Monday, June 8, 2009

Da Leg Bone Connected to Da Very Pricey Hip Bone

Based on recent experience, let me share with you three basic observations regarding total hip replacement therapy: EECHA! OOCHA! OUCHA!

I recently entered and emerged from the great maw of the U.S. health care system, or as Senator Richard Shelby (R: Alabama) so glowingly called it in a brief TV appearance last week, "The greatest health care system ever created in the history of the world."

We should all remember that Senator Shelby represents Alabama, the birthplace of the toothbrush (else it would be the "teethbrush") and where, it has been reported, family reunions first rose to popularity as efficient hookup events for singles. (Hey, I'm only kidding here. As we all know, it was really Mississippi
.) These facts, coupled with the Senator's apparent inability to slowly back away from an unattended microphone, prompted him to make a statement so at odds with virtually every objective evaluation of the U.S. health care system as to defy categorization. Senator Shelby is either (1) ignorant, (2) a liar or (3) deeply dependent on campaign contributions from Alabama's sophisticated health care community. Being a Republican has nothing to do with it, although, in the current political environment, it may help.

I actually like Dick Shelby, and on many issues, particularly defense and financial services reform, I think that he contributes knowledge-based conservative value to the debate. His take on American health care , however, drips with hyperbole and reeks of special-interest snake oil.

Given my recent experience with our health care system, I can defend the notion that if one is to replace a major body part, an American hospital such as the Emory Orthopaedic Hospital in Atlanta, is a confidence-enhancing choice. My doctor, Doogie Howser, M.D., is well-trained in the latest joint replacement techniques. The staff is devoted to ensuring that the patient's experience is as good as can be, given the realities of slicing, dislocating, sawing through bone, pounding prosthetic devices into femurs, stitching muscle back together, et al. The equipment appeared first rate, the drugs were very magical indeed and the food was better than the airline version.There was an in-room TV problem but that was a minor annoyance.

Lest you think that what follows is the musing of an unhappy or unappreciative patient, let me be very clear: I am grateful for the expertise, advanced technology and caring that contributed to what appears to be a successful medical intervention. I am a lucky guy.

I'm also a lucky guy in that the eventual price tag for the procedure, headed north of $40,000, will largely be borne by private health insurance via my wife's employer. This price tag does not compare favorably to the cost of having the same procedure done in say, Singapore or Mumbai, in a first class medical facility, staffed largely with surgeons who trained in U.S. hospitals (currently $5,000 to $15,000). Going offshore to obtain quality but far cheaper medical treatment is known as Medical Tourism. (Safety tip for those considering such a tourist adventure: I wouldn't plan time for sightseeing after the procedure because of the "eecha, oocha, oucha" factor.)

The savings and successful outcomes associated with going offshore for expensive surgeries are substantial enough that some U.S. insurers are now encouraging the practice and providing travel reimbursement as part of the coverage. Compared to what they would shell out for a U.S. procedure, they still save money.

My rejoinder to Senator Shelby is this, "No, but we do have the most expensive health care system ever created in the history of the world."

If it were the greatest then (1) any American (not just the fortunate ones like me) who needed a total hip replacement in order to live comfortably could get one without fear of financial ruin, (2) the health care outcomes in the U.S. would be far superior to those of the rest of the developed world (they are not) and (3) the costs would be competitive (reasonable) instead of eating up 17% of our Gross Domestic Product and climbing.

The changes required to actually achieve Senator Shelby's vision are daunting but claiming, as he does, that we are already there doesn't move us forward. The various U.S. health care players have substantial skin in the current fragmented game and they will defend the status quo vigorously, likely with Dick Shelby's help.

So, as a convenience to you alert readers, I am developing a guide to parsing the health care debate as it slowly builds toward aircraft engine decibels. To start, here is a list of words and phrases which indicate that you are listening to someone who either has a financial interest in keeping our health care expensive instead of making it great or hasn't actually done much homework on a complex issue.

1. access to health care insurance for everyone is socialism
2. nanny state
3. bureaucrats, not doctors, will decide
4. health care rationing
5. Canadian wait times
6. British wait times
7. innovation will disappear
8. the free market works better
9. government run health care will be like the post office, the IRS, (name of your least favorite federal bureaucracy)
10. Illegal immigration is the root of the problem
11. It's all the _________________fault (insert one choice only: doctors', hospitals', drug companies', insurance companies', government's, technology's, Democrat's, or Republican's)

More of these fear-inducing catch phrases will emerge as the defenders of the current system dig in. As they do, I will keep you updated.


Observoid of the Day: When it hurts like the dickens to bend at the hip, the toilet seat is very, very far away.


  1. Assuming, as you say, that we do not have the best health care in the world (so someone else must), which country would you like to model our system after?

  2. Germany, France, Japan and Switzerland all have systems with plenty of for-profit players, variations on the single-payer system (Germany, I believe, includes private insurers) and health outcome data superior to ours. It is not an assumption that our health care outcomes are mediocre compared to the rest of the developed world, it is hard imperical data collected by the WHO.

  3. The Swiss version seems attractive on the surface. Of course its tested on a country with 7 million people and less than half of our poverty level, but interesting none the less.

    I know the French get great health care, but they also pay 21% of their income every month towards it, the doctors average salary is only 60k/yr, and they are still heading towards fiscal trouble similar to ours.

    I don't know much about the German or Japanese models, will have to check up on it.