Seems like I read somewhere that the death of a
child leads the list of stressful human
disasters. More than death of a spouse. Serious
illness requiring urgent surgical intervention
has to be right up there in the top ten. I guess
it's time for some observations on the health
care system in the USA through the eyes of a user
rather than provider.
When it became apparent that we had a sick kid,
our first action was to contact the pediatrician
who ordered an outpatient MRI the following day.
This was accomplished with no delay and the film
was read by the radiologist and duly transmitted
to the pediatrician who asked my wife if she had
a preference for a neurosurgeon. I knew who to
talk to and the office was called same day. As it
turned out an appointment was made the following
afternoon. That was Friday of the Labor Day
weekend. On examining Devon and looking at the
MRI, the neurosurgeon felt this was an urgency
and bumped a case previously scheduled for the
following Tuesday (after labor Day). That
patient was postponed to be the second case. I
don't know that you get much better efficiency
than that for a non-emergency. Did this case get
speeded up because I was who I am? The usual
wait to see a neurosurgeon is about a month. I
don't think that was a serious consideration as
the surgeon was a pediatric surgeon in a
different hospital and didn't have a clue who I
was till the residents told him. I think the
process got speeded up because there were aspects
of it that leapt out as more urgent than usual.
There's a big billboard around town that says
something like: "If you have childrenŠ.be glad
you have Children's (Hospital). I wholeheartedly
agree. Kids are different. Pediatricians are
definitely different. You don't deal with a kid,
you get a mother-kid amalgam, some say akin to
various two headed monsters of mythical yore. No
everyone can deal with peds. i don't do it well.
The particular crew rotating through Ped NS does
it exceedingly well, to their eternal credit.
The surgery was performed with world-class
players, Pediatric Neurosurgeon, pediatric
anesthesiologist and went well. Postoperatively,
she was immediately put on patient controlled
analgesia and a physician from the "Pain Team"
visited every day to insure the setup was
titrated properly. They changed the settings
several times. She was quickly weaned off to
ketorolac and small amounts of diazepam. When
the attending surgeon arrives for rounds, with a
gaggle of residents, everyone in the room leaps
to attention. God-like isn't the right word,
just definitely in charge. "Commanding" is a
better word. When he speaks everything stops. The
pediatric nursing staff was superb. When the
call button was pushed, someone actually showed
up to deal with it. The sofa chair next to the
bed folded into a bed for her mother to sleep in.
All aspects of her care were superb.
Seems like a perfect healthcare system. Once a
need is recognized, the patient enters the system
quickly, evaluations are performed efficiently, a
diagnosis is made and the problem is rectified in
short order. So what's the big fuss about health
care in America?
I suspect the fuss is because the care for my
daughter, world class in every respect is going
to cost someone a whole lot of money. A
heart-stopping sum. But I won't be paying for
any of it out of pocket. It would be physically
impossible to put a dent in it if I paid the rest
of my life. I am essentially an employee of the
University of Pittsburgh Medical Center (UPMC),
which provides a Practice Plan for physicians.
We have negotiated salary and benefits, which are
very generous I think. One of those benefits is
health insurance through a UPMC Health
Maintenance Organization (HMO). There are
several plans to chose from, some with more
flashing lights and bells than others.
I can't remember exactly how much I pay out of
pocket a month to subsidize the health care plan
but I think it's somewhere around US$300.00 a
month. If I or any of my family requires health
care, the only caveat is that a UPMC provider
must render it at a UPMC hosptial and, unless I
get sick or injured out of town. Of course I
have absolutely no problem with that, as I
believe UPMC is as world class a center as it
gets. It would never cross my mind to go
elsewhere. But let me tell you, a neurosurgical
procedure and anesthesia by a double Boarded ped
anesthesiologist and (probably) four days in the
hospital is going to cost a LOT of money. If I
ever see a bill, I'll try to give you some idea
what it all costs.
What if I was not who I am? What if I was a
small business owner struggling to sell used
video tapes, DVDs and rock memorabilia in a small
shop on the strip on Liberty Avenue. Obviously
no extra money to purchase phenomenally expensive
private health insurance. Going bare and praying
for no illnesses in the family. What if that
man's daughter came up with the exact same
scenario as mine? Would that child enter into
the system with the rapidity and efficiency as
that of an attending physician in the system?
I'd like to think so but I don't know. I honestly
don't know.
We have binding laws that facilitate entrance
into the health care system for all comers
regardless of their ability to pay. We treat all
patients equally as far as their care goes, but
I'm not sure we continue to treat them the same
after the care is rendered. There are no laws
that I know of that prohibit dunning patients for
billable charges due and payable. I will never
see this hospital bill. I don't know if a
penuric father of a similar child as mine would
be presented with a multi hundred thousand bill
and told to pay up according to a court ordered
monthly schedule for the rest of his life. A high
risk, high stakes crap game in which none of the
rolls bring you riches but some of the rolls
might break your bank forever. I think that
would qualify as a BIG problem with our system.
Wouldn't you?
Currently we are only insuring about 80% of our
population, but many of them are dramatically
underinsured. Being "insured" is not the same as
having all your medical bills paid. The real
number of patients that can access the kind of
care my child received this week is probably
closer to 60%. Can we afford to suddenly
indemnify every single family in the USA for
phenomenally expensive catastrophic illness? No
one knows the answer to that since we have not
tried it. What we have done is dance around it,
or worse let Hillary tinker with it.
If we choose to try, it is arguable that we can
provide the exact same care my daughter received
on demand for everyone that needs it. First of
all, we probably don't have the personnel or
facilities to serve the increased demand.
Secondly, it will require a stunning increase in
taxes and employee co-pay to afford it. Everyone
wants "good" health care but these are the same
taxpayers that vote down tax referendums that
benefit their own kids. Thirdly, and perhaps most
important, we will need to cut back on expensive
services we now render that serve no useful
purpose other than to expend huge amounts of
money maintaining life-in-death for moribund end
of life patients.
That last one means we'll have to tell medical
ethicists supporting unlimited patient autonomy
as a right of living in civilized society to go
stick their nose in a book. Go to the families
of patients at end of life and tell them if they
want to continue maintaining open ended vital
signs with no hope of any other than delaying
death, they'll have to pony up for it themselves
Go see the cashier and make the same deal they
currently make for the father of the child with
an urgent operative disease similar to mine. We
can probably finance one, but not both. It's our
choice.
- -From Crippen's List
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