worth every penny in long term return, both financially and physically.
We won’t get into the fact that there is a primary care doc shortage, because David’s reasons for not having a primary doc seem to be more financially motivated. But it’s not unlikely that if he were motivated to find a primary MD, he might have trouble finding one and would have ended up at Urgent Care anyway.
2. He waited 2-3 hours for a 5 minute visit.
The doctor spent maybe 5 minutes with him, listened to his heart and his lungs, took his temp, then told him “You have the flu, there’s nothing I can do for you, go home”. His response “Nice. I guess I knew that already.'”
Now, once could argue that the diagnosis was clearly correct, since he indeed recovered on his own at home, and that 5 minutes was all it took to make that correct diagnosis and get him on his way home. And if he had been able to walk right in for that 5 minute visit without a wait, I suspect he would have been relieved and happy. But to wait that long and walk out feeling as crummy as you were when you went in is a recipe for dissatisfaction, no matter how right the doctor’s diagnosis was.
Of course, there are others who waited in emergency rooms who were not lucky enough to walk out…
3. This is a very healthy guy who he can’t get a preferred insurance rate from United because he is “too thin”.
He is 5’10” and 145 pounds. Sounds just Mr TBTAM to me. Healthiest man I know. He rode his bike to the Urgent Care Center! But because David is on his own purchasing insurance, he gets stuck being the actuarial table poster child. Something is terribly wrong when the healthiest among us can’t get affordable insurance.
4. He pays $100 a month for catastrophic insurance but has a very high deductible, and does not go to the doctor for “minor things” because he can’t afford to.
But minor thing become big things. This is the problem with high deductible plans as a cheap alternative for folks who can’t afford better plans. They wait till minor things get very serious. Then they head to the ER. And get stuck paying even more towards their high deductible.
5. If David had been insured by United, the Urgent Care Center would have accepted much less than what they were asking him to pay for his visit.
The highest fee charged an uninsured patient should be the highest negotiated insured fee. But if it were, the insurers would start lowering their fees even further. So providers play the game of raising their charges to justify the contracted rates with managed care. It’s a game whose rules have to be re-written.
This is just one man’s healthcare story.
It’s not even a big story. Nothing terrible exciting happened. There were no catastrophes, no near-deaths, and everyone made it out alive. It’s just another day in the life of an American trying to get decent healthcare in a system that doesn’t work.
If we can fix things for David, we will have gone a long way towards fixing healthcare in America.
Good post. I know other countries have problems with their health care systems but our problems are unique. We don’t guarantee patients appropriate care. You get what you can afford, no more.
What I really don’t understand is why health care reform has become so partisan. To me, health care is a public service, like schools or sewerage or electricity. Why does it have to be partisan? If the garbage gets picked up at every house,who cares if the garbage man is a Democrat or a Republican?
The reason health care is partisan is because (1) politicians win elections by picking fights over health care, and (2) most politicians don’t really give a damn if their constituents get health care or not.
Hi – I’m the David in the film clip and want to thank you for noticing and enumerating the wrong-doings of our system.
You’re totally right – my story is ordinary. No one died. No one went bankrupt. I have since been sent to collections and spoke with a lovely woman who was hired to shake me out for the doctor’s fee of $173. We chatted and she told me how SHE doesn’t have health coverage either and what a bummer it is for her every time she goes to the doctor and how her mother helps her out as well. So I agreed to pay $100 and she said she’d work at getting them to write off the remainder.
I told her that was all they’d get out of me, and damn my credit-rating. Really, in a time when a time when the credit industry is crumbling, who cares about a credit rating…it’s like keeping the deck chairs of the Titanic all nice-n-clean and orderly.
Anyway, I for one am doing my part to break this system. It is a small thing. But hey, my friend Darren exited a 3-week emergency stay at the hospital with a ruptured bowel from a lithotripsy gone awry. He had no insurance and got a bill of over $300,000 that he won’t be paying either.
And I’m off to Thailand in December to get my cholesterol checked, a dermatology exam and a visit to the GI doc. A day in the hospital there is about the same as 5-minutes in the US. I had a colonoscopy and a derm exam all for $400.
Not to mention a visit to the Andaman Sea.
