Answer to the riddle? (Question on the Facebook teaser: What's the difference between a popsicle stick and a tongue depressor?) About $6.
There are a dozen good explanations for why our healthcare system has spiraled into the depths of hell -- and I'm sure there's some measure of validity to all of them -- but I'd like to recount one from the trenches that you might find useful and informative.
Some time ago, I woke up with my elbow swollen and tender. Though I wasn't in any pain, my wife convinced me that it looked weird and deformed so I should probably get it examined. I had banged into a wall the previous day playing squash and thought I could have injured it in some way. I trekked to the ER at Roosevelt Hospital (closest one to my apartment), and was lucky that it was a weekday during lunch hour. No line at all and I was taken immediately. The doctor on duty X-rayed it and found "nothing to worry about." He suggested icing it to reduce the swelling and then following up with my regular internist. Co-pay: $50. Time spent: 45 minutes.
Icing it did not reduce the swelling, so after a few days, I went to see my regular doctor. He looked at it and said, "Oh, you have a bursa." According to one definition, "A bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures." The swelling was due to excess blood in the joint, and it needed to be drained. But, of course, he didn't do any draining himself. He mainly listens to complaints and types into his computer. He recommended a "specialist." Co-pay: $15. Time spent: 15 minutes.
I got an appointment with the referral, a Russian doctor, a woman in her 50s or 60s. She looked at it, and said, yes, a bursa, and it had to be drained. Before the simple procedure she spent a long time asking me about my medical history, and she took copious notes. Then she used three or four needles to extract the blood. I was impressed with her thoroughness. She recommended taking vitamin D supplements because I was getting up there with age and deficiencies came with the territory. Co-pay $15. Time spent: 1 hour.
This took two weeks and cost $80 out of pocket, and a lot more to the healthcare insurer. (Meaning all of us.) Oh, and when I received the financial statements from my HMO, it had knocked down the Russian lady doctor's reimbursement to about $65 (from about $250 claimed). She had done the most labor to treat my injury, and she received the least amount of compensation. What's wrong with this picture, folks?
After I was cured, I ran into one of my softball buddies, Dr. Mark Melrose, a terrific physician who had just opened an Urgent Care Clinic in my neighborhood. As soon as I began telling him my story -- literally, a minute into it -- he guessed, "Oh, a bursa."
Thirty or forty years ago, I would have gone to my family doctor and it would have been taken care of in one visit -- not three, and probably not a hospital visit -- and it would have cost a lot less, even in adjusted dollars.
Of course, the hospital ER doctor misdiagnosed my injury. He could have figured out what was wrong by just Googling "swollen elbow." But he was covering his ass by simply doing an X-ray, which didn't reveal a fracture.
What does this story tell us?
The system is designed for referrals. It's designed for specialties. It's designed for fear in taking responsibility for treatment. It's designed for inefficiency. And it's designed to cost us far more money than is necessary. And this is one reason it is bankrupting the country.