Medical Costs

My family has recently incurred a lot of medical expenses. In the case of my son, we paid over a thousand dollars for an ER visit that resulted in the wrong diagnosis. They told us his knee was sprained when it turned out it was fractured and he needed surgery. Now, I'm not really upset with the ER; I'm sure they do the best they can. They have to deal with a wide spectrum of problems, so they can't afford to specialize too much; they're ridiculously overpriced because they're required by law to treat everyone regardless of their ability to pay; their one virtue is that they're always open, which is why my wife took my son that night. But the expenses have got me thinking more about the reason for those high costs.

When was the last time you went to the doctor and saw a price sheet posted for various examinations, tests, and procedures? Have you ever seen a menu like that published by a medical practitioner? I've heard of a few scattered practices that cater to cash-paying customers who do things like that, but I've never seen one myself. Have you ever asked a doctor after he prescribes a procedure or a medication how much that treatment will cost? Or whether there are less expensive alternatives? I have. The doctors usually don't know. This is an industry that has become unconscious of price and I think I know why.

The unstated argument seems to be that health is more important than money. Now I would agree in general, but only "for the most part". If I had to pay a million dollars to fix an ingrown toenail, I would probably pass. Everything has a price. My own life is not worth a billion dollars and I would not think of saddling my family, or society, with a bill like that just to extend my own little life for an indeterminate amount of time. So that argument can't be universally true.

Given that, I think we have become far too complacent regarding the cost of medical treatment. If there is no awareness of cost, there can be no consumer-driven pressure to keep prices low. On the contrary, we typically accept whatever treatment doctors prescribe because they know more than we do and we are fearful of doing something that will negatively affect our health. And because insurance is there to bail us out, we don't worry about the cost. And then we wonder why our premiums go through the roof year after year.

So, the first reason that costs have become so ridiculous in the medical industry is because of the prevalence of insurance and the absence of mind this safety net gives the consumer, leading us to be unaware of cost. The insurance industry largely takes away the individual consumer's natural incentive to minimize his/her individual costs. Interestingly, we are seeking to fix the problem in my country by expanding the influence of this insurance industry, which is one of the causes of the problem. I have a great deal of sympathy for those who can't afford necessary medical procedures, but I'm afraid we're making the problem worse at a time when we can hardly afford to do so.

The second big reason I see is the impact of medical lawsuits. We love our lawsuits in this nation and so many precedents have been set for malpractice that doctors are forced to prescribe anything and everything that might help the condition of the patient and limit their own legal liability if anything should go wrong under their watch. And of course, the doctors know more than we do, so we accept their advice, unconscious of cost, and undertake every procedure, every test, and every medication they prescribe thinking they are acting in our best interests. No doubt most of them are trying to do exactly that, but they are a bit hemmed in by all the legal precedents.

Related to that are the costs of malpractice insurance that every doctor has to have to avoid the risk of going out of business when slapped with a multi-million dollar lawsuit. Every time you go to the doctor, you're subsidizing those insurance premiums, which are necessary thanks to the army of lawyers who have helped to take money out of the system.

I have no doubt that there are many legitimate malpractice cases and some people, whose lives have been damaged or ruined because of the negligence of medical professionals, should justifiably be compensated. But I believe there have been far more suits over the years that have not been justified and have led to the necessity and high premiums of this interesting form of insurance and have served to cage doctors in to some extend in what they prescribe out of fear of a lawsuit.

There are high costs associated with both of these factors, but it seems to me that if consumers would become conscious of the medical costs they incur and seek to minimize their own costs, it would go a long way to keeping those nosebleed costs in check.

I'm afraid I have little hope that will happen in the current environment. But maybe I'm wrong.

Since writing the above, we've received bills for my initial orthopedist visit and my son's surgery.

• Total cost of surgery: about $22K. No kidding.
• Most ridiculous item in my opinion: almost $200 for some pre-surgery medication ... two pain pills.

• Total cost of my visit: about $1500.
• Most ridiculous item: about $1100 to set my ankle. This consisted of the doctor painfully forcing my ankle into position while the nurse cast it. The cost of the casting material was separate.

The lady in charge of the billing at that office told me that about half of that $1100 would go to pay for malpractice insurance premiums. For insurance purposes, that setting was basically considered the same as surgery and any complications that arose from it could potentially subject their office to malpractice suits. I really am in awe of the miracles of modern medicine, but I think we've broken the medical industry with selfishness and greed.

No TV Month

We have a fun little tradition in our house of turning off the TV for the month of February. My wife was inspired with that idea several years ago and it has made a wonderful difference in the atmosphere in our home. We don't watch TV shows, movies, or anything like it on one of those big screens. We also avoid video games and other electronic distractions and by the end of February, we usually feel more productive and united as a family because we talk and play together more than other times in the year.

This year, our youngest hasn't yet seen the benefits of our little tradition and she had the following conversation with my wife. These may not be exact quotes, but they're pretty close.

Child: "Can I watch Backyardigans?"

Emily: "No honey; this is February and we don't watch TV in February."

Child: "Really? No TV?"

