My doctor, my friend?

“Don’t you feel violated?” Peggy asked when she saw the bill, $250 of it for glancing up my nose.

I feel violated every time a doctor’s bill comes, but $250 for a ten second glance up the old snoot does give the phrase pay through the nose a whole new meaning. The average medical specialist makes more money for the few minutes that he spends with the average patient than a minimum wage worker makes all week, and more than what most everyone else earns all day. American doctors make nearly twice as much as doctors in other “developed nations” (see first graph), and their fees are increasing at seven times the overall cost of living, yet America is falling further and further behind in life expectancy (see second graph) and nearly every other measure of quality care. Over the past several weeks, I’ve felt cheated by six doctors and a dentist (I paid $520 last week for two small fillings that took 25 minutes total), and it doesn’t set well. In fact, I’m enraged. I mostly get along well with doctors, but it isn’t because I respect them, but because I want to get the best service for the least aggravation. Besides, they would charge me for the time I spent complaining that they overcharge.

Doctors argue that they deserve their inflated salaries and more too* because they went to school for a long time, but doctors in other countries go to school for a long time without feeling the need to charge so much that millions of people (most of whom have insurance) can’t afford them (“In 2013, 37% of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared with as few as 4 percent to 6 percent in the United Kingdom and Sweden. **) “Only in America, land of opportunity…”  Yes, only in America, a nation that considers it no more immoral to deny someone medical care than to deny her a yacht.

Regardless of what a few politicians might say, under the value system by which America lives, whatever you can afford, you have a right to, and whatever you can’t afford, you don’t have a right to. For example, millions of Americans oppose abortion on the grounds that life is sacred, yet those same people--and the country itself--base one’s post-birth right to life on personal wealth. It is for this reason that, when we refer to a person’s worth, we follow the word with a dollar sign. Mitt Romney is worth $250-million”; Joe Blow is worth $500.

Do you ever wonder why the number of years a person goes to school should be the determinant of his or her income? Why not pay the most for the jobs that are the dirtiest, or most dangerous, or most boring, or the hardest on a person’s body? Watch a carpet installer crawl around on a floor, breathing filth from the carpet he’s taking up, and dust and formaldehyde from the carpet he’s putting down by kicking a stretcher with his knees; and ask yourself how long anyone’s body can survive such work, and reflect on the reality that, when his body gives out, he’ll be facing decades of pain and disability without adequate medical care.

What follows is a further sampling of my problem with doctors. They provide an essential service, but they don’t compete cost-wise, and if you can’t afford insurance, they charge you more because you lack the clout to negotiate their fees. With or without insurance, a doctor won’t see you without charging you hundreds of dollars, and you can’t decide if a particular doctor is right for you without paying it. To make matters worse, it can take months to get in to see a specialist, only to find him in such a hurry to get you out again (20% of physicians see more than 100 patients a week***) that it destroys any hope you might have had that he would care about your welfare. If worse comes to worse, and you mistrust your doctor to the point of wanting another, you have to start the wait--and pay the hundreds of dollars--all over again, and that’s assuming that every area specialist of the type you need doesn’t work in the same clinic, in which case, they won’t allow you to see another doctor because they care a great deal about their egos and little about your health. In short, a patient’s relationship with a doctor is one in which the doctor holds all the power and comes out richer no matter what, while the patient, more often than not, receives inferior care and is forced to pay through the nose for it. 

It’s not by accident that when a person’s independence, self-confidence, and bank account, are assaulted by bodily failure, they are also assaulted by the very people he or she turns to for help. It serves doctors well for their patients to regard themselves as beaten, helpless, compliant, ignorant, out of their league, and dependent upon their betters, because such patients will accept rudeness, arrogance, and substandard care as just the way things are, and pay their bills without complaint. I know from experience that it gets ever harder to fight the system when your days are filled with pain, you’re unable to work, your mind is increasingly befuddled by drugs, and your life savings are being poured into the pockets of people who don’t need them. My greatest problem with every serious health problem I’ve ever had wasn’t the problem itself, but my impotent rage at my supposed caregivers. Considering that I’ve been through, that’s quite a statement, but the truth of the matter is that an injury or an illness isn’t rude, pompous, greedy, or callous, and it won’t betray me for money. 

