Sunday, March 18, 2018

The Cost of a Kidney Stone

If you have never had a kidney stone, count yourself blessed. I had one in 1999 after returning from the Philippines. It was small, excruciating, and gone within 24 hours. The doctor said it may have been caused by dehydration during my trip to the Philippines. But he also told me to avoid spinach and asparagus. It turns out the advice on spinach was good. It’s extremely high in oxalate, one of the two substances that combine to form about 85 percent of kidney stones. The other substance is calcium. Asparagus, however, is pretty low in oxalate. But I followed doctor’s orders and didn’t have another kidney stone . . . until a week before Christmas 2017. So I went 18 years without one.
When the pre-Christmas stone hit, I was pretty sure what it was, having had some experience with that sort of pain. I might add that I’ve now had three different mothers inform me that they have had both children and kidney stones, and the kidney stone was definitely more painful than childbirth—and the result was not nearly as cute. I’m not speaking from experience here on pain comparisons, of course, just repeating what I’ve been told.
Anyway, this time around I was not so lucky on passing the stone quickly. My wife drove me to Orem Community Hospital, part of Intermountain Healthcare, where they gave me some opioids for the pain, did a CT scan, and sent me to a urologist. This stone, they said, would not pass on its own. They estimated it at 9 mm. That’s about 3/8 inch. So the urologist scheduled me for lithotripsy, which is the technical term for blasting kidney stones with sound waves. They thought they’d pulverized it, but when the dust settled, I still had some pretty impressive chunks left, and they caused significant pain before they finally decided to pass.
I want to talk about a different kind of pain today, though. This past week I finally received the itemized bill from Intermountain Healthcare for my little trip to the emergency room. Ouch. I’ll forego the little stuff, but I was pretty impressed with the outrageous costs of our health-care system. For instance, they charged $2,048 for the CT scan. It took maybe five minutes. Japan has figured out how to do this for under $200. The cost of what I’ll call room and board for my short stay in the ER was $1,180. That’s one heck of an expensive hotel. And they didn’t even have a swimming pool or offer me a continental breakfast. I know, I know, they have to cover their overhead, not to mention malpractice insurance. But the item on the bill that really floored me was the IV. They poked me in the arm, pumped in a bag of sodium chloride, and gave me the aforementioned opioids. Counting the medications, this routine IV was billed at $884.
The total damage for my short stay in Orem Community Hospital was $4,361. And that didn’t count the ER doctor, who billed separately—$792 for the perhaps 15 minutes he spent with me. And after all this extravagant billing, I still had a 9-mm kidney stone when I left the ER. Fortunately, I have good insurance, and Deseret Mutual has an understanding with Intermountain Healthcare that they will pay only a portion of the charge. In fact, they paid just $2,212. My portion of the bill was a copay of $75 and another $242 out of pocket for the various elements of my short stay at Orem Community. I owed the ER physician only $38.
If I had known what that ER visit would cost and what the rest of the ordeal would cost, I certainly would not have gone to the emergency room. I would have taken some Tylenol and called the urologist. If I have another kidney stone, that’s what I will do. (Note for anyone planning on having a kidney stone: don’t take aspirin or ibuprofen, because they can’t do lithotripsy within a week of your last dose. These medicines thin the blood, which puts you at risk to lose a kidney.)
So, what about the rest of the adventure? The lithotripsy, counting the urologist’s fee came to about $8,000. Because we had already purchased plane tickets to visit our daughter and her family in Houston over NewYear’s and I didn’t want to have an attack on the flight, or in Houston, the urologist put a stent in for a couple of weeks. That was billed at $4,400. There were also several relatively small charges, for things like x-rays and their interpretation, prescriptions, and office visits. In total, this little piece of human-created rock resulted in initial charges of about $18,000.
If you’re thinking that’s pretty crazy, you’re right. And we’re the only developed country on earth that does this sort of thing. Yes, the insurance and I together paid maybe $11,000. But still, that’s pretty crazy. I couldn’t help thinking about those people we’ve decided to exclude from our health-care system, who can’t afford insurance or who otherwise slip between the cracks. A simple kidney stone could bankrupt some of these people. Only in America. And only because of the Republican Party.
