In Thailand, one well known scam is that men are lured into a bar by a local girl and invited to have a drink. You order the drink, and when you leave you get charged something like $300 for it. $300 for a beer. If you refuse, the bar proprietors start to get threatening. Most people will just cough up the money because otherwise you’re in for a world of hurt.
A recent Time cover story entitled “Bitter Pill: Why Medical Bills are Killing Us” was one of the most scary articles I’ve read in a long time.
It details how the medical industry routinely engages in what is essentially extortion – charging patients outrageous prices for services, medicines, and medical supplies that bear no resemblance to reality. Patients who are cured of life threatening illnesses are summarily crippled financially by hundred-page bills that many uninsured and underinsured patients have no hope of paying off in full.
Hospitals bill patients off a “chargemaster” sheet which feature obscene markups on everything from basic medical supplies and advanced medical services. Despite the fact that a visit can run up a bill that ranges from several hundred dollars to several hundreds of thousands of dollars, no one ever discloses the costs to you upfront. Health care professionals don’t tell you that as soon as you sit down in the doctor’s office, that’s $300 for a 15 minute consult. You just get a bill in the mail several weeks after you leave, and if you’re not insured, well… just bend over and take it, because that’s what it feels like. You think lawyers are terrible money-grubbers? The medical profession in America is several orders of magnitude worse.
In preparation for a trip to India, I went to a travel clinic at the Palo Alto Medical Foundation to get vaccinated. Travel medicine is generally not covered by insurance, so I was going to have to pay full freight. At no point was I told how much the visit and medicines were going to cost me.
When I asked to see the schedule of fees, they had to rifle through a stack of folders (it wasn’t readily available) and the guy behind the counter produced a sheet which had a list of products, prices, and a big label which said: “DO NOT COPY – PRICES SUBJECT TO CHANGE”
So you couldn’t even take a copy of the fee schedule. It turns out that the four vaccines I needed would set me back about $500, plus another undisclosed sum for the consultation itself.
To add insult to injury, the doctor that saw me was the surliest human being that I’ve dealt with all year. I’m not going to mince words – she was a complete asshole. I don’t have my immunization records handy because my dad is a physician and he’s traditionally taken care of my health. He’s in Australia so I don’t have any medical records available in America. I instead got him to email me with what immunizations I’ve had and when I had them.
When the doctor received me, she asked whether I had brought my immunization history with me. I explained that I did not have one available because they’re all in Australia, but I had an email which described what I’ve had. She read about one paragraph from the email and then shot back acerbically, “This isn’t an immunization history.”
I repeated what I had just said, but it was like she wasn’t listening. “What am I supposed to do now? I don’t know what to do.” She threw up her hands and scoffed at me. Loudly. What the fuck? I almost lost my cool right there. You’re the doctor, lady, you should know.
I told her what I thought she should do. “Why don’t you tell me what vaccines I need for India and I will tell you if I’ve had them before? Anyway, it’s all on the sheet.”
“But I don’t know if they are still active.”
“I don’t know if they are still active.”
“What do you mean.”
“I don’t know if the vaccines you took are still good.”
“Well then, why don’t you tell me how long the vaccines I need last for, and I’ll tell you when I had them, and then you can tell me if I need another one.”
She scoffed again like I was stupid and useless. It certainly made me feel that way. I’m no doctor, but I know I’m neither stupid nor useless. I stood my ground.
I told her that no one had told me to bring my immunization history. I certainly wasn’t told when I made the appointment.
“Who did you speak to?” she shot back at me.
“Who did you speak to on the phone?”
“When I made my appointment?”
“I don’t know.”
“Well then how am I supposed to tell them?”
Why the hell would I get the name of the person who took my appointment? When you call in to make a reservation at a restaurant do you ask for the name of the person who answers the phone?
After a very painful experience, we worked it out and I got my vaccines. I am never going back there again, except that I need to get another follow up treatment in six months.
If I’m going to drop over $500 in the course of 20 minutes, I expect to be treated, at the least, with professionalism, courtesy and dignity. I expect to know how much I am going to be charged with at the time. I don’t expect to be ambushed with a bill several weeks later. (To make matters worse, I checked the Stanford travel clinic, which does publish their vaccine fee schedule online and it is literally HALF the price. These are the same drugs and there is a price difference of 2x between clinics that are literally one kilometer away from each other!)
The power/knowledge differential in health care is huge between service provider and customer. And the customer is often at his or her most vulnerable when they go to seek health care. Given this you would think that bedside manner and customer service (or patient service, rather) would be paramount. I have no doubt that most doctors are, but it amazes me that there are any at all like this woman.
When I deal with immigration matters in my workplace, the employee can often be in a very precarious and vulnerable situation. They are navigating a confusing area of law and their right to stay in the country may be at stake (along with their and their family’s livelihoods). I ensure that when I deal with these matters, I approach them super sensitively because they can make a massive difference to the lives of individuals and their families.
The way the medical industry works in this country is ridiculous. I haven’t looked at it from a legal perspective, but I’m amazed that there aren’t more problems with consumer protection and the FTC, problems with antitrust law, and problems with basic contract law. How can you have consent to paying a bill when you have no knowledge of what you’re going to pay beforehand? In Australia, lawyers are by law required to give fee estimates before starting to work for clients.
The cost of medical treatment here are so egregious that if I were to get anything more than a minor procedure done, and I wasn’t sufficiently insured, it would be far cheaper for me to jump on a plane right back to Sydney and get the treatment done there.
The American medical system is so fucked up.