As bad as it sounds, the truth of the matter is that every time I hear of some mass murderer shooting shoppers, theatergoers, or school children, I wish the dead had been doctors because their greed has put blood on their hands, and their callousness constitutes a betrayal of their medical oath. According to the first-person accounts I’ve read, even doctors come to hate doctors when they are ones who have a severe enough problem that they’re able to get an outsider’s view of what a nightmare it is to profoundly need someone only to find that his or her main concern is with running up a bill. Yet, the situation wasn’t always this bad. $5 to $10 for an unhurried doctor’s appointment might have represented a lot of money when I was a young man making a buck-ninety an hour (30-cents above minimum wage at the time), but it was nowhere close to the $350 quickies that I’ve been paying for recently. Specialists in America make twice as much**** as general practice doctors. They also look down upon them nearly as much as they look down upon their patients, and they dump as much of the low paying work on them as possible. This is why most of my complaints are about specialists. They are to other doctors what a rabid wolf is to a Pekingese.

For reasons that completely escape me, when the already exorbitant and ever-exploding costs of medical care are discussed, doctors rarely receive any of the blame. Liberals blame Big Pharma and Big Insurance (“The U.S. spent the most on insurance…$606 per person, compared to $277 in France and $266 in Switzerland, the next-highest countries.”*****); conservatives think that everyone should make all the money possible by any means possible so that some of their wealth will trickle down to the little people (meaning leprechauns, I suppose); and doctors are perpetually rated by both groups as belonging to the most respected of professions. What the hell is there to respect?

Call me a damn fool (it wouldn’t be the first time), but I think we need universal medical care or, at the very least, price controls. If the government has an obligation to cap what the utility industry can charge for an essential service, surely it has an equal obligation to control the medical industry, but to do so, it must rid itself of the notion that those who can't afford the cost have no more of a moral right to healthcare than Donald Trump has to another  mansion. 
Here are two more links.


angela said...

I always wondered about a country the demands the right to have guns and shoot one another, but has no national medical insurance. Its like you have the right to shoot and be shot but then your on your own.
We have a national insurance policy. ,everyone pays one percent of their wage into it and they you can see doctors for free, hospital visits are fee, my friend has had three ops and five rounds of chemo all for free. Me I've had two children an op with a weeks stay in hospital and many visits to doctors and all for free. I donte understand all the hooha with the issue inthe states.

Elephant's Child said...

Oh Snow. Our universal health system is by no means perfect, but I love that it is there. Our relatively new Government is showing alarming signs that they want to change it. At the moment (at naturally the doctors discretion) some patients are 'bulk-billed', meaning that they don't pay, the costs are met by the Government. The Government is hinting about introducing a co-payment 'to discourage unnecessary doctor's visits). To cut their costs. Next step? Abolishing our MediCare, or tacking more conditions on to it. My general practioner refuses to bulk-bill and charges more than double the scheduled fee (which I can claim back). And most doctor's books are closed so finding another is not easy. Sorry this comment is long, and I could go on and on and on.
I hope that your health woes ease up. Soon.

Snowbrush said...

It's the money that's to be made and the politicians that the money can buy (this isn't an empty charge, it's common knowledge). Everyone wants a finger in the medical pie including the insurance companies that take away one-third of America's healthcare money without giving so much as an aspirin or a bandaid to the actual care.

Take a look at the brace I'm wearing in the last photo. That cost $700. Two little aluminum cross pieces, four plastic pads, and a Velcro strap. Can anyone even imagine that $700 was a fair price for that? Yet, the conservative politicians managed to get a tax on such things. They didn't want to, of course, but their only other option was to make rich people pay the same income tax rate as ordinary people, and of course, they couldn't do that because they themselves are rich, and they're dependent upon rich people to finance their campaigns (Congressmen in America spend more time raising money to stay in office than they spend working at being in office).

