The Most Expensive Screw I’ll Ever Buy

2013-05-08 13.27.23

Look close and you can see the most expensive screw I will ever buy. (Keep your dirty thoughts to yourself.)

About 3 weeks ago, my younger son broke his finger while riding on a tube flying at a pretty good clip behind a boat. His finger caught in the handle and (according to his recounting of the tale) popped sending the finger side-ways. In the hopes that it was “just jammed,” he straightened the finger (tough guy) hoping that would help.

Never one for half measures, he didn’t just break the finger. He chipped the bone in his interphalangeal joint. The x-rays showed a small piece of bone just sitting there, perfectly aligned but with a gap where bone should sit. I’m no medical doctor, but it was not difficult to read the x-ray. The doctor told us we were going to need to screw the bone together to improve the chances of healing.

I told him I had a drill at home if he could just tell me what kind of screw to get. Does Ace Hardware sell that?

Understand that we are no strangers to the emergency room or doctor’s offices. We have two boys who do more than play video games. We’ve broken arms, cut the tip of a finger off, endured a boxer’s fracture, and had stitches among other ailments. I myself have bought various cars and boats for doctors within a 350 mile radius.

Yet, I’m always shocked at the cost of health care in America. The night before my son was going in for surgery, the hospital called to tell me they estimated the hospital portion  of the cost at $13,000. “That doesn’t include the surgeon or anesthesiologist. Will you be making a payment tomorrow when you come in?”

Yeah. Let me just grab my wallet.

“Of course I’m not making a payment tomorrow,” I told the poor woman on the other end of the line. “I’ve bought cars that cost less than this surgery. Why exactly does this surgery cost so much?”

Silence. “I’m just reading the paperwork they gave me sir.”

Clearly, my son wasn’t the only one getting a screw the next day, if you know what I mean.

What we all know after reading Steven Brill’s Time Magazine article “Bitter Pill: Why Medical Bills are Killing Us” is that there is no real rhyme or reason for the charges on your most recent hospital bill.

Brill shows us, and I don’t think anyone will be surprised, that health care is a for-profit racket where insurance executives, doctors, and hospitals are working in cahoots to maximize profits.

Hospitals have a charge-list that may or may not be connected to the actual service or cost of a procedure, insurance companies negotiate a “plan discount” of 40-50% based on that charge list, doctors are courted by various hospitals who will bring in patients to perform certain procedures, and the AMA/ABMS, groups made of doctors who have a vested interest in high medical costs, certifies who is “allowed” to practice medicine and join the club.

Gee. What could go wrong in this scenario?

Certainly, health care is a complex issue with a variety inter-mingled parts but we should be able to admit a few basic things:

1. Health care cannot work based on free-market assumptions. When you are having a heart-attack, you can’t shop around for the best deal.

2. Economics shouldn’t dictate our ability to receive basic, competent medical care.

3. The emergency room should be reserved for emergencies (snapping your finger in a tube on Sunday night or cutting the tip of your finger off at 8:00 pm on a Saturday, for instance) but that means there have to be alternative places to get treatment.

4. Doctors are humans who make mistakes. If we stop suing them, they might stop doctoring defensively. (Having said that, let’s also remember that Texas capped malpractice lawsuits years ago and medical costs in the state have not gone down.)

But, as complex as this issue might be, we can reduce costs.

1. Decouple medical insurance from work. Insurance emerged as a benefit in the early 20th century to attract the best workers. Such expenses made sense at the time. People rarely went to doctors and employers needed to entice the best and brightest to join their business. The emergence of insurance agencies, though, has created a loop of rising prices and negotiated discounts that is inefficient and costly. Worse yet, medical costs are the fastest rising costs for employers and employees. At my university, we not only went 5 years without any cost of living increase, we saw our medical costs increase. In effect, we all took a pay cut. Yet, we are not free to negotiate a different insurance plan or choose a different type of insurance. In essence, I don’t have the ability not to have insurance through my work place and my work place is required to spend money on my health care. (Of course for many companies, they can turn around and use that as a tax write off, decreasing the amount of funds available to help fund government programs.) Example after example shows that insurance tied to work decreases market competition and increases both cost and external control of care and expense. While many don’t like the way they are being established, health care exchanges can work by establishing insurance pools we can purchase, provided there are low cost/low benefit options. We don’t all need a Cadillac insurance plan. In fact, too many of us have such easy access to health care that we are forgetting how to care for ourselves. Words of wisdom from my doctor once: I can give you medicine and you will recover in a week. Or, you can drink fluids, rest, and be better in 7 days.

2. As much as I hate to write this statement, we need the government involved in medical care. Health care exchanges will not work, nothing will work, if we don’t establish baseline price controls. Brill shows pretty conclusively that medicare and medicaid work precisely because they have established the actual cost and pay 6% above that cost. Doctors and hospitals are still making a profit and people are getting quality health care. While some fields work just great in a deregulated market, others become bloated, inefficient, and unfair. The state of Texas deregulated utilities about 10 years ago. The price of those utilities has doubled in that time span. Texas has, in essence, a completely deregulated home and auto insurance climate. We pay the highest home owner’s insurance prices in the country. We don’t have that many natural disasters. I don’t want to accuse State Farm of anything nefarious, but it’s possible they are using Texas to increase profit. And our state legislators are making it easy for them. Because we can’t go without these things and because the services are specialized enough that there isn’t a wide-availability of options, the market won’t control prices. Are you willing to go without electricity? A heart valve transplant?

How much, I might ask the hospital, will the surgery cost? How much do you have, they reply.

Our current health care system is overpriced, inconsistent, unfair, and, if we look at the average health numbers in America, not terribly good. Certainly, we have some very wealth doctors and hospital administrators, but we also have too many people without health care and not enough access.

Simply put, we must move to a system that provides for the people and not a system where only the wealthy are healthy. Let’s save the screws for our bones not our wallets.

Things I Read

And Things I Learned

Washington Monthly

Do I contradict myself? / Very well then I contradict myself, / (I am large, I contain multitudes.)

Joanne Jacobs

Thinking and Linking by Joanne Jacobs

Inside Higher Ed

Do I contradict myself? / Very well then I contradict myself, / (I am large, I contain multitudes.)

NYT > U.S. > Politics

Do I contradict myself? / Very well then I contradict myself, / (I am large, I contain multitudes.)

Balloon Juice

Do I contradict myself? / Very well then I contradict myself, / (I am large, I contain multitudes.)

Dilbert Daily Strip

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The Full Feed from

Do I contradict myself? / Very well then I contradict myself, / (I am large, I contain multitudes.)