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Monday, April 16, 2007

A tale of two ureter stones.

An election year must be coming because universal health care is back in the news. . .and the bloggers are having a field day. I believe I have written on single payor universal health care before, so my views are probably known, but I am going to write here, right now, about 2 real patients that I saw this week in an affluent part of Long Island, both with kidney stones. One has insurance, one does not. Both are tax paying, US citizens. These 2 cases epitomize the good and the bad in our system.

Patient 1 (with insurance): She came to me with severe left flank pain x 5 days, tenderness in the flank, and blood in the urine. She had not been able to keep anything down by mouth. I sent her for a CT scan, and since this is the good'ole USA, she was able to get one that morning. The CT showed a stone in the middle of the ureter that was approximately 8mm in size. Again, because this is the good'ole USA, we were able to send her that day for a lithotripsy (non-invasive stone procedure), and she was stone free and pain free 6 hours later. Her out of pocket costs: $20.00. She had NY States insurance plan that government officials and police get. That, I believe, represents the best health care in the world, no doubt.

Patient 2 (no insurance): He came to me after 10 days of severe flank pain. He was referred from an urgent care center, which he went to twice ($300 for the 2 visits). He had a CT scan, done the day it was ordered (good'ole USA) that showed a 6mm stone in the upper ureter. The CT scan set him back $800. Then he came to me, only without the ability to pay. Now here are his treatment options. He can, A: wait it out. Cost $0.00, except for lost wages and possibly lost job. B: Go to the ER and get pain meds, and maybe, if he is lucky, a urologist will see him (probably not). Cost, $3500 for ER visit. Up to $15000 if he needs urologic intervention such as a stent or ureteroscopy or lithotripsy in the hospital. