Modern Medicine: Horse and Buggy Delivery

Recently I got a bill for $11.47. A tiny bill for a medical bill. But nevertheless aggravating. Not the amount—the fact that it came at all. If you ever have surgery or execute an estate, you will find nickel and dime bills like that coming in months after the procedure or death.
If you sell a house, you can pay off the last utility bills in reasonable order. You know what to expect, and that’s what you get. If you take your car in for some serious repair, you get one bill. Even if the mechanic had to send the vehicle out for some work he couldn’t do himself—you get a single bill for the repair job.
You don’t, for instance, get a bill for the parts. Then a few weeks or days latera bill for the labor. Then, further down the road, a bill for the paint. And then a bill from the specialist who wielded the paint gun. Or a bill for rent from the person who owns the building. You get one bill.
Not for a medical repair job you don’t. You get bills from the doctor, bills from the hospital and a bill from the anesthetist. Then come the $50 and $75 bills from specialists you never heard of, never met, but you are assured actually entered your room, tut tutted and left—while charging for the nine years in medical school that informed their tut tutting. These bills can trickle in for months.
But you should feel good about them! A perpetual game goes on. The doctor, for instance, bills for $700. The insurance company pays him $425. He adjusts another $200 down and you get billed for a mysteriously arrived at $75 co-pay.
If you call to question this calculation (just to understand it), the physician’s book keeper is liable to wax righteously indignant that you, you lucky fellow, got a $200 adjustment off what the doctor’s customary fee is. You will come away without a clear answer. How dare you question it in the first place!?!
(The uninsured, due to an inspired fit of medical and economic insanity, get billed for the full $700. In the cases where the hospital and physician are forced to write the whole matter off due to indigency, they then tack the full loss onto the bills of insured patients—so the next procedure may cost you $750, less an adjustment, leaving a co-pay of, say, $86.10.)
The entire system becomes madly expensive—and much of its expense rises out of an inefficiency that would make the proprietor of any backwoods auto body shop blush. The brutal fact is that much of the economic (accounts and billing) side of medicine remains deeply mired in the Nineteenth Century.
The business side of medicine is run like a small general store back in the 1880s. Physicians retain the mentality of jealously independent sole proprietors or partnerships back in the days an entire store was the size of a modern grocery’s produce section.
A few of us are old enough to remember when you bought your bread and donuts at a bakery, you bought your meat at a butchers, you bought your vegetables at a produce stand, you went to the drug store for your medicines and you went to the five and ten for your notions.
Then somebody came up with the clever idea of combining much of that into what was called a “super market”. You could buy all of your edibles—and a fair amount of your toiletries—all under one roof. One bill. One check. That was it.
Then a man I knew personally had the clever idea of combining food, clothes, hardware, shoes, automotive supplies, lawn and garden plants and tools, toys, pharmacy and household goods all in the same store—the super store.
He had his problems. No American bank would loan money for such a crazy idea. So he sent his son back to Europe to raise the money there (rumor even had it that it was laundered Mafia cash), and the first super store opened on 28th Street in Grand Rapids, Michigan, in 1962.
Walmart saw these Meijers stores and tried to buy the chain. Fred said no. So Walmart hired away some executives to learn the knack and took the superstore idea nationwide. You need a hammer? You need lettuce? You need a lawn mower? A dress? Film? A TV? Have to change your oil? It’s all there under a single roof—one bill, one check. You can even buy tires and have them installed.
The medical community hasn’t figured out the benefits of this system yet. Why not the GP, the specialists, the anesthetist, the podiatrist, et cetera, et cetera, et cetera under the same “super market” roof? All with one central billing department—one bill, one check.
To say nothing of me not having to get back in my car and drive miles across town to first this specialist, then that medical supply store and then the next specialist a few miles further on! The Walmart and Meijers superstores have been able to bring the price for my food and toys way down with this kind of efficiency of scale—why not the physicians?
Want to start saving money on medical care? Force the MDs into the modern world. Let them share extremely expensive equipment—just like there is one lift truck in my super store that moves cases of soup, boxed TVs and packages of toilet paper.
Bring the hospital into the same medical superstore. As part of one to start with. Let them share the billing system with the physicians and medical supply stores. Let them share the expensive equipment. Then let me walk out with a single bill—and write a single check.
That’s so rational it defies argument. Why hasn’t it happened? Because docs are cussedly independent like old time store keepers. And there’s a bit of snobbery. What urologist wants to share a practice with a mere GP or podiatrist? Or, God forbid, what cardiologist would?
There’s only one way to force this kind of efficiency (I suspect it would have tremendous MEDICAL benefits as well!). You need a single payer system (read government) who could force this change simply by refusing to allow MDs to charge for the luxury of each one having his own little office with his own set of expensive toys. Nope. We (the payer) are only going to pay ONE bill per procedure. If you get left off, you don’t get paid.
I’ve known a lot of physicians in my life (having worked for the US Public Health Service among other places). I’ve liked many of them, respected several. But I can assure you the one thing that can surely move a physician either to tears or action is the thought of losing money.
They’ll team up—and eventually learn to appreciate the convenience and savings—for THEM.
And I won’t get any more bills for $11.47.