Bureaucrats Hike Hospital Bills

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 Washington didn’t just pass bills and give out money.  You erected a fantastic bureaucracy to monitor how the money was to be spent.  As a matter of fact, I’ll bet that if you counted up the cost of administrating the bills you will find that it added about 30 per cent to your mother’s hospital bill.  Actually, your mother didn’t need a regular hospital for the work that had to be done.  But as a consequence of the government building hospitals, they have imposed a series of regulations to protect their franchise.”

“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?”