Happy Trails.
wow, it’s cheaper to go to thailand for regular medical care?
we had something kind of similar happen recently. my young adult son is currently unemployed and uninsured. he has asthma. he needed an Rx for his inhaler. we have used the same primary care practice for 18 years, so i took him there.
the practice is now part of a big hospital medical group. instead of the $40 uninsured rate my son has gotten before, they charged $70, which i paid because, you know, he needed the inhaler and couldn’t get it without a doctor visit. we were there 1.5 hours for a 5 minute visit. and then i got a bill from the hospital medical group that ate the practice, for another $50!
they ended up writing off the extra $50. son’s good on inhaler refills for the next year, but for anything else that might come up, he’s on the “cross your fingers” plan. makes me nervous.
McHebert –
There are quite a few Americans, not just politicians, who would argue with your premise that health care should be a public service. I happen to feel it is not a right, but as our responsibility to make it affordable, safe and accessible. And totally agree that the solution has to be de-politicized. Politics comepletely ruined things when Hillary was trying to figure it out. If it happens again this time around, I expect Thailand will become a very busy place….
David –
Wow. You are willing to fork out airfare to Thailand just to get a doctor visit? I suppost the value-added by a vacation in the Far East makes you feel better about forking out the money that waiting in an urgent care waiting room. That I totally get. But one could argue that the money would be better spent on a good insurance plan here at home so that you can get the care you need here. Not to mention the concerns about the level of healthcare there.
For more on this topic, here’s an interesting article on medical tourism from Maggie maher’s healthbeat blog.
http://www.healthbeatblog.org/2008/08/medical-tourism.html
Kathy a –
One more story about a 5 minute visit at a high cost. Unfortunately, from the pracrtice side, if they spent any more time with your son than they did, they would be losing money.
No one is making out in this system these days except the insurers.
TBAM —
When I say health care is a public service, I don’t necessarily mean government. We get electricity, telephone, and cable service from private corporations. Nothing I say in this area should ever be construed to mean I favor nationalizing health care like nationalizing the roads.
Quality health care should be available to anyone who wants it, the way telephone service is. This does not mean it should be free, but it shouldn’t be hard to get.
As for whether it is a right or not, it depends on what you mean. A person who is bleeding to death better have a “right” to health care, or I chose the wrong profession. But I think someone who has diabetes, for example, should have to make some kind of effort. I don’t like patients who think everything should be done for them. It’s your body, and you have to take some initiative.
Health care should be affordable and accessible, that’s all. Right now, it is neither.
amen to your last sentence, TBATM.
i suspect that our beloved PCP practice got absorbed by the big hospital medical group *because* that would help them with all the insurance/billing stuff. the practice is quite busy and has hired additional medical staff; i have to admire them for keeping on, as there seem to be fewer PCP’s, and those have more administrative hoops and fewer rewards these days.
my son didn’t need any more than the 5 minutes. he is healthy aside from the asthma. without his meds, he could end up in the hospital, a much more expensive proposition.
what do you think the answer is?
Dr McHebert –
“A person who is bleeding to death better have a “right” to health care, or I chose the wrong profession.”
Well put. Completely agree with your comment.
You too, Kathy A.
It’s not quite true that people choose high-deductible plans because they can’t afford better plans.
I have a high-deductible plan because it is the only health plan my employer offers. Either I take it or I go uninsured.
Individual plans, as demonstrated by David’s story, are not the answer either, not when insurers can pick and choose who’s going to get the most affordable rates.
There is a perception that people are making “choices” about the level of coverage they have. In reality most of us have very little choice.
P.S. This patient might have felt he got at least some of his money’s worth if the physician hadn’t been so dismissive. The doctor could have offered the standard advice – get lots of rest, drink plenty of liquids, take ibuprofen to relieve symptoms, seek medical care if the symptoms worsen, etc.
Maybe it’s all in how you spin it, but telling someone “there’s nothing we can do” and then socking them with a huge bill can be perceived as crass and unhelpful. Especially when there *was* something they could do, namely provide some useful advice aimed at helping the patient feel better.
Brilliant post and comments too.
The first story that comes to my mind is from a friend whose wife had same day surgery (no overnight stay) for a symptomatic benign ovarian cyst. Their insurance company (Cigna) denied coverage after the fact because it “wasn’t life threatening”. They are stuck with a $16,000 hospital bill. Anesthesiologist charged $550 and surgeons bill hasn’t yet arrived.
Name all of the things wrong with this story!