Recently, I took care of two health issues, one for me and one for my cat. What happened to me? I had a couple of suspicious-looking bumps on my forehead. I'm from Slavic stock. I have two skin colors, pasty white in winter and tomato red in summer. If anyone has the type of skin prone to cancer, it's me. I went to a local skin doctor to have the bumps looked at. He took a little slice from each bump, did some biopsies, and asked for a second opinion from people at Stanford. The grand total for this tiny procedure that took ten minutes of his time and another half hour of a tech's time preparing some slides? Eight hundred and ninety bucks, 540 from my doctor and 350 from Stanford to look at the slides. The verdict? One wart and one pre-cancer growth, both of which need to be removed.
I was furious about the bill for the second opinion. Stanford's fee for looking at the slides was 110 dollars more than my skin doctor charged for his entire biopsy. It cost me three hundred and fifty bucks for one Stanford doc (or tech) to look at a couple of slides probably for no more than two minutes each. I've been trying to avoid Stanford for all my medical work for a long time. They have a wonderful gleaming facility that looks like a high end hotel. In the end, you pay for all the spit and polish, more than anywhere else in the area.
Four years ago, I had a routine colonoscopy at Stanford and they charged 800 dollars more than a nearby hospital charged my wife for the same work. For the extra money, they did give me nice booties to wear so I wouldn't slip on the floor if I walked around while I was recovering (my wife didn't get booties at her hospital). Three years ago, I had Stanford look at a urine sample and the fee was 800 bucks, about three times more than I had ever been charged before. After that, I decided to foreswear Stanford Hospital and I dropped my Stanford primary care physician. This little extra Stanford bill for my biopsies reminded me just why I hate Stanford's medical facilities.
Enough about me and my kvetching about Stanford. A week after my biopsy, my cat was attacked by a raccoon. She's lucky to be alive. I took her to the veterinary emergency room late at night and waited while they sedated her and stitched her up. The total fee? A mere five hundred ninety seven bucks. The facility was kind of run down. Nothing gleamed. The vet certainly didn't give my cat little booties to wear. But she came out of the emergency room alive and well, adorned a silly Elizabethan collar to try and keep her from ripping out her stitches. The collar lasted less then 10 minutes, the length of the drive home. Somehow, she found a way to slip it off while still in her transporter. My cat is a feline Houdini.
Had I been attacked like my cat and gone to the emergency room at Stanford or El Camino hospitals, I know what the fee would have been for being sedated and patched up. Somewhere around 10 times more than the fee for my cat (and since my insurance deductible is 8K, I would have paid for all of that out of my own wallet). Thinking about the difference in cost made me think about the difference in care. The pet hospital was very basic. The hospitals on the other hand are both gleaming towers. Forty years ago, they weren't that way I know. Stanford and El Camino hospitals weren't as grungy as the pet hospital, but they were modest, no-frills things. It's not surprising that they both charged much less way back when.
I know I'm being glib here, but after taking my cat home I really did start to think to myself, "You know next time I have a medical problem that needs emergency treatment, I'm going to stop talking, start meowing, drive myself to the pet hospital, and try to convince those vets that I'm a cat. The care will probably be fine and I'll save myself several thousand dollars."
It's obvious that animal hospitals charge less than human hospitals chiefly because we value our pets' lives far less than our own. Had the animal hospital told me it would cost 6K to treat my cat's raccoon wounds, I would have balked, though I really do like my cat. Vets charge what the market bears. The quality of their facilities reflects their lower fees. No one gets outraged when we put a cat down and talks about death panels for Fluffy.
I'm going to say something outrageous here. We can learn something about our own health care from how we treat our pets when they are sick. We put limits on the care we provide them. We put a value on their lives.
Americans don't do this when it comes to human life. We believe that we should spend whatever it takes to keep the ones we love alive whether it be for a day or month longer. We've even embedded this idea into our insurance policies, which no longer are allowed to have monetary caps. We believe that hospitals should be symbols of life everlasting, possessing every piece of equipment known to keep us going for as long as possible. This effort at extending life no matter what, ignoring the definite inevitability of our mortality is slowly but surely bankrupting this country.
I have seen this denial of mortality in my own family. My parents and grandparents were all European. Both my father and grandparents came here as full adults and their attitude toward death was much more pragmatic and realistic than what I see is typical with Americans. For example, after a decade of dealing with Parkinson's disease, my father was more than willing to say good bye to this world. "Give me a pill," he said to me. "This is no way to live." I would have done just as he requested, but first I asked my mother for permission. She said no, she wanted him to go on for as long as he could. He did live for several more years, but I never saw the point in it, and neither did my father. Then again, despite all the hardship, I truly believe my mother was grateful to have my father for that extra time.
My mother's attitude toward death was far more aligned with American attitudes (of course I'm generalizing and assigning cultural trends to individual behavior). After living with a fatal cancer for more than a year, far longer than anyone thought was possible, she had major surgery to remove a tumor so that she could live a few more months. The cost was about 100K, almost all of it paid by Medicare and a Medicare supplement. I'm a mama's boy through and through, and was happy to have her live those extra months. But I knew that had we lived anywhere else, that surgery would have never happened.
My wife's family is a typical American one and not surprisingly in my view, there have been major surgeries involving my wife's family for people in their eighties that have totaled hundreds of thousands of dollars in costs. One of those surgeries left the patient unconscious for over a month. She was eventually electro-shocked back to consciousness, but now suffers from dementia. She is in a nursing home, bedridden, and the bills keep piling up. When all is said and done, the cost of her care will be over one half-million dollars.
As I write this another relative in his nineties - who has been blessed with health and a sharp mind for almost all those years - has spent a week in the hospital in and out of consciousness as doctors continue to keep him going. Only in America.
America is by its nature an optimistic, can-do country. I've never seen any other place quite like it. We believe that no hurdle is insurmountable. It's wonderful to see this optimism in action. But when it comes to dealing with sickness and inevitable death, that optimism has a limited place. Somehow we need to come to terms with the fact that it is neither desirable nor financially viable to extend the lives of our citizens no matter the cost and the quality of that life.
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