A Bangor, Maine mom recently wrote about an Emergency Room visit with her young daughter. Her little girl had injured her lip, and was screaming and bleeding. Understandably alarmed, she took her to the Emergency Room. Thankfully, it wasn’t a big deal – her child didn’t even need stitches. She received first aid treatment and a popsicle. Oh, yeah, and mom got a $514 bill.
The point of the article was that parenting is tough. When confronted with a screaming, bleeding kid, it’s hard to know what to do. Parents sometimes seek medical care that isn’t really necessary and when they do, they can pay a high price.
But then an Emergency Room doc blogging as WhiteCoat got hold of the story and shined another light on the situation. He felt the $500 cost was justified and detailed what the patient got for her money. And of course, her care was worth every penny. I would pay much more than $500 to make sure that my kid was ok!
But as I read the ER doc’s take on the incident, I found myself thinking, “He’s got a point, but why are things this way in the first place?”
To begin, the doc points out that it costs millions of dollars in overhead to keep a hospital open 24 hours a day, staffed with highly trained personnel and advanced medical equipment. Well that’s true, but there’s more to it than that.
Here’s one tiny example. Hospitals often purchase extremely expensive equipment that other hospitals in the community already have. There’s no overall regional planning of equipment purchases based an analysis of community needs. The hospitals buy what they want and simply amortize the costs to their patients. When the equipment is underused, the cost per patient using it goes up.
These inefficiencies could be eliminated by “Uber-izing” major medical equipment use. Combining rational planning based on actual community usage with a cloud-based approach, millions of dollars spent on purchasing or renting duplicate medical equipment could be saved. Having a single payer system could make this process simpler because with a unified payment system, we would have the ability to efficiently compile excellent data on community needs, usage and costs.
Back to our doctor. The next point he makes is that the medical professionals treating the little girl invested hundreds of thousands of dollars in their education.
Again, so true! Our doctors come out of medical school with a debt load equivalent to the price of a Tesla.
Of course, the cost of medical school didn’t directly contribute to the $500 bill, because that cost is borne by the individual doctors and nurses. Still, the experts say the high cost of medical training definitely contributes on some level to high healthcare costs, at least in global terms. But it doesn’t have to!
Many countries absorb the education costs of their citizens, including countries with the highest quality healthcare systems (such as France, Denmark, Sweden). Their doctors graduate with no debt at all. In France, they spend 11.6% of their GDP on healthcare, enjoy better health outcomes than we do, and medical school is free. In the US, we spend 17% of our GDP and saddle our doctors with debt. High healthcare costs definitely limit our opportunities for other social investments, like education.
The last point the doctor makes is about the federal mandate that hospitals and doctors provide emergency treatment to patients regardless of their insurance status or ability to pay. This is called the Emergency Medical Treatment and Active Labor Act (EMTALA), established in 1986. In the past, the cost of this “uncompensated care” hovered between 5% and 6% of total hospital costs
Our doc points out that having to provide uncompensated care to the poor probably contributed to the $500 bill. That could be, and the problem will not be going away soon. In spite of the claim that Obamacare is “universal,” 30 million Americans remain without coverage. So doctors and hospitals will continue to be on the hook for uncompensated care, with no end in sight.
There’s a lot more to consider than these three issues when it comes to our high healthcare costs. It’s a very complex problem. But with universal single payer, there would be no uninsured people and we could reduce the costs of major medical equipment purchases because we’d have better data and a unified payment system.
Moreover, with lower healthcare costs, we would have more money to spend on what matters to us – like education. And the price of popsicles might go down, too!
Learn more:
Medical Equipment
http://medcitynews.com/2014/10/cohealo-uber-ride-sharing-medical-equipment-sharing/
Medical Education
http://www.uphs.upenn.edu/news/News_Releases/2013/11/asch/
http://www.attn.com/stories/211/how-does-germany-afford-free-tuition-all-its-citizens
Healthcare Expenditures as a Percent of GDP
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
EMTALA
http://www.acep.org/content.aspx?id=25936
http://www.aha.org/research/policy/finfactsheets.shtml
http://aspe.hhs.gov/health/reports/2015/medicaidexpansion/ib_uncompensatedcare.pdf