WEBVTT

NOTE 49. I’m Part of the Problem

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I'm part of the problem.

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Yesterday, I inadvertently squandered $4,000 plus worth of medical resources during a lunch

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break.

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That I could do this, gain no benefit and not even see the bills, is what's right

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and wrong with American medical care.

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I'll tell the story, but first consider that none of the politically active reform

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Form proposals being debated deal with the absence of market pricing for medical care,

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that system-wide problem that there is a disconnect between the supplier and the consumer, and

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this problem is absolutely pervasive.

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You rarely know the prices of what you are getting, and even when you do, the prices

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are an abstraction, something to know but not act on, since they don't really affect

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your premiums, as with other forms of insurance.

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The result is hardly surprising.

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End-user costs soar higher and higher, and the resource use lacks that essential component

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of economizing by priority.

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The American system just assumes that there is no such thing as too much technology, too

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many drugs, too much service, too much care.

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The consumer, in the end, isn't really a consumer, but a passive conduit of an unchecked

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Contractual Relationship Between Producer and Third Party Payers Who Were Heavily Subsidized

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by Taxpayers

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So, now my slightly goofy story of how I spent probably $4,000 yesterday without knowing it.

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I had a chest cold of some sort that was getting on my nerve, so I finally decided to see the

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doctor at a walk-in clinic.

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I complained of tightness in my chest that wouldn't go away.

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In minutes, an EKG machine was hooked up to my heart, and x-rays were being taken of

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my chest.

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Fifteen minutes later, the doctor came back to tell me that he found a big black spot

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on my lungs.

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He inquired about my past smoking.

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Of course, at this point, I am ashen and woozy and worrying about who will update my Facebook

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page after I am dead.

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The doctor orders a CAT scan.

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Stat!

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Suddenly, I felt like I was in a television show.

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I make my way to a medical specialist company, a place that looks like an industrial castle.

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I'm greeted by a receptionist hooked up to an IV by nurse practitioners and slapped down

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on the scanning machine, which whirls and buzzes wildly all over my chest.

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The staff gathers around the pictures I can't see, but I can see all these people's faces

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through a glass.

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They are staring and pointing with looks of intense seriousness.

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Meanwhile, the scans are sent to a radiologist in Tennessee, who is also examining them.

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In my mind I've already divided up my property among heirs and I'm hoping that I have time

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to train someone to do stuff that I do.

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My final wishes for world peace and prosperity will be written in my last message to the

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world, read to all those gathered at my funeral.

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Thirty minutes later, they gather to tell me the news.

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Nothing.

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No one can see anything at all.

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My lungs are pink, my heart is working away, and I'm healthy as can be.

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The nurse suggests that the walk-in clinic needs to fix their x-ray machine, which is

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evidently throwing black spots around the images.

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Maybe it is a filter, maybe someone bumped the machine.

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Regardless, my life was back, and I appreciated all things anew.

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Oh, but wait, I pointed out to them that I never received anything from my chest cold.

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The lady said, oh, that takes some use in X.

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And that's what $4,000 bought yesterday between the hours of 1 and 5 p.m.

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Maybe it was more, maybe it was less, I don't really know.

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On the one hand, the whole process was amazing, the speed, the efficiency, the miraculous

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technology.

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On the other hand, it was all wholly unnecessary.

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Now you might say, hey, don't complain, at least you know.

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That's true enough.

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But if there were really a concern about costs, I'm not entirely sure this would have happened.

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And can there be any doubt that the scan was ordered over liability concerns, mainly?

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Lots of people benefit in this system.

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You could say that I benefited, but at what cost?

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And is the cost proportional to the benefit?

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This is what the system doesn't seem to address.

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And the reform proposals, so far as I can tell, are designed to make what I went through

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a universal feature of American medicine – it's wishful thinking.

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And while the attempt might last a while, eventually it will go the same way all such

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attempts go – skyrocketing costs, and universal stagnation.