Snowbrush said...

"The Government is hinting about introducing a co-payment 'to discourage unnecessary doctor's visits). To cut their costs. Next step?"

No doubt some Australians take advantage of the system, but I can see how proposals to reduce its benefits would be scary because when a ball starts rolling in a given direction, where does it stop? That said, I think people should pay something themselves; it's just that here in America, medical costs are extremely high and getting worse everyday, far out of proportion to the costs of other things. In fact, medical bills are the major reason for bankruptcy in this country, and only the very rich (the multi-multi millionaires) are immune from it happening to them.

Elephant's Child said...

All but the very poorest already pay - through their taxes, in addition to that part of the doctors fee which is more than 85% of the scheduled fee. This latest step is hinting at charging even the poorest. Which I believe to be wrong. There is quite a lot of evidence which suggests that people already delay filling prescriptions because of the expense and a further charge can only exacerbate the problem.

All Consuming said...

This feels all the more at the fore for me as now two of blogger friends are in dire need of these overpaid greedy bastards and live in a land where those in power only see fit to heal those with the cash to pay for it, and everyone else can die and that's their own fault for being so bloody poor in the first place. And then those who actually CAN pay see countless shoddy shite doctors who are no use anyway! I'm thinking of you and Dana here. She can't have the best surgeon for her operation because he isn't under her insurance policy, so has to take a chance on having found one on the internet. It is utterly beyond me how pervasive greed is in this world to the extent that so few give a crap about anyone else but themselves and their own as long as they're alright and can make more cash that's the main thing. You're spot on about those who do jobs easily as taxing and tough as doctors, yet get paid a pittance for their efforts. I'd probably be dead by now if I lived in America, I really would. I was lucky to get the right specialist the third time round here, and by then a great deal of damage had been done. It's awful here at times, and the conservatives would love to completely privatise the health system, oh the money that could be made from the sick!! Plus, they could rid themselves of all the elderly and ill who we're to short on funds to get care. I'm ranting, but it's through utter fury on your and Dana's behalf. It makes me so angry. (Love the reference to leprechauns -tickled me that). X *pardon the poor writing, I'm full of painkillers and shattered from lack of sleep.

Strayer said...

Oh boy, don't get me started on this one. The medical system stole my life after I got referred with problems to psychiatric care, after childhood abuse. Get drugged up, abused on psych wards, become experimental subjects without voice for shrinks making money off new drugs out, beaten, tied down, oh brother 25 years of my life stolen by crazy greedy lazy doctors. Then when I am beaten, nearly to death, at a hospital by staff, think I can get treatment for the injury? Hell no, took over a year and intervention by a southern Oregon doctor who knew how to make threats and swear. My brother hates them. He'll make an appointment, be charged if he's late, but then have to sit and wait for an hour himself, like his time isn't valuable but theirs is. He too got charged for the up your nose look, over $200, never was asked or told it would cost that either. he was furious. What he hates is hospitals turned into mansions, all from medicare and medicaid dollars, often ill gainly got....anyhow, you are so right on all this!

Prices need posted out right, so patients can shop and compare. Free visits if wait time exceeds ten minutes. They need to give an estimate and permission from the patient or patient's rep, to exceed the estimate, just like auto shops have to do. And if they can't figure out what is wrong with you in two visits, visits are free until accurate diagnosis is made, because that's a lousy doctor or a too busy doctor and the patient has to pay for him or her being lousy or too busy to be any good.

Snowbrush said...

"All but the very poorest already pay - through their taxes"

I appear to have spoken on the basis of ignorance. Thanks for filling me in.

"I'd probably be dead by now if I lived in America, I really would."

It can be a night-and-day difference for those who have either a lot of money or really good insurance, but even then, America is falling lower and lower in nearly every category of care. For instance, those who can afford it tend to be given a great many unnecessary tests, each of which comes with some risk. They also tend to be given a lot more unnecessary medicines, surgeries, and so forth than people in other countries. In other words, things that people can make money from are emphasized despite their necessity or their danger.

