How is American Healthcare Like a Restaurant?

Philip Greenspun’s April 2010 blog post titled American Health Care System: Worse Than the DMV spun off some interesting comments about how the healthcare system is run like a (very weird) restaurant (with arbitrary, inefficient and detrimental rules):

One commenter: “Everyone in the country is seated at the same table, with the bill divided arbitrarily between only the solvent diners under 62. The menu has no prices, the staff is unaware of what they might be, and the topic never came up in their 10 years of training. 50 pc of the diners are obese and eat like it. In order to scramble an egg the kitchen staff must have studied for 5 years in a distinguished school of cuisine that rejects 2/3 of its overqualified applicants. The wait for a meal is from .5 to 5 hours. Several hundred thousand Americans per year die of food poisoning from this restaurant, but the staff is somewhat offended by the suggestion they consider washing their hands more often, an no one is about to make them.”

When we had high-deductible insurance($10,000 per person per year)  for a few years, I asked about every procedure I was going to have done. The cardiologist who recommended I get an echocardiogram  had absolutely no idea what one might cost.  It took her a few calls to find out, and I did end up getting it done — $754, plus the office visit charge of $145. I guess no one had ever asked what it cost before.

Another commenter: “I do like the restaurant analogy but would add the chef  (someone like myself – an Internal Medicine specialist) spends little time actually cooking for the gymnasium-sized dining room, instead whiling away the hours calling suppliers confirming the carrots and pepper can indeed be placed in a stew. The trained chef then calls the owner of the restaurant (who has an MBA and the culinary training gleaned from watching an hour of the food network every week) to confirm the choices. Unfortunately, the fresh carrots were replaced by frozen and a pepper substitute was approved. I agree many of the simpler dishes- i.e. a hamburger, can be made by just about anyone but complicated dishes do require a bit more knowledge to get just right. …

“Personally this chef is winding down the kitchen and will be closing shop in 6 months. I plan to keep current in medicine as I expect to take care of myself as medical anarchy arrives. Perhaps I will work as a vet tech for my veterinarian sister who has double my income and feels great about what she does all day.”

Speaking of vets, my dog just had surgery on her forepaw to remove a tumour that may or may not be malignant (we’ll know next week). With charges (clearly detailed) for the excision, the anaesthesia, sutures, histopathology, antibiotics for a week following, and an overnight in the vet hospital, the cost came to $269.50. (And they threw in a skin tag removal for free.)

A few years ago, she had a longer and more complicated surgery to remove a mast cell tumour (cancer). That one was more expensive, at $1,485. The invoice is extremely detailed, with charges for the surgeon and surgical tech of $113, the excision (with margins) of $300, pain meds (various types) at $67, anaesthesias (two kinds) at $200, IV fluids at $78, radiosurgery unit at $127, histopathology at $120, and so on.  She was in the hospital most of the day but not overnight.

Contrast either of these with my spouse’s first surgery in March to remove a tumour on his foot (which we soon found out was a sarcoma). He did not stay overnight in the hospital but came home after a couple of hours, with prescriptions for various drugs. The surgery took less than an hour and was not complicated.

We received several insurance company ‘explanation of benefits’ sheets for this surgery, which totalled $27,137. I don’t know what $24,129 went towards; the only details we have are for the surgeon (an oncologist), who charged $1,838 and the anaesthesiologist, $1,170.

Since then, he has been an inpatient on four occasions (12 days, 7 days, and two 2-day stints), where the cost per day varied from $5,000 per day to almost $12,000 per day.

The bill for the dog’s overnight stay this week, on the other hand — and granted, she wasn’t hooked up to machinery to check her vitals, and there was at most one vet tech and one vet to check on her (and only once during the night) — came to $30.

What most astounded me about the hospital was that they threw everything away, except linens. Plastic water pitchers, plastic tubs and washing bowls, entire suture kits whose scissors has been used once to cut off a gauze wrap, 100-count packs of heavy napkins that had been opened, and in fact packs, tubes and containers of anything that had been opened.

(Philip’s vision for health care reform is here.)


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