The Cost of Profit-Driven Health Care

By | 2018-03-15T16:56:20+00:00 March 15th, 2018|
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One week after coming home to bed confinement following my debridement/biopsy, Dr. B’s scheduler calls to tell me my flap operation will happen in nine weeks. “Nine weeks?!”

“It’s the first opening he has. He’s a busy man.”

“Do you have any idea what lying in bed for nine weeks costs in time lost working and home health nursing care, not to mention muscle loss and weakness?”

“I’m sorry, it’s the best we can do.”

I ask to talk directly to Dr. B, but he never calls. So I argue my case with his lead nurse, imploring her to do all she can to shorten the wait. A week later she calls and tells me Dr. B has re-arranged his schedule and my surgery is now five weeks sooner.

Hallelujah! The good doctor has a heart.

My elation subsides when I learn that Dr. B wants me to arrive by stretcher service for a routine office visit in a week. This means a non-covered, roundtrip non-emergency ambulance ride that will cost me $800. I appeal to my insurance customer service rep: “The ambulance is a medical necessity,” I say.

“It still isn’t covered, but I’ll do my best to push through your appeal,” she says. “If approved, you’ll still have a co-pay of $250 each way — $500 total.”

I arrive by stretcher for my appointment, ready to do battle with Dr. B, who has ordered the stretcher service because his exam tables are inaccessible and unsafe. He refuses to use them for non-ambulatory patients like me because of liability concerns, thus ignoring his legal responsibility to comply with the ADA and provide equitable care. He gets around personal medical liability by ordering the ambulance paramedics to help. They turn me on my hip on the uncomfortable rail-thin stretcher and hold me while he inspects my wound.

“It looks good, pink, healthy,” he says, and instructs a nurse to re-dress the wound. Then he apologizes for the inconvenience, saying it is all about safety.

“Why don’t you just purchase one adjustable exam table?” I ask.

“They don’t have safety rails.”

“I’ll bet I can find one online.” He does not respond. The appointment is over.

Back home, I go online and find the perfect barrier-free exam table with well-designed safety rails. In my email to his lead nurse (he won’t correspond directly with patients) I attach the link and explain the benefits for the doctor, staff, ambulance service, and patient, asking, “Why not do the right thing?”

No response. I consider filing a lawsuit. I have the leverage of the ADA, such as it is, but Dr. B holds the power of the scalpel. In the meantime, the House of Representatives passes HR 620, giving those who are not in ADA compliance an extra 120 days to begin complying after written notification, as if 26 years following implementation of the federal civil rights law has not afforded them sufficient time.

The Bed Cost is Extortionary

While I await my operation, I work on how to stay out of the nursing home following flap surgery. To do so, I must either rent or buy a medical grade wound therapy bed for home use. The best one for someone my age with my underlying mix of complications (prior flap surgery in same area, diabetes, occluded internal iliac artery) is the Hill-Rom P500, but the bed and frame price is $35,000! — with no rental possible. My Medicare policy won’t cover it.

My home health provider has instead shipped me a poor quality Drive Medical “Essential” low air loss bed from a DME contractor that rents for $900 per month, the “regular and customary cost.” My 20 percent co-pay will be $180 each month for maybe four months, a total of $720. The bed kills my shoulder, gives me headaches and doesn’t work as advertised. I go online and find the exact same bed costs $347 for outright purchase on Amazon.com.

I complain and they replace it with an alternating pressure bed that is no longer manufactured and has no reliable support service. I get a pressure sore on the stump of my left leg in this one. So I bite the cost bullet and push for the expensive Hill-Rom P500. Since it is only available out of network, my co-pay will be 30 percent, if approved. Assuming a negotiated price of $25,000, the bed would cost me $7,500 out of pocket.

I make the call I’ve been putting off. “Hey, McQ, remember when you said you might be able to help me purchase that bed we talked about?”

I feel humbled and grateful to have a lifelong friend like McQ. The bed is like an insurance policy for independent living. Healing must go perfectly following surgery, or the operation will have to be re-done. It would also protect me from further risk-laden skin breakdowns.

After I hang up, I say a prayer of thanks and ponder, once again, what others in my situation who are at a time of critical need — but are not as fortunate as I — can possibly do when faced with the unjust, prohibitive costs of a product-driven, profit-based health care system.

This is the third installment in Journey to the Far Side of Tomorrow, a six-part blog series chronicling our editor Tim Gilmer’s unexpected immersion into the world of flap surgery and all it entails. Read the first installment here and the second installment here. Look for the fourth part in early April.