Stirring My Scots Blood

No one told me how pleasant an MRI could be.

I'd expected it to be a little challenging, to feel a little bit entombed in that tube, surrounded by unsettling roarings and thumpings and rhythmic pulses as magnetic energies surged around and through my body.  Claustrophobic panic isn't ever helpful in a procedure, so I'd considered calming exercises, tools from meditation and prayer that would gird up my loins for the process.

I needn't have worried.

It was profoundly restful, and on several occasions, I had to attend to not falling asleep, which might have messed with the imaging process.  But it was more than restful.  No-one had told me that it was possible to feel the magnetic fields as they surged through your body.  It's not common, but there are folks who swear up and down that the electromagnetic pulses set off a response in their nervous system, and given that I'm just the teeniest bit hypersensitive to things, I guess I'm in that camp.  

CHUKCHUKCHUKCHUKCHUK, the machine would go, and with each beat, I'd feel a peculiar tickling, like every nerve along a plane would activate.  It felt like I was being bisected, over and over again, each slice very faintly pleasurable, like a caress of energy, an aurora in my flesh.  With that came a deep, comfortable warming, and it was lovely.  

"This is really nice," I thought, "I'd pay money for this."

Which, Lord have mercy, I did.

The bill, when it came, was well over four thousand dollars.  That's for the procedure only.  Having a radiologist look at the results for ten minutes was another two hundred dollars.  

I have insurance, thank the Maker and my congregation, so my out of pocket costs were less.  Blue Cross Blue Shield negotiated the asking price of the procedure down to a wee bit over three thousand bucks, of which the "patients responsibility" was eight hundred bucks.  I paid seventy two dollars and seventy three cents of the two hundred dollars for the radiologist.   Total cost to me: over nine hundred dollars.  Total cost to the insurer:  over four thousand dollars.

So, combined, roughly five grand total, for a thirty minute non-invasive procedure and ten minutes to assess the results.

I have Scots blood, through my paternal grandmother Arline Tionesta MacDougall, and this outlay stirred that thrifty gene more than electromagnetic pulses ever could.  I know, we all know, all of us, that this is too much money, that we're being fleeced by a system that doesn't even begin to represent the actual costs of the services provided.

Let's do that familiar "how much does it cost elsewhere" exercise.  Were I to get an MRI from a private clinic in Glasgow, Scotland, how much would it run me?  Here, I'm talking about going outside of the public health system in the United Kingdom to a privately operated for-profit clinic, and paying out of pocket.  I found a nice little clinic in Glasgow.  Costs for the process there varied, based on location and procedure, but for the lower pelvic/prostate, I could expect to pay about four hundred dollars, exchange rate dependent, and that includes radiological review and a formal actionable medical report.

Four hundred dollars.   A round trip flight to Glasgow?  Nine hundred dollars.  Two nights in a nice hotel in Glasgow?  Four hundred dollars.  Meals?  Two hundred dollars.  A rental car to putter around Glasgow for two days?  Three hundred dollars.

Total cost, to fly across the Atlantic, stay in a nice hotel, eat well, have the procedure, do a little tourism, then fly back?  Two thousand two hundred dollars, nearly two thousand bucks less than the "best price" Blue Cross Blue Shield could negotiate here.  

Same procedure, same results, half the price.  How many times have you seen this same exercise done?  The "you fly halfway across the earth, get a procedure done, and fly back for cheaper" schtick is well worn, and yet still we tolerate the parasitic drain of our bloated mess of a health care system.

Defenders of that system claim that it's the "gold standard," the best in the world, and that we should be grateful for the privilege.

But we know that's a load of bollocks.  

Health Care Palaces and How They're Paid For

A few days ago, I was driving across the Northern Virginia suburbs with my wife.  We were on our way to Old Town Alexandria to attend a wedding, and as we puttered our way through the inevitable traffic, we passed the massive construction site that once was Landmark Mall.  Landmark wasn't ever the most successful of malls, even back in the 1990s, and like so many of those monuments to late 20th century consumerism, it couldn't withstand the onslaught of Amazon.  I bought a fridge at the Sears there once, and would pop in to the Avis there to rent SUVs when it snowed.   That was about it.  After the Sears closed in 2017, it just kinda sat there empty for a while.

It was a prime property, though, and is now being redeveloped into a massive hospital complex by INOVA, the nonprofit entity that dominates the Northern Virginia hospital and health services market.

Like most organizations in the health care sector, INOVA's pretty flush these days.  They've been expanding a whole bunch lately, at least in areas where there's still population density and wealth.  Back in 2020, they dropped a couple hundred million to purchase the former national headquarters of a little outfit called ExxonMobil, a massive office complex nestled in dozens of acres of wooded land right by the Beltway.  They made it even fancier, a great edifice filled with specialists and services.

They're growing, and I suppose in this era when the rural parts of our country have become a health care desert, I should be grateful for that.

But where does all the money for these sprawling new facilities come from?  Despite some major donors and philanthropic inputs, most of that money comes from us.

I'd noted...in a sermon earlier this year about poverty and what it means to be Christlike towards the poor...that the average ER visit now costs a tick over three grand.  

This isn't quite right, as I discovered after a recent five hour visit to an INOVA ER.  The billing from the ER that treated me included a three thousand dollar charge for receiving ER services, true.  But that's only for entering the facility.  There were other charges.

The bill for the ER doctor alone was $1,400.  I mean, he was helpful and all, no question, but that represents about a half hour of his time.  $2,800 an hour?  

The total bill...charges for imaging, for pharmaceuticals, for doctor services, for nursing services, and for miscellaneous fees and charges...ended up totaling over $11,000.  For five hours, no surgery, no invasive procedures, nothing but confirming a diagnosis and prescribing a different antibiotic than the one I was already on.  Eleven thousand.  Again, the care provided was fine, but the cost?

It's what you pay if the alternative is pain and death.

I'm blessed with insurance, so I only footed 10% of the eleven grand, but that total bill?  It ain't something most Americans have just lying around.  In fact, it exceeds the total savings of the median American by thousands of dollars.  That's "median," not "average," because wealth is so concentrated in the hands of the rich now that the "average" is essentially meaningless.  

If you're uninsured, that's "now you've got a problem with debt" money.  It's "put you on your back foot financially" kind of money.  It's why we're saddled with paying insane amounts for our insurance, and why insurance costs have risen to levels that are nothing short of punitive.

So as I drove by those rising health care towers in the ruins of an old mall, I found myself thinking about how they're made possible.