My Blog About What Is Wrong With Healthcare.

This post was originally written on 1/5/2012

      My children have a wonderful pediatrician.  I like their doctor, and I have no complaints about her skill and knowledge as a doctor.  That being said, she provides me with a perfect example of what is wrong with the American health care system as it relates to the average American consumer- she costs too damn much.
      This pediatrician shares a practice with her husband.  He is a pediatric neurologist, and I like him too.  He has seen and treated both of my daughters, and I have no complaints about his skill or knowledge either.  A few years ago this husband and wife team chose to leave the large medical complex in which they had previously operated and open their own office.
       The new office is a simple frame construction building, set off by itself on land that they purchased.  Being somewhat familiar with land prices and construction costs in my area, I would estimate that their new location probably cost them no more than $200,000- if you include every expenditure, all the way down to the lightbulbs.  It is not a fancy office, and the most technologically advanced piece of equipment it boasts is the digital infant scale and the neat little wall mounted otoscopes.  Six patient rooms, one bathroom, two common areas and another six small rooms for storage and office space.  Overall about 4000 square feet of space (at the most) in a building that could easily be reconfigured into a single family home.  They do no lab work, it's just about seeing patients and writing prescriptions or referrals.
       Sounds commendable right? Two doctors simplifying the process and cutting their overhead to create an environment that functions solely to provide them with a space where they can do their jobs and see their patients.  Utility bills probably running them about the same as what their average patient pays at home.  They have a small staff- One LPN, four CNA's, two office girls.  Staff costs probably running them $200,000 per year at the outside.  So let's figure that the total overhead costs of this office- building, utilities, and staff are running them $20,000 per month.  I've gone ahead and inflated all the numbers just to give them the benefit of the doubt, assuming that they are paying their staff well above what is average for our area, and assuming that they financed the entire cost of building their location.
       Now looking at this number, one might start to feel a little bit sorry for these doctors about how much it costs them just to go to work everyday and do a job they love.  20K A MONTH just to go to work?  That's insane!  Don't start crying for them yet.
        Remember that I mentioned that this office has six patient rooms?  Well, with a little observation and some casual questions to the office staff, I've ferreted out that the policy of this office is to schedule 1 patient every 15 minutes for each of those rooms, 5 days a week, from 8:30 am- 5:00 pm.  The office is closed on weekends and maybe 4 days per year for various holidays.  A little more research (looking at the paperwork mailed to me by my insurance company) reveals that each of those visits is billed out at $125 each.  For a grand total of $25,500 PER DAY in office visit fees.  Each of the 256 days of the year that the office is open.  That grand total is equal to $6,528,000.  SIX AND A HALF MILLION DOLLARS a year in fees generated by a husband a wife team of doctors.
       Even now I am looking at this and thinking I must have missed something.  I've rerun the calculations 5 times, and yes, that number is correct.  What is terrifying is that those are just the charges for getting in to see the doctor or a member of their staff.  Every immunization, any thing that goes beyond just seeing and speaking to one of these medical professionals is billed as a separate and additional item to either the patient or their insurance company.  And these doctors (primarily the husband) also see patients in our local hospital.  Every single baby born who becomes a patient of their practice gets a visit in the hospital that generates another, much higher, charge.
       Now I know that doctors rarely manage to collect all their fees from their patients.  I know that they often pay fees to outside companies to handle their billing, and that they pay premiums for malpractice insurance, taxes, additional taxes for their employees, etc etc etc.  But come on.  75 years ago in this country doctors were still delivering babies and treating patients in exchange for potatoes.  Literally in some cases.  Despite all the hardships involved in becoming a doctor and maintaining a practice in today's economy and society, my pediatrician and her husband still manage to drive luxury vehicles and pay tuition for their children to attend Montessori schools (look up those prices if you want to make your eyes bulge).
      There are many factors that have contributed to us as a country having reached the place where this is accepted as the norm in healthcare.  The doctors and greed on their parts cannot be apportioned all or even most of the blame.  But people do need to start noticing and thinking about the situation that we're in, and give serious thought to whether we as individuals or as a nation can afford to go on letting this problem spiral out of control.  Doctors have their part to do, and patients, as the consumer, really need to start doing their part in dissecting the issue to understand how we got here and what it's going to take to fix the problem.
      No one has a true grasp of what health care is actually worth anymore, and without knowing what the value of something is you cannot begin to assess what is a reasonable amount is to pay for it.  Blindly ignoring the cost of health care until such time as you are forced out of need to pay for it makes you a victim of the person or entity that controls the thing you need, rather than a participant in a system that supposedly exists to meet a need.