Emily: "No sweetie. February is no TV month."

Child: "I don't like February."

More recently, she upped the ante and told us she HATED February. :) She'll get over it. I LOVE February. So far, I'm already really enjoying it and I look forward to spending more quality time with my family.

Frugal Living

Pip, the main character in "Great Expectations" begins his life very poor. Having obtained an expectation of inheriting property and wealth, he is given a liberal allowance for several years and spends it freely. He lives extravagantly and somewhat without purpose because he doesn't work for his money. He becomes so lavish in his spending habits that he incurs a lot of debt in spite of his liberal allowance.

Later in life, when money doesn't flow quite as freely, he moves abroad and works with a merchant in his shipping house. Pip comments near the end of the book: "I lived happily ... and lived frugally, and paid my debts."

On visiting his old home, he is asked by a friend, "you live abroad still? .... And do well, I am sure?" He replies: "I work pretty hard for a sufficient living, and therefore - yes, I do well."
I loved that short answer of his. It contains a great deal of wisdom regarding what it means to do well. Doing well is not the same as making a lot of money. It means working hard for what you obtain, earning it, and obtaining enough by which to live and enjoy life. Beyond meeting your own needs and some of your wants and having the ability to help others in need, money doesn't buy much in the way of happiness. The greatest happiness I find connected to money is living below my means. That gives me a great deal of freedom no matter how much money I make.

To Have Loved and Lost

Spoiler Alert! If you haven't read "Great Expectations", but think you might, you may not want to read this post.

I finished reading "Great Expectations" recently and I loved it! The character Pip falls in love early on with a young girl named Estella and as they both grow, that love grows stronger and stronger. Unfortunately, Estella is under the tutelage of a woman, Miss Havisham, whose heart had been ripped apart years before by an unscrupulous man and this woman, over time, comes to see Estella as a tool by which she can exact revenge on the male sex. In training the young girl, her adopted daughter, she takes away her heart full of feeling and gives her a heart of stone. She comes to regret her actions bitterly, highlighted by a conversation between the two in which Miss Havisham reproaches Estella for her coldness toward herself.

Miss Havisham: "Would it be weakness to return my love?"

Estella: "If you had brought up your adopted daughter wholly in the dark confinement of these rooms, and had never let her know that there was such a thing as the daylight by which she had never once seen your face, - if you had done that, and then, for a purpose had wanted her to understand the daylight and know all about it, you would have been disappointed and angry? ... Or, which is a nearer case, - if you had taught her, from the dawn of her intelligence, with your utmost energy and might, that there was such a thing as daylight, but that it was made to be her enemy and destroyer, and she must always turn against it, for it had blighted you and would else blight her; - if you had done this, and then, for a purpose, had wanted her to take naturally to the daylight and she could not do it, you would have been disappointed and angry?"

In using daylight as a metaphor for love, Estella clearly demonstrates the state of her heart and soul and the outcome of Pip's love for her becomes easy to foretell. Unfortunately, Pip, not unaware of the dangers to himself intellectually, continues to pursue Estella, blinded in a way by his love for her, seemingly unable to help himself. Estella ultimately marries a base, cruel man out of spite for mankind and Pip loses her.

Later, Miss Havisham, seeing what she has done to Estella and to Pip, asks Pip to forgive her. Pip replies, "There have been sore mistakes; and my life has been a blind and thankless one; and I want forgiveness and direction far too much, to be bitter with you." But he's not so easy on her when it comes to Estella. Shortly after this comment, the following dialogue takes place.

Miss Havisham, speaking of Estella: "I stole her heart away, and put ice in its place."

Pip:  "Better to have left her a natural heart, even to be bruised or broken."

Pip rightly recognizes that the worse evil was inflicted on Estella. Pip had loved and lost, but he had at least loved. He recognized that evil had been inflicted on him, but he bore no malice toward this woman and yet, he couldn't help pointing out that she had done a greater evil to Estella, who seemed unable to love. There is a beautiful truth in this that even with its attendant pains, a heart of flesh is much to be preferred to a heart of stone. It is far better to have loved and lost than to have never loved.

Years later, Pip was asked about Estella by a friend, Biddy.

Biddy: "Tell me as an old, old friend. Have you quite forgotten her?"

Pip: "My dear Biddy, I have forgotten nothing in my life that ever had a foremost place there, and little that ever had any place there. But that poor dream, as I once used to call it, has all gone by, Biddy, - all gone by!"

Pip adds, by way of narrative ...

Nevertheless, I knew, while I said those words, that I secretly intended to revisit the site of the old house that evening, alone, for her sake. Yes, even so. For Estella's sake.

That bittersweet memory of a love that he had for her was not just a memory. He loved her still and his genuineness, his sincerity near the end of the book really touched my emotions. I know what it is like to have loved and lost and although I have found many loves since (foremost among them being my wife and children), like Pip, I have never forgotten those things in my life that ever had a foremost place in my heart. And I don't regret the pain of what was lost because I believe that in having loved so deeply, I became more real, more human, and came closer to what God wants for me, having experienced that love.