Complaining About Cost
US healthcare does cost too much. But we must focus our complaints on the real problems. I thank Dr. Lauren Florence for the following which she wrote in response to the wrong kind of cost complaint:
I write in response to Mr. Kent Overly’s letter “Too Much for Too Little” 11/12/11 (Salt Lake Tribune). His wife unfortunately cut her hand while cooking. They went to an emergency room for care. I hope her finger has healed appropriately since then.
I’m glad the emergency room where they went was close to their home and open at the time that they needed care, not several hours’ drive and only open 2 or 3 days per week or only in the daylight. Keeping the doors open, temperature controlled, and well-lit is part of what the Overly’s paid for.
If they spent 30 minutes, that means that someone at the front desk greeted them and informed the rest of the staff that they were there. An orderly escorted them to the private area where they received care. A triage nurse reviewed their issues and found the right physician to care for their particular problem. Another person had to make sure that the facility would get paid or there won’t be a facility next year. If the same person had done all of those things, it would have taken longer than 30 minutes since they would be doing all of that for everyone who comes with problems. But staffing doesn’t stop there.
Health care distress can sometimes be messy. A professional custodial staff wiped away the green and brown drops that someone before left on the floor, walls, curtains and furniture before the Overly’s got there. Oh, by the way, I’m assuming furniture and that they didn’t crouch against the wall while they waited.
Also, I’m assuming it was safe. Places open at 3am when some people have accidents also attract persons with emotional disturbances who bring guns to act out their demons, on the staff.
Maintaining an efficient, organized, first world facility to do these things for hundreds of people who come with disease and injury each day is what the Overly’s paid for.
They also paid for expertise. Nurses, Physician’s Assistants and Physicians train for decades to be the professionals that you can trust. Two simple stitches is not quite so simple in the wrong hands. Comedy movies are made when the untrained perform without knowhow. Surgeons go to 12 years of public school, 4 years of college, 4 years of medical school, and 3-7 years of surgical training. The Overly’s paid for expertise acquired while the professionals were called “student” and were not paid but paid out to receive training. That trained professional made those two stitches look easy.
The stitches, by the way, are about $6-15 per sterile packet. That’s a one-use needle and 18 inches of suture. The needle is attached to the suture so that only one piece of suture has to pass through the wound. Threading a needle and pulling both the in and outgoing part of the thread through the tissues rips a bigger hole than one piece of thread passing through. That means the scar is smaller and the injured tissue is damaged less with the expensive needle. Damaged tissue has a higher incidence of infection. A threaded needle, by the way, costs about 3 cents.
An emergency facility has to maintain at least four different sizes of suture so that, for instance, no one has to have a giant rope in their finger. But the tiny sutures won’t hold a big wound closed so they are needed as well. Also, different kinds of suture must be maintained. That stiff suture so appropriate for a finger is impossible inside the mouth. The ends of the tie would puncture the soft mouth tissue. But, the mouth suture will cause a big reaction in finger skin. Finally, one can’t just buy one suture. They come in packs of twelve at minimum. The Overly’s paid for hundreds of thousands of dollars worth of different supplies to sit on shelves just in case they came in. Finally, medical supplies have sterility dead lines. When they pass the “use by” date, they are thrown out. The Overly’s paid for that, too. No one took the pliers from the garage to pass the two little stitches through her finger.
Mrs. Overly, thank the heavens, was stable. But the people who are on the edge of mortal life, say with heart attacks, need monitoring. These machines cost thousands of dollars each. More than one of these has to be on hand to monitor any of the hundreds who pass through any emergency room any day.
Perhaps from outside the healthcare system, I sound defensive. I am. I defend people against the ravages of the world. Keeping the system revved up for the innumerable possibilities around us is expensive, for all of us.
Dr. Lauren O. Florence, MD
Solo Private Practice
Suturing is an appropriate medical intervention response to a laceration. It is a simple medical procedure, outlined here by Dr. Lauren Florence, a plastic surgeon and my good friend. There are many decisions, hidden from the patient, which are made related to this procedure, including the choice of suture and technique. Patients are totally dependent upon physicians to make these decisions properly because they lack the information necessary to even know that a decision is required. A certain amount of cost must be expected if one is to receive prompt care of high quality, as Dr. Florence points out.
High cost in US health care comes from two kinds of waste: poor quality and inefficiency. Poor quality care comes in three principle varieties: inappropriate care, patient injury, and failure to achieve best clinical care. Most of the mistakes which lead to poor quality care are made because the health care system is fraught with perverse incentives, imposed on health care delivery by the mistaken notion that health care is a commodity best delivered through 'market forces'. As pointed out above, patients are not the all-knowing consumers anticipated by market theory. Inefficiency is the principle intent of the American health care financing business model better known as private, for-profit health insurance. Between these two types of waste, Americans experience more than $1 trillion in excess, needless cost in our health care delivery.
Mr. Overly, like most Americans, needs to become more focused when complaining about high health care costs. Let's get rid of the waste in our health care system. Complain about inappropriate care, patient injury, or inefficiency. But don't just complain, do something. Join the Utah Healthcare Initiative.
Dr. Joe Jarvis