Robert Louis Stevenson, author of many 19th Century action-packed thrillers such as Treasure Island and Kidnapped, wrote these suspense-filled stories from his sickbed, where he was plagued with “bloody lungs,” probably tuberculosis. While doing some research for a column about our bizarre, scam-filled, and often totally baffling health care “system,” I thought of another Stevenson novel, The Strange Case of Dr. Jekylland Mr. Hyde. This story is based on a rather rare mental condition now called dissociative identity disorder, but commonly called “split personality” by most. So here we have the good Dr. Jekyll and the very evil Mr. Hyde residing in the same body as a result of a very bad potion. The American health care system also has a split personality. On the one hand we have marvelous Dr. Jekyll with wonderful bedside manners bringing life back to patients with technological and medical miracles. But then we have malevolent Mr. Hydes as insurance and hospital CEOs and administrators who have created bizarre, Rube Goldberg, Mafia-an-offer-one-cannot-refuse, a financial Rubik’s Cube system no one—not even a Ponzi—can understand.
On the one hand, good Dr. Jekyll’s in two San Francisco hospitals who specialize in kidney transplants performed 18 transplants in a record 36 hours. Because of a newly developed computer program that connected willing donors with compatible patients quickly, the doctors were able to complete the transplants in record time. However, we still have 101,000 people waiting for a kidney in the United States. Also, good Dr. Jekyll’s at the Howard Hughes Medical Institute and Brigham and Women’s Hospital have developed a new test utilizing less than a drop of blood that can reveal nearly every virus a person has ever been exposed to in his lifetime. And for about $25! The test can detect over a 1,000 different viruses at the present time that are known to infect people. Most people have been exposed to about ten viruses. This test may be used to determine at what age most children tend to get viruses so that vaccinations may be scheduled near that time. One infectious disease expert said this cheap test is a bigger deal than the invention of the electron microscope.
Remember that old song “Hey big spender, hey big spender, spend a little time with me?” This must be the theme song in many hospital accounting rooms run by Jekyll’s ultra evil Mr. Edward Hyde. In 2014 American patients spent $3 billion for medical care, more than the next ten big spenders in the world: Japan, Germany, France, China, the United Kingdom, Italy, Canada, Brazil, Spain and Australia. We have about 700,000 Henry and Henrietta Jekyll’s providing the medical care while we have about 1,500,000 Edward and Edwina Hydes in the health insurance industry determining what those hospitals and doctors should charge. Technology has increased the cost of medicine exponentially. As an example, The United States has 31.5 imaging machines (MRIs) per one million people. The National Health Service of Great Britain provides perfectly adequate medical treatment with 5.9 MRIs per one million people. Boy, do we have accessible machines! But medicine seems to be the only industry in the U.S. where technology has dramatically increased costs instead of lowering them.
The evil Mr. Hyde struck again when Julian Wilson, a Cuban refugee, was allowed entrance to this country in 2014 after he had applied for entrance. Wilson had told the U.S. Interests Section in Havana that he had had a liver transplant in 2007 under Cuba’s free universal health plan and was supplied with free drugs to avoid the rejection. He was given permission to bring some of those drugs with him when he immigrated to Florida. He purchased Florida insurance but moved to Texas after a few months. He discovered that the rejection drugs in Texas would cost him $5,000 a month because his insurance wouldn’t cover him in that state. He applied for Medicaid but was denied. The U.S. consulate advised him that if he didn’t want to die he could return to Cuba and get free drugs. But Wilson does not have enough money to get back to Cuba. The richest country in the world charges $5,000 a month for the drugs while one of the poorest countries in the world provides them free. What a country!
Several Dr. Jekyll’s at the MD Anderson Cancer Center and the Houston Methodist Hospital recently replaced some important body parts in 55-year-old Jim Boysen on May 22. Boysen had had a kidney-pancreas transplant 23 years ago because he had had diabetes since the age of five. But the anti-rejection drugs he was taking probably helped to develop a cancer which invaded his scalp and skull. So these medical geniuses conducted the first skull-scalp transplant in the world. He had a very large hole in his skull from the cancer. At the same time of the skull-scalp transplant he had a new kidney-pancreas transplant to replace the old one which was beginning to cease to function. Reminds one of a victim of a major auto crash getting essential parts installed in a repair shop.
While the Jekylls developed new methods and procedures to cure life’s ills, the Hydes kept padding the bills so that we spent a world-leading $8,508 per capita for health care in 2014. Norway was in second place at $5,669. We had the dubious distinction of being in last place among the world’s top eleven in quality and other measures of health outcomes. The United Kingdom, spending only $3,405 per person, placed first in the survey. Among the eleven in the survey are Australia, New Zealand, Switzerland, Canada, France, and Germany. Among all of the industrialized nations we rank 34th in health outcomes, quality, and efficiency as judged by the World Health Organization (WHO). We are 34th because of infant mortality, lack of primary physicians, poor access to primary care, the number of uninsured who skip needed care, very expensive prescriptions, and difficulties in getting timely information to doctors. These surveys were taken before the Affordable Care Act, perhaps better known as Obamacare, went into full effect.