"The medical system stole my life"

I was thinking of you as I wrote because you're far worse-off than I when you need medical attention. At least, I can get it, and if I didn't think it did more good than harm, I wouldn't, but you don't have the option to choose.

"What he hates is hospitals turned into mansions"

Like Peggy's hospital? For years, the it justified shafting employees because it couldn't afford to treat them properly. Then this was built, and those who didn't already know quickly learned what a lying and manipulative institution (that would be a Catholic instisution) they worked for:

Strayer said...

And that contraption you wear, costing $700, that floors me. I could build that from my junk in my garage, for nothing.

$700 is my monthly income. Man alive!

Strayer said...

Here's another thing, around here, we call hospice the death factory, or "heartless hospice". I've so many stories now it chills my blood. My neighbor, the moment he went into hospice, his place became his prison, curtains drawn, and no longer could I see him. If I could have, maybe he wouldn't have lain on the floor for something like 14 hours after tripping on his oxygen lines. They hauled him off to hospice to die of his fall then. Another woman, whom I'd helped with cats along with her husband, told me a horror story, with him right beside her, alive and well. He'd been put into hospice, but didn't die quick enough. They recommended then she cut off his heart meds and when he got a urinary tract infection, he got no meds, so she called them up and said she was removing him from hospice and taking him to the hospital, where he was treated for his urinary tract infection and was doing well, walking around, at their place when I saw him last. Then another friend told me her friend was dying and in hospice, but her tongue started to swell, choking her, some drug allergy, and the hospice caregiver couldn't get ahold of a hospice nurse so her friend choked to death on that tongue. Then I had a friend who volunteered with hospice and became very disturbed by what she called the death factory. Their motto is no one dies alone. She was at the hospice center and noticed a man was dying and said "Shall I sit with him then, you know, no one dies alone." She said she was told they had better things for her to do. She quit then and is afraid of hospice. Me too.

kj said...

Snow, I almost fell over when I learned my pcp has 2500 patients. 2500?! so surely you can't follow me closely

It all sucks. We should pay to stay well, not to be sick. And when sick we should not worry one second about paying because we shouldn't pay

Doctors, athletes, actors. So out of whack and imbalanced. I'm very proud that I made $33 /hr as a therapist to very poor and marginalized inner city clients and families. Medicaid paid my clinic probably $80/hr and the clinic paid me. I don't begrudge anybody money--I like it myself--but at what cost to others?

Fear and greed: the root of all problems.

Great post, snow. Your passion gas freed ours

CreekHiker / HollysFolly said...

You're preaching to the choir here Snowy! I was amazed back in 2003 when I needed surgery to get out of my wheelchair and NO ONE could tell me how much the surgery would cost.

And most doctors will tell you it because of dealing with insurance companies that they need to make so much. My own doctor's office has gone from feeling like a small geriatric practice to a large office (still one doc) and part time spa offering botox and body wraps. There are SIX other employees there besides the doc. That seems a bit much to me.

Stephen Hayes said...

I have a good rapport with my doctor and during a recent visit I asked him what he thought of Obamacare. I had no idea what he's say but his response surprised me. He said people should have demanded a single-pay program because that is the only thing that would control prices. He also said he thought it would work out okay once it was up and running. I then asked him how many patients he had and he said thousands....

Charles Gramlich said...

I agree absolutely. I do think doctors are pricing themselves out of the market in some cases, though. Unfortunately they have a monopoly. or near to it.

PhilipH said...

It's a growing problem: healthcare. We are all living longer and more 'cures' are available than ever before. I do not know the answer but things will not get better with time.

I went for a routine blood test on Thursday to check my INR for Warfarin. I became worried whilst waiting as I could feel my atrial fibrillation kicking in. The nurse called me in. "Are you alright she asked?"