My experience with the kidney stone reminds me of two medical encounters our family had in 2005 (back when health care was relatively cheap in America). My oldest son managed to experience a ruptured appendix while serving a mission in Germany. His abdomen was full of peritonitis, a life-threatening condition. He spent a week in the ICU while the doctors got the infection under control. Then he spent another week in the hospital recovering. When he was released, because he was still quite weak, the mission president assigned him to the mission office as financial secretary, which means he got to pay his own hospital bill. We figured that the German health-care system, because both we and the Church had insurance, would charge us a pretty pfennig. The entire bill came to $6,000. That included surgery, a week in the ICU, and another week in the hospital. The doctors were highly qualified. In fact, the one I talked with most often, as we monitored Matt’s progress from afar, was educated at the University of Chicago. We spoke in English because his medical English was a lot better than my medical German.
At about this same time, I had nonemergency outpatient surgery in Provo to repair a hernia. For that routine half-day experience, our insurance was billed $12,000. Twice as much as the two-week treatment for a ruptured appendix in Germany. Yes, I know that the Germans pay taxes so that they can enjoy relatively inexpensive universal care. But overall they pay far less than we do, all because of government involvement. In 2014, Germany spent 11.3 percent of GDP on health care. The United States spent 17.1 percent. Canada is at 10.4 percent, France at 11.5 percent, Denmark at 10.8 percent, the United Kingdom at 9.7 percent, Norway at 9.7 percent, Sweden at 11.9 percent, Finland at 9.7 percent, Switzerland at 11.7 percent, Australia at 9.4 percent, Netherlands at 10.9 percent. You get the idea. We spend 44 percent more than the highest of these countries, 82 percent more than the lowest. But we’re not comparing apples and apples here. These countries all cover everyone. We don’t. And they get better overall results than we do. Yes, conservatives love to point out how bad the care is in these other countries, but this is largely myth, not supported by either statistics or personal sentiment. Granted, no system is perfect, and people love to complain, but virtually no one in these countries would trade their system for ours.
There really is no rational argument against America adopting a system based on the best features of our foreign neighbors. It would be more humane, better for our overall health, and far less expensive. And here’s the biggest irony. My German friends have a lot more freedom in selecting health-care options than I do. Republicans love to play the freedom card. But in health care, government involvement in creating a system that covers everyone actually gives everyone more freedom. Everyone, that is, except those who would prey on the sick to make exorbitant profits. The biggest difference between our “system” and our neighbors’ systems is that we are the only country that allows the profit motive to control (and restrict) medical care.
Republicans get all up in arms about Bernie Sanders and the “extremists” on the left who want to implement “socialized medicine,” that old bogeyman the right wing loves to throw verbal darts at. But this isn’t extremism. It’s common sense. It needs to happen. We gave the Republicans their opportunity to “repeal and replace” the ACA. They couldn’t do it. All the options they came up with made things worse, not better. It became obvious that their whole “repeal and replace” dog and pony show was just political theatre. They never wanted to replace the ACA. And they couldn’t, really, because it was already built upon a flawed conservative foundation. The Democrats would have chosen a single-payer system that covered everyone, but they knew the Republicans would never go for it. And look at the political price they paid for implementing even a conservative health-care plan. But now things have changed. The GOP has had its chance to come up with something better. They couldn’t. We still need to fix health care. Our only reasonable choice at this point is to follow the example of our foreign neighbors and embrace a lower-cost system that covers everyone and gets the profit motive out of health care. That means raising taxes. But as I’ve explained on this blog before, we are one of the lowest-taxes countries in the OECD. And overall, we would end up saving a lot of money by doing this. We need to start being responsible and practical instead of ideological.

1 comment:

  1. I agree with almost everything you said. Something I learned about the Canadian system is that it costs the provinces (states) at least 40% if their overall budgets. I don’t believe most US states could ever afford that.