Daily Observer
Titus
Chiseldon was loaded for bear.
“Look
here, Lapius,” he thundered, “just look at this bill
for medical services for my mother. She
went to the hospital for a work up for a gastrointestinal complaint, and it
cost her almost $1,500. For what? A couple of
x-rays, a semi-private hospital room that was as crowded as a monkey cage
during visiting hours. How can you
justify that?”
“Calm
down,” Lapius said sternly. “You are an old friend, but that’s no excuse
for you to take my one semi-day off a week to come here and belabor me. I thought you wanted to play chess.”
“We’ll
get to that, Simon. But really, now,
that’s a hell of a lot of money for some work that could have been done on the
outside.”
“Why
wasn’t it done on the outside?”
“Simon. My mother is almost 90 years old. She lives alone, you know. How can she be expected to take those
purgatives, go to a radiologist’s office and then repeat the procedure for
three or four days. It would weaken
her.”
“Of
course it would. Your physician was wise
to send her to the hospital. Incidentally,
what was his bill for supervising her care?”
“About $200 or thereabouts.”
“Not
bad,” mused Lapius.
“A
little more than ten per cent of the total cost of her care, room, x-rays,
etc. It proves one thing any way, Chiseldon, that the doctor’s bill represents only a small
fraction of the hospital bill.”
“But
why should the whole business be so damnably expensive?”
“Because,
Titus, when you were in Congress, you didn’t scrutinize the bills you were
voting for, nor the effect they would have on the cost of medical care. Indeed, you were careless, and didn’t do your
homework.”
“That’s
ridiculous. Medicare was a national
necessity. You agree with that, don’t
you, Lapius?
Hill-Burton helped build more hospital beds. You agree with that of course?”
“Sure
I do,” Lapius said.
“But you fellows down in
“For instance?”
“Come,
come, Chiseldon.
Since your retirement you surely have been out of touch.”
“To
tell the truth, Lapius, even while in Congress I had
no idea what the grassroots implications of our laws were. Actually, all the public knows is that the
cost of medical care is high. But we
simply assume that it is the result of inflation, greed, careless administration…”
“Okay,
Chiseldon, you can stop now. The reasons are wrong, and the public is
ill-informed. The main reason medical
costs are high is because the government has to a great extent taken the market
place out of the hospital field. Your
mother didn’t need a hospital. She
needed something akin to a non-surgical hospital, or a well-equipped nursing
home where her needs could be attended, her x-rays taken, and she could be kept
under medical surveillance. But the
government in collusion with the third party insurers won’t have it. In the first place, no such facility
exists. They don’t exist because even if
some investors wanted to create a non-surgical hospital for chronic cases and
the elderly such as your mother who have minor medical problems, they wouldn’t
be allowed.”
“Why not? Since when
has an investor been prevented from putting up a hospital?”
“Since
the government got into the act. The
government wants to protect its Hill-Burton investment, and is desperately
afraid of competition. As a result,
states have been encouraged to pass laws requiring that a certificate of need
be acquired before permits for hospital construction can be issued.”
“Well, why
couldn’t my mother just go to a nursing home directly for these studies?”
“Because nursing homes don’t have x-ray departments.”
“Why not?”
“First
it probably wouldn’t pay unless they could assign some beds for outpatient
work. But that would constitute them as
a quasi-hospital, and the government, as I said before, doesn’t want the
competition. Secondly, they would have
to get a certificate of need for the x-ray department. Thirdly, Blue Cross won’t pay for nursing
home care unless your mother goes to a hospital first and spends at least three
days there. Fourth, Medicare and
Medicaid insist that a doctor validate each visit to the nursing home and swear
that the visit was necessary, and doctors don’t feel like getting into those
brambles. Now the bald facts are that
for mysterious reasons that no one can fathom, the average national cost for a
single hospital bed is $80,000 compared to $20,000 for the nursing home
bed. As a result, since the array of
administrative, bureaucratic and legal forces so restrict the alternatives of
doctors and patients alike, your mother had no choice but to be hospitalized in
a high cost hospital facility. And I
want you to keep in mind, Chiseldon, that taking up a
bed uselessly for her case, deprived a more seriously ill patient of a bed in a
full-fledged hospital. Does that help to
answer your question about hospital costs? The public is kept in the dark about all of
this, and like yourself, has really no idea what’s
going on.”
“It’s
ghastly,” exclaimed Chiseldon. “I am almost prompted to run for Congress
again.”
“Restrain
yourself, Chiseldon.
Don’t you think you have done enough for us already?”