Where Does All the Money Go?

My neighbor, last week while working on some tile, nicked his hand with a razor knife. To hear him tell it, sort of a borderline injury, he thought to get it stitched up. Well the bill came in for this at $4,400. I just don’t get it, is the silk so expensive, is it the cost of sterilizing the instruments? Sure, medical equipment costs big bucks, but not a lot of hi tec gear used here. They did make an x-ray just to be sure he didn’t nick a tendon, but that was the extent of the sophistication in this little patch job. The doctor is not getting rich in working this job. I wouldn’t mind if he was! He certainly put his time in, years of study, he’d deserve it. I have heard these costs are driven up by insurance costs, of the doctors, of the institution. Breaking this down, what I see as going on is, we the public, in the price we pay, pay for all of the insurance coverage, that the institution carries, as well as the doctors. If we all have medical coverage, this all works very well. I don’t think the insurance company will mind paying down that $4,400 bill for a couple stitches, knowing most of it will come right back to them. I learned a lesson long ago about insurance, when I purchased an extended warranty to go along with a new car. I had some real problems with that car, those problems were just the beginning. I looked for help from the policy I had purchased, very flatly I was told I was not covered. It all became clear to me, insurance companies collect money, they don’t pay it out. My experience with State Farm, I have to say has been good, I think it had a lot to do with the agent involved. All over this country there are agents in communities, doing good for the people they service. It all is very personal, unfortunately this hasn’t carried through into health care. I can remember when I found out where the blade in a skill saw was, I was moving fast, most likely too fast, when passing underneath, the wood I had cut, I nicked my wrist with the blade. My finger was off the trigger, my wrist stopped the blade from spinning. There was a lot of blood, I wrapped my wrist and headed for the doctor. I didn’t have a lot back then, but I had a great doctor. It was about three in the afternoon, when I got to his office on LaBrea, Dr. Cutler had just got back from a late lunch, you could tell he was feeling good, the entire office was upbeat, you knew these people enjoyed being there. When the doc saw my wrist, everything changed, right away I was taken into a room, Dr Cutler was right there, very serious, he began looking over my wrist. He thought out loud, he talked with me about the possible damage I might have done, he told me the best thing would be to clean it, to stitch it, and give me a tetnis shot. He said when I come back in a week, he could better tell, if there was anything more needed, than what a few stitches could fix. When I left that office, I left owing no money, I payed the $60 and went back to the job. It was an ugly cut, I still see the scar today, but a week later and another $30, the stitches came out and the doc felt I had been lucky, that everything was moving like it should. This all happened decades ago, I realize prices across the board have all gone up, but what I’m talking about here is care. There is something in the oath doctors take as they enter the profession about not inflicting any harm to the one they are treating. To me, being involved in a system, that buries under $4,400 rock, a patient who comes in for a little bit of help seems outrageous. Come on now, it is just a few stitches. I found a great doctor while living in South Philly. Helping a friend, I was in a crawl space, doing a little plumbing. In the process of that work, a spider bit my upper arm. For a couple days, it was a bit irritated, but it all cleared up in three. In about 8 days, it started to bother me a little, in eleven days my arm was the size of a football. It hurt a lot, it throbbed, I began to see color changes in my skin. I had no doctor at the time, so I started asking around the neighborhood, was told of a guy a little South on Ninth. I had suffered with this through the weekend, I knew I needed to do something quick. I was waiting when the office opened, a really nice neighborhood office. The doc was a young guy, I had seen him in the neighborhood. He got me in, started looking over my arm, and I could tell he didn’t like what he was looking at. We talked a little about the bite, he asked me if I had actually seen the spider bite me? I told him the events over the last week or so, that I saw what appeared to be a bite mark, how it had healed, how a few days later it began to swell. He took time to confirm my insurance situation, that I had none. He told me that I really should be checked in to a hospital, that I had a serious bacterial infection, that I was very close to becoming septic. This was a great man, a great Doctor, he was looking at my situation on all levels. Although he felt medically, the best place for me was a hospital, he knew the harm done, being buried by bills, would be something to hard to crawl from beneath. He wrestled with his choices, I watched him, It all broke down to what was best for me! He put me on Cipro, he pulled it off his shelf, and told me to pay attention to my arm, that some of the pain should subside, and to see him in a few days for a follow up. Coming back, the swelling had gone down some, it wasn’t throbbing. He felt the Cipro had killed whatever bug it was, and to see how it looked in a week. The first visit, if I remember right, was $85, he didn’t charge for the follow up. It is a nice feeling leaving a doctors office not carrying a balance. When I went back in a week, I was loosing ground again. The doc got pretty pissed off, this bug wasn’t acting right, he felt, what he had thrown at it, shouldn’t have left anything standing. I just asked him for more Cipro, he’s the doctor, and he told me I had enough of that. You could almost see the smoke coming out of the top of his head as he thought. I know there was a big part of him saying hospital, he got serious with me, telling me I had a dangerous infection, like I didn’t know. He pulled some different antibiotics off his shelf, and told me to take them for ten days, to come back and see him in a week. He said if I notice it getting worse, to get in quick. I was able to leave his office debt free once more! When I was back in a week my arm was looking normal again, he was happy with what he was seeing. He had this look of being on the job, the last visit had been a little tense, the displeasure he had with the stubbornness of the infection, I had taken personal, I remember thinking I wasn’t doing something right. This doctor had a lot of pride with the work he had done. The week before he was in a battle. You could tell this guy didn’t like to loose. Am I wrong in thinking these insurance corporations have all but killed this kind of health care? The profits engineered into these over inflated medical bills, one way or another end up back in their hands. I hear medical costs are high because of people who seek care and then are unable to pay. Is it a mystery to anyone why a guy just trying to keep food on his table,working a little tile job, would have a bit of difficulty paying off a $4,400 bill for a few stitches. That amount of money is the take home pay for a month of a union carpenter. This money does not go to the doctors. Last week I talked a bit about the 859 billion dollar profit generated in the third quarter for united health. All it seems these insurance corporations do is sit around scheming on new ways to get at our money. I was talking with a good friend of mine, a very smart guy. I told him I was really trying to understand the whole financial mess, that what I was having a hard time understanding were derivatives, he told me that was at the core of the problem, that no one understood derivatives, not even the people who traded in them