Medical Care Costs Arm and Leg

Massachusetts has "the world’s costliest health care," with
average annual spending above $7,000 per person, according to an analysis
of federal data to be released today.

The report by Boston University’s Alan Sager and Deborah Socolar, health
care advocates at the university’s School of Public Health, is based on
state-by-state 2004 expenditures disclosed last month by the federal Centers
for Medicare and Medicaid Services .

The findings also show that health care spending in the state increased
faster than in the rest of the country from 2000 to 2004, the period covered
by the data.

from the Boston Globe

Lately the Dowbrigade has been studying the Massachusetts health care
system up close and personal. Last Friday we let our unmentionables
go fifteen minutes early because we
had a doctor’s
appointment
over in
Cambridge.
Five months
after
surgery for a tear in our diaphragm through which our stomach had migrated
from
our abdomen to our chest, we were still experiencing an assortment
of stomach pains, nasty gas and sulphur burps.

Our long-time Primary Care Physician is a moderately overweight laid-back
middle-aged Jewish guy, like the Dowbrigade, with a penchant for mixing
work and
pleasure on
extended trips to exotic locales.  Luckily, he had a cancellation and
was able to see us that week.

As soon as we got to the office we were informed by the receptionist secretary
that he was running late – had not yet arrived, in fact – due to an emergency
at the hospital. Such is life, we thought, glad we had brought the New
York Times and a pencil.

45 minutes later the doctor finally hurried in. Half an hour after that
we were invited into an examining room and 15 minutes later the doctor
finally came in.

"Sorry I’m running late. I was at the hospital. I just had a patient die,
suddenly. He wasn’t expected to die, but he just took a turn for the worst,
and in two hours, he was gone."

"It must be difficult," we ventured, wondering what the poor bastard had
died from. However, wanting to move the appointment along, and lighten
the mood, we didn’t ask.  Instead we made some small talk about Ecuador,
where the doctor had recently advised the government on a UN-funded supplemental
health care program.

We agreed that the people were nicer and the official corruption more
endemic than in any of the other South American nations we had visited.

Finally
we got down to business. We have been having digestive problems lately,
involving socially questionable symptoms such as voluminous farting
and
burping. Five months ago we were operated on for a hiatal hernia – a hole
in our diaphragm through which our stomach had migrated from our abdomen
into our chest.

To put everything back where it belonged and tie it down took popping
us open like a lobster tail and mucking around quite a bit. Our stay at
the local City Hospital, whose precise name we have been advised by counsel
not to mention, was a nightmare involving a historic blizzard, a seven-hour
surgery, awakening in an equipment storeroom, mind-boggling post-operative
pain, delirious ravings, filchered medicinal narcotics and a 5-foot, 300-lb
female African nurse with a gleaming white human bone on a leather thong
around her neck. We are trying to forget the whole thing.

Of course, our Primary Doc referred us to a new specialist in town, who
of course had his offices in the very hospital from which we had barely
escaped five months earlier.

But we gritted our teeth, found parking in the neighborhood, and shuffled
in to see, believe it or not, Dr. Payne. Turns out we had been at college
together, he two years ahead of us, but in different fields and out paths
never crossed. 30 years later, we got on famously. He ordered blood work,
a three-day course of fecal analysis, a CAT scan and an endoscopy. If those
don’t turn
up
anything they’ll make us eat a radioactive egg and watch it digest.

And there’s the possibility that our current stomach
problems are being caused by worrying about our financial problems, which
are being created by our stomach problems.

Today we went in for the CAT scan. Same hospital. Luckily it was in the
afternoon, so we didn’t need to miss class. We had to register, dropped
our samples
at
the lab, and waited for our turn in the Big Tube. France and Togo were
just starting a World Cup match on a tiny monitor hanging from the ceiling.
We watched standing next to a middle-aged gentleman from an indeterminate
Caribbean
nation.

It was almost half time when they finally called us. We were led into
the back and given a hospital johnny. We were putting our cloths in a plastic
bag when they asked us if we had been able to get down all two liters of
the chalky white scan-shake.

What shake? we asked. No one, it seemed, had remembered to tell us when
we made the appointment, that we needed to pick up said reactive material
and ingest it all two hours before
our appointment. A simple oversight. No way to continue. We needed to reschedule.

We grew incensed with the ineptitude, incompetence and insulting inefficiency
shown in this simple oversight. Fortunately, we had the presence of mind
to realize that the people in the CAT scan lab had nothing to do with the
mistake. Quickly and silently we dressed, got a new appointment for Monday,
and stomped upstairs to Medical Specialties, where they had given us the
appointment two days earlier.

"Can I help you?"

"Not now, you can’t. But you could have helped me two days ago when I
was in here getting the appointment for my CAT scan.  You could have
told me, for example, I needed to pick up these two bottles of white shake
and drink them before my appointment. Since you didn’t, they couldn’t do
the
scan
and I’ve  wasted half a day!"

"Well, I’m sorry, sir," she was glancing nervously around, looking for
a weapon or a clear escape route. "I wasn’t even here Wednesday."

"Well, I was, and nobody said anything about any white liquid. I had to
find a substitute teacher to teach my class this afternoon, and pay her
out of my own pocket. I’m out $100 and half a day of my life. I missed
my student’s final presentations. Do you have any idea of the effects of
your little "mistakes"?"

"Actually, we’re just admin staff. I’ll try and find a nurse." Her eyes
continued darting around the area, but the office suddenly seemed strangely
silent and empty.

"Never mind" It occurred to us that she might have a silent alarm below
the desk to summon security,and the last thing we wanted at that point
was to spend a few more involuntary hours in that hospital, "But when you  find
the person responsible make sure they know that they wrecked my entire
day and I will come back soon to talk to them about it."

We hate losing our cool, but that damn hospital creeps us out. As we hurried
out to save the White Whale from the Parking Police, we thought back to
the original appointment with our late-running Primary Care Doc.  Why
hadn’t we let well enough alone?

It was on the way out that we finally asked our friend the doctor what
had been the immediate cause of death of his unfortunate patient at the
hospital that day.

He gave me a weird, reluctant look like he wished he could lie but couldn’t,
and answered.

"Ruptured diaphragm"

Too close to home.