Maybe we’ll score better in 2015, but the Hydes were still too active in 2014. Example: A Wisconsin woman suffered cardiac arrest and was in a coma when she was rushed to a hospital nearest her. The hospital gave her excellent care, but she had been taken to a hospital that was “out of her insurance network,” whatever that meant to good health care. Then the bills started to come to her address, totaling $300,000. An in-network hospital had been only three blocks from the one she had been taken to, but being in a coma, she was unable to tell the ambulance crew to go to her network hospital. She would have been billed only $1,500 instead of $300,000! This is way beyond crazy! But it gets worse. Her insurance company eventually agreed to pay $156,000 of the bill—which they would have paid if she had gone to the “right” hospital. The “wrong” hospital reluctantly reduced her bill by $90,000. This means she still owes the “wrong” hospital $40,000. No wonder experienced CPAs agree they can’t understand hospital billing standards. These practices, standards, side agreements, and other insurance mazes go way beyond “Catch 22.” Even outright thievery would be hard to prove.
The World Health Organization has the U.S. ranked lower than Cuba in its health care survey. Here are a few reasons why. Fidel Castro established a research group called the Biological Front many years ago which later became the Center for Molecular Immunology. This group has made several vaccination breakthroughs for meningitis B, hepatitis B, and monoclonal antibodies for kidney transplants. But here’s the real big news. Cuban doctors have been working for over 25 years on cancer drugs. Over that time it has developed a lung cancer vaccine called Cimavax, which has been tested for five years in Cuba—and is now undergoing trials in Canada and Japan. U.S. politicians have kept the drug out of this country until now. Tests show lung cancer patients who received the vaccine live four to six months longer. The price? It costs about a dollar a shot. The Roswell Park Cancer Institute of New York and the Cuban group will combine to use Cimavax and other promising cancer drugs in trials soon. Let’s hope the Hydes of New York don’t get their hands on the drug.
Ignorance, religion, and stupidity still dominate some politicians when it comes to health care. Idaho Republican Representative Vito Barbieri revealed his ignorance about female anatomy when he asked a testifying doctor in a hearing if a pregnant woman could swallow small cameras “to determine what the situation is…” Dr. Julie Madsen had difficulty keeping her cool when she responded that “swallowed pills—or cameras—do not end up in the vagina.” Oh Lord, help us. And did you know that “good Christians” who behave “biblically” cannot get PTSD even if they are bombed out of their skulls in war? Evangelists Kenneth Copeland and David Barton promised. Oh Lord, help us.
There are billing codes for a Kleenex tissue and a single Tylenol. There are dozens of codes concerning the health of your big toe. There is a code for an injury caused by knitting needles. The World Health Organization has issued the 10th version of the International Classification of Disease, a common code system used by most countries in the world so we can gather statistics worldwide about health care. The first code was issued in the 1800’s. It contained a fascinating code as one cause of death: “Visitation by God.” Holey Moley! The 10th ICD contains about 68,000 codes describing diagnoses and 87,000 covering medical procedures. There is even one for being injured in a spacecraft. The ICD has to represent billing nirvana for a hospital or health insurance accountant or clerk. Here are some recent billings by Hydes from around the country. Deepa Singh of San Francisco gashed her knee at a backyard barbecue which required three stitches at California Pacific Medical Center. Her bill? $2,229.11. Toddler Orla Roche fell and split her head on a coffee table. A dab of skin glue closed the wound. Her parent’s bill? $1,696. By the way, the average hospital stay in the U.S. runs $12,000 while Germany’s average is $5,000. An uninsured woman in Kansas pays $138 a month for a prescription. Her pharmacy buys the same prescription for $1.55. Daniel Diaz of New York City cut his finger while peeling an avocado. Five stitches cost him #3,355.96. A patient at most California hospitals is charged $20 for a codeine pill. Walgreens sells them for 50 cents. The California Pacific Medical Center charges a new mother $543 for a breast pump. Providers on the Internet sell them for $25. About 575,000 Americans spent $50,000 or more on medications in 2014, while 139,000 of them spent at least $100,000. That’s an increase of 63% over 2013!
It appears that the entire health care system is possessed by dissociative identity disorder (DID), the source of the Jekyll-Hyde split personality problem. A very controversial psychiatric disorder, there is no treatment yet. Behavior within the health care system is marked by the two distinct identities with Jekyll-and-Hyde personality tendencies, the choice between good and evil.
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