How would you decrease the costs of healthcare?

[angus]

I had my first surgery about four years ago.  I was on a boat in the Caribbean, in the Straits of Cozumel about two miles off the coast of mainland Mexico, and I bent down to rinse my mask off in the sea.  This was something I had done a thousand times before.  I was wearing about fifty pounds of gear:  tanks, weights, BCD, fins, flashlights, etc.  As I put my knee down and turned to bend toward the water, we hit a big wave.  Bam!  A searing pain shot up through my leg.  I may have winced but I doubt it.  I remember that I bit my lip to keep from showing any pain.  They always tell you not to dive if you're sick or in pain, and I knew that the captain or the divemaster would not let me go if I showed any pain.  I sucked it up and said, "estoy bien" or something like that and took a giant stride off the back of the vessel and enjoyed my dive.  I was finning with only one fin, because it hurt to move my right leg, and so I was sort of going in circles, but it was fun.  We dived on a sunken tugboat, and I enjoy penetrating as much as I can on submerged vessels.  Lots of reef fish and a few fairly large pelagic fish, with some recent coral and sponge growth. 

When the dive was over and I got back to the condo we had rented, my wife noticed my limp.  I told her what had happened and she insisted that I seek medical attention.  As it happened, there was a diving specialty clinic about two blocks from where we were staying, so we walked there.  When we arrived, I told the receptionist/nurse that I had a great sadness in my little squirrel.  She looked at me with a strange look, and then I understood my mistake and immediately became very embarrassed.  (Those who speak spanish will appreciate the mistake.)  Then I said, very clearly, that I had great pain in my knee.  She explained that el medico had an emergency last night, and was out until about 3AM, so even though the clinic was open, she did not expect him until later.  She gave me some good advice, most of which I followed, and I tried to enjoy the rest of our vacation.  Luckily, this happened about two and a half weeks into a three-week vacation.

Upon my return to the United States, I went to the clinic a few blocks from our house and saw the general practicioner there.  He ordered an X-ray, even though I assured him that there were no broken bones or anything else that would show up in an X-ray.  He then explained that there was probably some ligament damage--actually he narrowed it down to three, and explained the possibilities in some detail--and said that if I were a septegenarian he would advise me to live with it, but if I were an NFL starting quarterback, I'd be ready to play by next week.  I was somewhere in-between, and I'd have to decide how much I wanted to do.  I couldn't even extend my leg fully!  Surely this will not work for me.  It just doesn't suit my lifestyle. 

I decided to see an orthopedic surgeon.  Not having any experience in this arena, I talked to my neighbor Carol, asking her for a recommendation.  She was about eighty years old and probably knew all the physicians and specialists.  Also she was very, very picky--I've seen her fire landscapers for choosing the wrong type of woodchips--so I thought that anyone that she would recommend would be really experienced and effective.  She recommended Chris X.  (Let us leave his last name out.)  He's wonderful, she said.  Well, if Carol recommends him, then he must be good.

It turned out that Chris X. was very popular.  I had to wait almost a month for an appointment with him.  Finally, when I saw him, he ordered an X-ray.  An X-ray?  I just had one.  Can't you get it from the other place?  No, he needed his own X-ray.  Then he ordered an MRI.  Ever had one of those?  Really loud, really weird.  Neither the X-ray nor the MRI showed what was wrong.  But Chris knew what he was doing.  He told me what he thought was wrong--I would later learn that a football injury when he was 16 caused exactly the same problem for him and it was what inspired him to go into orthopedic surgery.  He said he wouldn't know for sure till he got inside, so we set a date for surgery.  I was a terrible patient.  Impatient is probably a better word for it.  I was rude to the nurses and the technicians, but to be fair the had me disrobe and put on a little dress that tied in the back, then they shaved my leg.  Well, a part of it anyway.  I never felt so emasculated in all my life.  (One high point was that my neighbor, Luis, showed up.  Apparently he was the anesthesiologist on call that day.  I felt comforted when I saw a familiar face.  I had been stuck and had a manifold already and when I saw him put a needle in a jar and asked him what it was, he said, "It's propyphol?  Ever heard of that?"  I said, "no."  He then said, "That's what killed Michael Jackson."  That was the last thing I remember.  Then I woke up and saw that it was 9:30AM.  Two hours later!  For me it was like an instant.  No REM sleep, no dreams, just an instant later it was two hours later and I was in another room.  Really, really weird.  But I digress...

Long story short, Chris was spot on.  He called it.  They made two little holes in my leg--you can't even see them now--one was for a crow bar and a camera, and the other was for a sewing needle and pick.  They pried the bones apart and took some photos.  Later Chris emailed them to me.  Apparently my medial meniscus was torn.  They removed about 20% of it and it will never grow back, but I'm 100% recovered now.  I can run and jump and ride a bicycle and swim.  And there are no scars.  Modern medicine is definitely amazing.  And expensive, apparently. 

Afterward, I saved the bills.  I reckoned that the whole thing cost about $2600, at least on paper.  My out-of-pocket expense was much lower, of course.  Around 35 dollars as I recall.  But the bills were very, very detailed.  One from the X-ray specialist.  One from the MRI people.  One from the GP.  One from the orthopedic specialist.  One from the therapist.  One from the hospital.  Etc., etc.  And they were all very, very detailed.  It had line-item explanations with costs.  One agent apparently asked my insurance company for $301.52 for a certain service or product, and my insurance company would write them back and say, "Well, we think that is only worth $162.57, of which we will pay $159.98," so I would get a bill for $2.59 for that, and every little item was like that.  2600 dollars worth of charges went back and forth between many medical service industry agents and my various insurance agents, and they'd agree on a price, of which I'd pay a tiny fraction.  How many man-hours went into this billing procedure?  How many clerks and postal agents were involved in the transfer of all this information?  And how many X-rays does it take to tell a man who is certain that he has no broken bones that he has no broken bones?  It's all very wasteful. 

Well, at least I have some really cool images of the inside of my right knee, both before and after the surgery.  I posted them on Facebook, of course.