Sunday, May 15, 2011

For Health and Money

It's been something on the order of ten years since I watched television regularly. I still don't have cable, but with a pair of rabbit ears and a clear view to the south, I can at least pick up KVOS-TV out of Bellingham. I mainly use it to watch House. Good show, sure, but I can't help but think I would have liked it even more a few years ago, back when I didn't know as much. Now, watching it from my Canadian perspective, I can't help but try to fill in the blanks with what I know about the nature of American health care; about what happens after.

Really, look at an average episode of House - the patient of the week comes in with some incredibly exotic or unusual disease that frequently takes three-quarters of the episode just to pin down, and that's after investigations and multiple treatments for what House's team thought the most likely candidate was. I know enough to understand that things MRI and CT time, angiograms, biopsies, and the like are expensive: according to the Florida Institute for Advanced Diagnostic Imaging, a standard angiogram costs $7,000 USD. Beyond that there's the cost of the drugs, the doctor's time, and whatever the hospital charges you for just being in the bed.

Sure, there are plenty of House episodes with happy endings, where the patient's brought back from the brink of death when the true cause of their sickness is finally determined. So far, though, I haven't seen anything that looks at that after, of this patient now on the hook for tens if not hundreds of thousands of dollars worth of medical procedures. There's a reason that medical bills are the leading cause of personal bankruptcy in the United States. Beyond that, American hospitals seem to position themselves practically as businesses in their own right; in the second episode that KVOS aired last night, the hospital's new Chairman of the Board criticized House's Department of Diagnostic Medicine as a "financial black hole."

Here is a photograph of St. Paul's Hospital in Vancouver for illustration.

Perhaps it's partially because I'm Canadian, but I find that kind of viewpoint abhorrent - but it's one that's become all too common in our society. It's easy to find outside the medical world as well, with people like hizzoner Rob Ford in Toronto jawing about how he wants the city to run like a business. The way I see it, there are things that should be run like businesses, sure - profit-making businesses! Not organizations that have what I would call a higher responsibility to the people.

The point of a government isn't to make money, it's to ensure the security and well-being of its citizens. The first priority of a hospital shouldn't be to turn a profit, but to deliver the best care that it can. Introducing the profit motive into situations like this is, in my mind, a catalyst for abuse; a person should not have to trade their future for their life, but in many cases, that ends up happening when they get slammed with medical bills that they cannot afford to pay. The inflated cost of medical insurance in the United States, to feed the maws of the insurance companies, feeds into this too - while I, as a British Columbia resident, pay something on the order of $60 per month for the government-administered Medical Services Plan premiums, in the United States the average health insurance premium for a single person in 2009 was $4,824, or $402 per month.

Why so high? Because the British Columbia government isn't setting out to make money through medical insurance; it has taxes and the BCL for that. But it also means that someone in British Columbia who came down with the sort of disease that House would salivate over wouldn't have to worry about mortgaging their kidneys once it was cured and done.

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