Medical Costs


“You are brooding Simon.”  I made a statement of fact.  His heavy-lidded eyes behind the lenses of his spectacles resembled those of a sad beagle.


S.Q. Lapius snorted.  “Not brooding, Harry, disconsolate.”


“What piques you?”


“It says here that the deductible for Medicare is jumping to $84 a year from $72.


“You are not there yet.  What’s to be sad about?”


“I’ll be there shortly, and by that time the initial payments will be nigh over a hundred dollars.  It is not only for myself that I shudder, Harry, but for the millions of superannuated Americans who will have to pick up the tab.  After all, the older you get the greater the chance that you will become ill, and dependent on medical care.”


“But you aren’t even sick.  You haven’t a symptom in the world.”


“The fates are uncertain, Harry.  I might even have a tumor starting inside of me at this very moment.  Anyway, it looks as though the government assumed the medical obligations for the elderly without sufficient research, somewhat glibly.  After all, there’s no limit to the care a sick person might require.  What happens to someone paralyzed, in a nursing home, slowly deteriorating?  First they have to go into a hospital for a brief period of time before they even qualify for payments to a skilled nursing home or an extended care unit.  This alone distorts the hospital census and puts people in the hospital who really should go directly to a nursing home.  Then after there has been collusion on the part of all concerned to lie a little bit about the need for hospitalization, the patient can be moved to a nursing home where his benefits last for only about three months or so.  What happens after that?”


“They go home to their families.”


“But many families can’t provide the special care the patient needs.  I see them all the time.  They are brought to my offices in wheel chairs, or sometimes by ambulance.  Or, believe it or not, Harry, I make house calls.  Ah, sickness doth make paupers of us all.”


“You are waxing philosophic tonight.”


“You must admit that we have a problem, Harry.  After all, as a person ages he grows increasingly dependent on those around him, more and more of a burden, unless some lucky illness claims him quickly. The government is already feeling the pinch as evidenced by the jacked up initial deductible.  But in addition, the government is misleading about their promise to pay 80 per cent of ensuing medical costs.”


“How can they get out of that?”


“It’s a simple device, Harry.  My patients, for instance, complain that the government refunds them only 64 per cent of the fee they pay me for an office visit.  I was puzzled and inquired into it.  I called the Medicare representative, and told them that one of their providers wanted to speak to the chief administrator.”


“I’m proud of you Simon.  You, a mere provider, got through to the chief?”


“A false presumption, Harry.  I only asked to speak to the chief.  I got instead some untitled functionary, who, however low his estate, seemed reasonably knowledgeable.  I asked him why my patients only received 64 per cent of the bill they paid me instead of the 80 per cent of the bill that the government promised to refund.”


“And what did he say?” I prompted.    


“He said that they did indeed receive 80 per cent.  I told him the $6.40 on a ten-dollar bill was clearly not eighty per cent. ‘Ah,’ he said to me, ‘that’s what the trouble is.  Your bill is too high.  It should only be $8.  You see $6.40 is truly eighty per cent of $8.’”


“And what did you say to that?”


“Actually, Harry, I was restrained, and didn’t say what I wanted to say.  But I asked on what basis he had gratuitously reduced my bill to $8.  He told me the $8 was the average doctor’s fee for the neighborhood or geographical area or whatever it is that we practice in.  He said that he had data from a survey that showed $8 to be the prevailing fee.”


“Well, maybe you should reduce your fee then.”


“Sure, and my rent, phone bill, salaries and cost of supplies as well.  That would go over with a bang.  But seriously, Harry, can you imagine that situation?  They decide autocratically that all medical office visits should cost only $8.  They don’t ask how long the visit is, or how many patients the doctor sees in a day, be it 20 or 70, or what the condition of the patient is. “I guess if the government budget gets too large the government may decide I should only charge $5 and refund the patients 80 per cent of that, or namely $4.  Certainly this is a classic case of administrative chicanery, default on a solemn promise that a government has made to its own citizens.”


“What do you suggest?”


“Well, at least tell the public the facts.  Admit honestly that the Medicare bill is more than the government wants to pay, and lower the percentage return.  Don’t create a façade, and pretend that medical fees are what they are not.  The other thing they ought to do is to leave to the judgment of the doctor what constitutes catastrophic and compensable illness.  If a doctor testifies that a patient should spend the rest of his days in a nursing home, that should be good enough.  Or perhaps ask for another opinion from a different doctor.  Leave some room in the system for humane consideration.  Life and death can’t be run by administrative codes and statutes.  Each individual must be treated as a separate case on its merits.”


“I must say, Simon, you are very cranky about this matter.”


S.Q. Lapius was not soothable.  “Our government is committing a breach of faith.  I don’t like to see our government behave in an undignified manner.  It casts a bad reflection on Americans who are, after all, a dignified people.”


“You are taking it all too seriously, Simon.”


“Wait till you grow older, Harry.”