Other Voices: A tale of 2 wounded knees
Once upon a time, two middle-aged, active, self-employed women each injured a knee. This is where the similarity stops. One lived in France and the other one in the U.S. The title is purposely deceiving: The story reads as fiction, but unfortunately, it’s a true account. Are you ready for a reality check?
A little over a year ago, my wife, Sarah, broke the anterior cruciate ligament of her right knee. Last February, Claudine, the sister of a close friend in France, did the same. Sarah had her ACL replacement surgery on Aug. 7, 2007, in Truckee. Claudine had hers the month before on July 1 in Grenoble, France. A comparison of the cost of the same procedures to treat the same injury in the two countries makes you wonder where the difference might come from:
A) Sarah; B) Claudine.
Pre Surgery visits and tests: A) $823; B) 101Û.
Surgery, surgeon(s), anesthesiologist, operating room and supplies: A) $2,762, $580, $16,320; B) 587Û, 198Û, 304Û.
Hospital or clinic stay (no days for Sarah, four days for Claudine): A) $0; B) 1,877Û.
Medication: A) $950; B) 387Û.
Physical Therapy: A) 24 x $131; B) 40 x 40Û.
Total: A) $24,579, B) 5,054Û.
The value of the Euro (Û) is currently around $1.45.
The comparison is not between the U.S. and a third-world country but between the U.S. and France, where doctors enjoy an upper-middle class status, pretty much as they do here. How can the difference in prices be so staggering between two industrialized countries when the costs of most other products or services are somewhat equivalent (cars, electronics, food, lodging, airline tickets, etc.)? The most obscene difference is the cost of the operating room: 37 times more at Truckee Forest Hospital than at the Clinique des Cèdres, Grenoble, which is a 100 percent private, for-profit facility.
If you were to take a dozen of the brightest minds in the country and lock them in a room until they design the most inefficient health-care system possible, they could not come up with something worse that what we have now. Look at this:
Some 1,500 private health insurance companies, Medicare A, Medicare B, Medicare D, Medicare approved health plans (117 for Northern California only), 50 state workman’s compensation funds (plus a myriad of private insurance in this market, as well), 50 state children insurance funds, the Veteran’s Administration, 50 state Medicaid funds, etc., insure, and often under-insure, 84 percent of the population.
This administrative nightmare does not exist in France, where one single-payer, public but nongovernmental insurance fund fully covers 99.9 percent of the population.
Private health insurance constitute a huge disservice to the cause of health care in wasting 25 to 40 percent of your premium in overhead, commissions, advertising, lobbying and profit (and charging huge malpractice premiums, unrelated to the actual cost of malpractice). It also tremendously increases the overhead of health-care practitioners just to obtain pre-authorizations, handle claims, collect money, etc. In the United States, doctors, hospitals, labs and other medical services could charge much less if they were free of the bureaucracy and were fully reimbursed within five days by a single-payer insurance. All they would have to do is swipe their patients’ medical ID cards in their terminals as was done 1 billion times in France in 2006 (Caisse Maladie de la Sécurité Sociale).
To come back to our original story, let’s look at the out-of-pocket costs for Sarah and Claudine. It would take too much space to give all the details but, in a nutshell, Claudine had no deductible and had to pay 182Û because half of the supplemental cost of her private room wasn’t covered by her insurance. As for Sarah, between her deductible, co-pay and noncovered expenses, the amount was more than $7,000.
If we had to pay $25 for a gallon of gas, $1.5 million for an entry-level house or $15 for a quart of milk, I wonder if the American public would start to revolt. How do we get prices that are inflated five to 10 times for medical procedures, not to mention the cost of drugs? Well, no wonder, we elect and re-elect the same politicians who finance their campaigns with health insurance and pharmaceutical industry money.
I am happy to report that both women are doing very well as of this writing.
Alain Lazard lives in Penn Valley.
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