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Preventive Medicine Brought Home

real men don't go to doctors, you know

This is Dark Cloud on Wednesday, July 29, 2009.

Anybody who doesn’t appreciate the mud pit that is American health care should consider this. I’ve been ill for some months, heroically – if I do say so myself – fighting it with good old Yankee common sense, my immense virile vitality, a cleansing diet, and optimistic outlook devoid of religious overtones. After six weeks of a disgusting biodegradation, ending with full daylight hallucinations fueled by the one sandwich a day energy allowed me to prepare, a friend called attention to the fact I resembled something left inexplicably unentombed, that I’d lost a ton of weight, and I had the black circles around the eyes and gray skin of someone not particularly healthy, a visage enhanced by two months of abnormally long and scraggly hair. So, I buckled and saw a doctor, who wanted to admit me to the hospital post haste, which I did decline, but she demanded tests immediately.

Turns out that if you pay cash on the barrelhead at Boulder Community Hospital on the day of service, you pay half the normal price. I assume nobody felt sorry for me above the masses. Because I lost health insurance with everything else a while back and can’t find anyone terribly interested in hosting me since then, I’m self insured, as they say, and so was quite pleased to get $1500 worth of tests and pokes for $750, enhanced by the results, because all it was, it seems, was pedestrian pneumonia, which is easy to deal with. And I’m fine. Had I an IQ in three digits and gone to a doctor early on, say the third week of declining breath and increasing gasping cough, I could have saved the entire $750 and only spent for medication and an office visit, which was less than half that. This is an illustration of how prevention or even minimal attention being paid to abnormalities in your health can save money. If I’d been admitted without insurance, the hospital’s charges, I’m guessing, would have been well over $10k before they let me free. That would take me a while to pay off, but if I never paid it, guess who would? Why, you. Somehow. And that’s not an uncommon occurrence around the country. The ER’s are used as public clinics by the uninsured, and accounts receivable are passed on. Just like, in fact, credit card companies do it when cardholders do not pay. Rates go up. Services curtailed. Of course, CEO bonuses get paid with their record profits.

So, if a person who cannot reasonably expected to pay for hospital care for full blown pneumonia but could for medication and a quick visit weeks previous had made the early visit and still not fully paid for it, everyone has still saved money, time, expense. Prevention or early action is pretty cheap, in fact, compared to what we shell out now.

I know we’ve been inundated with conflicting explanations for our health crisis and insurance and all that, and both sides don’t hesitate to include scare tactics, but what does it say if the hospital and doctors make their normal profit, all expenses are paid, for half the price of when insurance companies and processing agencies are involved? It suggests to me that there is a lot of padding going on upstream from the actual medical team. Well, duh, we’ve known that, but did we really think it as high as 50%?

Of course, when they sent out my Account Summary, there were errors, claiming more was owed. The fact is doctors and hospitals don’t like to deal in cash. They have no change in their office, understandably. They often have no receipt book at all. It’s terra incognita for the Accounting Department, and cash discounts not un-often get added on as if the initial transaction was in error. It’s corrected, but time and paper are money, eating into the 50% they did not collect. The whole process has become autopilot. Fill out the insurance forms, send off to Hartford or wherever, and it comes back all figured out for them. Or not, but at least paid for. Or not, but it’ll get worked out. Or not. But in any case, the patient pays for it. Or not.

I still believe that most people, like you, are hypochondriacs, and that obesity, booze, and stupid diets are the major causes of America’s ill health. I’ve also recently discovered that disease can sneak up and usurp your common sense before you know it. That common sense need be installed early so that people can make smarter choices than I did. Because it costs us.