"I'll be OK in a minute or two" I said. She took my blood pressure and extracted some blood for testing. The BP machine showed an excessively high pulse rate so she called a colleague and I had an ECG test. Then a doctor was called to check the ECG. He examined me and checked my records. After about ten minutes he said things were normalizing as they usually do. I left the med centre. Felt better when I got home.

I couldn't have wished for better service. The charge to me: £0.

The UK health service was set up just after WW2 and although it is creaking at the joints, especially in Accident/Emergency departments it is still 50 times better than when my Dad had to call the doctor when I was very sick at age 4. It cost half a crown in 1939 and that was a big chunk out of his wages. I just do not know how the USA can let so many people suffer because they cannot afford insurance. Diabolical.

Shakespeare said: "Firstly, kill all the lawyers." Maybe he should now add "And medical insurance moguls!"

Winifred said...

It is so sad that medical care costs people so much in the USA. We used to have to pay for ours too before World War 2.

Thankfully after WW2 we got a government that really cared about ordinary people who couldn't afford to pay for doctors' appointments, medicines & hospital treatment. They nationalised healthcare so it was available to everyone. Sadly I think we're heading towards our National Health Service being gradually privatised sneakily by the back door. It's all down to the politicians running the country. Rich posh boys who don't care about ordinary people! Conservative governments don't care about the poor! Sadly I'm not sure any of the politicians really care any more.

Myrna R. said...

Well stated Snow. I'm totally in agreement about universal health care. As I age and find that I have to interact with the medical system more, I can't help but understand your words. I read your previous post too and am sorry you're experiencing even more health issues.
What can I say? Wish you felt better but I know my words make little difference.

Helen said...

My dear Snow,
Your title says it all! My daughter is doing battle with St. Charles hospital in Bend. It will ages to sort through the billing fiasco. And the absolute non-disclosure by the admitting clerk regarding fees. Bill for $12,000+ ... Insurance deductible of $7,500. On an hourly salary of $12.00. Someone from billing called her yesterday advising everything is on hold, for now. To make matters worse, her OB/GYN misread the ultrasound and operated to remove a small polyp ... Which turned out to be a fibroid filling a large part of her uterus ... Which she could not completely remove, citing dangerous situation to keep my daughter any longer. If my daughter had known in advance the charge, she would have opted NOT to have the procedure ... after all I've been living most of my life with a fibroid, which shrinks considerably as women age. Now, aren't you sorry you got me started?

Hope you are feeling better every day.


Paula said...

I hope that I am not going to repeat any things that might have already been said. I found you from Anamcara 2's blog and comment that you had made about healthcare. I live in a smaller town of only about 46,000 here in the middle of America. I worked as an RN in a hospital for almost 30 years. I have good health insurance paid for by my retired husband's company and ourselves. I really think our biggest problem with healthcare in this country is all of the people who DO NOT PAY A DIME for healthcare. Well someone is having to pay for them. And that someone is US. You and me. That is a major reason medical care costs so much. There are too many people that use the ER as their health clinic and never pay a dime for it. We do need national health care but we have to figure out a way to get all the 20-30 year old moms with 4 and 5 kids off the system. I know what I am talking about. I worked with them and they taught each other how to get as much from 'the system' as they could get without paying. We have, for the most part, very caring doctors in my community. There are bad apples in every profession and health care in America is appalling, no doubt, but I don't think we can lump every doctor or hospital into the same category. Also to the person who spoke about the there is a racket! But my husband is receiving Hospice care right now and the nurses are great. But they are receiving $4,000 per month for him from Medicare and I am the one providing most of the care. I just cannot afford the equipment or the medications. But it sure is not costing $4,000 a month for any of that. Now I feel better that I got to have my say. I hope you are better really soon Snow! I will be a new follower. I like what you have to say

Snowbrush said...

"I just do not know how the USA can let so many people suffer because they cannot afford insurance. Diabolical."

