Thursday, August 9, 2007

Hospital Charges

One of my fellow bloggers, "The Power Within the Architecture," wrote her last entry on the topic of limited medical liability - the idea that there should be a limit to the amount of money a plaintiff can receive when suing for malpractice. I agree with her that this does seem a little inane given the varied types of injuries and degrees to which a plaintiff may have suffered.

Still, I think the issue goes deeper than that. Since the creation of Medicare the use of insurance companies to help defray the costs of health care has become a widely accepted practice, but before then hospital charges were solely between doctor and patient. Medicare introduced a sort of bartering system to hospitals - the hospital would deliver the charges and then Medicare would tell them how much they were going to pay, which was (and is) typically lower than the hospital's initial asking price. In response to this system the hospitals raised charges in hopes of obtaining sufficient funds to cover their costs. Hospitals and insurance companies are now engaged in an ongoing price war that continues to raise hospital charges every year.

At this point things get tricky: insurance companies and health care providers become like a couple of divorced parents bickering over child support. The patient is powerlessly stuck in the middle, forced to suffer the consequences. It's no wonder that "The Power Within..." was worried by the possibility of malpractice: "What if the doctor messes up - I don't even know this guy so what does it matter to him?!" Inviting a third party into the situation impersonalizes the doctor-patient relationship and inflates costs to an unrealistic level.

Although we know that hospitals undoubtedly charge more than they simply need to cover costs and make an understandable profit, exactly what the real costs are has become unclear to everyone - including the hospitals themselves. According to the article, "Hospital bills spin out of control" on, one woman tried to get a fair estimate of the cost of her daughter's knee surgery before undergoing treatment and paid the hospital exactly what they asked - $4,200. Later, however, she received another bill asking for an additional $21,000. After she provided a detailed description of the care her daughter had received during her hospital stay the hospital reduced the bill to $610. Nobody could provide an explanation for the initial discrepancy - not even the doctor.

Placing a cap on the amount of liability a plaintiff can receive from a malpractice lawsuit does not help ease the minds of people in need of medical attention, but who can be at ease when nobody knows where their money will come from or even if it will be enough? Neither doctors nor patients.

In the words of "The Power Within..." somehow we need to create a situation where you are "able to comfortably put your life in the hands of a doctor and say: fix me, I trust you."

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Friday, August 3, 2007

The Bureaucracy

Beginning with Roosevelt's "New Deal" in the 1930s, the number of organizations created by the government to accomplish miscellanious duties has become a complex mass known by acronyms that list off like an overly abbreviated text message: the IRS, CIA, USDA, NASA, USPS, etc. Bureaucrats accomplish everything from renewing our drivers licenses to defending our country from foreign enemies.

The bureaucracy is an institution that Americans famously love to hate, notorious for its maze of rules and red tape, its slowness, and its impersonalization. Many complain about the toll it takes in adding to the inconveniences of their day, but few realize the consequences it has elsewhere in their lives.

Those that work for the bureaucracy become normalized to the extensive rules that plague whom they serve. They see the logic behind requirements such as needing paperwork documentation for every action, often making it their life's work to see that every 'i' is dotted and every 't' is crossed. This does not, however, foster independent thought. Bureaucrats spend forty hours a week enforcing rules for causes in which they grow to strongly believe and rarely question. Excluding the time one needs to sleep, eat, and run the inevitable errand, this leaves precious little time for truly personal use.

The result is an entire population of people who have been conditioned not to think, not to change, and not be individualistic - rather, they have conformed to the norms of the bureau.

I believe that the tasks they accomplish need to be done and someone obviously has to do them. But something very precious dies when an individual ceases to be just that - an individual. They lose a sense of person, a sense of presence, a sense of life. They get bored.

The real harm of the bureaucracy is not in the excessive rules or annoying red tape - it is the creation of ineffective human beings.