It's partly tied to our values regarding "rugged individualism," which we unfortunately carry to the point of believing that those who aren't self-sufficient are no damn good and deserve what happens to them. As Paula wrote, we consider them moochers. Of course, many of them are, but when you see yourself up against a system that cares so very much for the rich but will literally let people like you die needlessly, it doesn't produce loyalty but rather a desire to strike back and to get all you can while you can. Americans think that if we give medical care to everyone for free, they won't appreciate it, yet what I get from those of my readers who live under nationalized health care is that they're very appreciative of it.

"Sadly I think we're heading towards our National Health Service being gradually privatised sneakily by the back door."

Every good thing that the government tries to do here goes that route too. It serves big business well to promote the notion that whatever the government can do, big business can do better (and they can too when it comes to making money at the expense of the taxpayer).

"As I age and find that I have to interact with the medical system more, I can't help but understand your words."

I dread every new problem because it means being fleeced all over again, yet to simply not go to the doctor with a serious medical issue is also untenable.

"Now, aren't you sorry you got me started?"

No, I appreciate all that you wrote. It's good to share.

"my husband is receiving Hospice care right now"

I'm so sorry.

"we have to figure out a way to get all the 20-30 year old moms with 4 and 5 kids off the system. I know what I am talking about."

My wife is a L&D nurse who is planning to retire early, partly because she's so sick of her money-grubbing employer but also because she's so sick of the steady stream of 25 year old druggies having their fifth kid, which, like all the rest, will be taken away from them as soon as it's born. Well-adjusted couples with stable lives and good jobs who want their babies have, over time, become the minority of her patients, and she's burned-out by the others. So, I don't mean to dispute what you say, but it doesn't negate anything that I said. People (whether they are moochers or simply desperate) will continue to go to the ER for minor problems as long as they don't have a better option, and it's not their fault that that their only option is also the most expensive option. Although I agree with you, I can also see how we force people to be manipulative by reducing their treatment options to the ER, and then we turn right around and blame them for telling the lies they have to tell in order to even get treatment from the ER. I relate inasmuch as I live with chronic pain and need narcotics. I'm not a druggie, but I find myself rehearsing how to talk to doctors in order to get drugs (i.e. acting like a junkie) simply because I never know when my supply will be cut off because doctors are so squirrelly when it comes to providing pain relief. What I mean to say is that people are going to do whatever they have to do to live, and if some of them appear scheming, it might or might not reflect poorly on their individual level of personal integrity, but it certainly reflects poorly upon a system that creates such desperation.

Paula said...

I don't think there will be a system created that will make everyone happy. I just know that I am tired of paying for people who can't seem to help themselves. This nation has created a whole generation of entitled deadbeats.

Snowbrush said...

"I just know that I am tired of paying for people who can't seem to help themselves."

I agree. I wouldn't, for example, spend a penny to save the life of a druggie having her fifth child. What I would do would be to force her to be sterilized for the good of society. By criticizing the medical community, I'm criticizing what I see. By criticizing dead-beats who fleece the system, you're criticizing what you see. If I had your experiences, my emphasis might be where your's is. I'm not disagreeing with you. Whether it's the rich who are ripping people off, or the poor who are ripping people off, it's bad to rip people off. By appearing to defend the people you were criticizing, I was simply trying to see things as some of them might see them. Surely, not everyone who is desperate enough to show up at an ER for help is despicable.

Paula said...

You are absolutely right. Even some of those who can pay their own way end up being absolutely despicable!

Snowbrush said...

I just read the following, and since it is somewhat relevant, I thought I would share it:

"According to Fidelity’s annual retiree health care costs estimate, a 65-year-old couple retiring in 2013 will need an estimated $220,000 to cover health care costs during their retirement, and that is just using average life expectancy data.1 Many people will live longer and have higher costs. And that cost doesn’t include long-term-care (LTC) expenses.

"According to the U.S. Department of Health and Human Services, about 70% of those age 65 and older will require some type of LTC services—either at home, in adult day care, in an assisted living facility, or in a traditional nursing home. The average private-pay cost of a nursing home is about $90,000 per year according to MetLife, and exceeds $100,000 in some states."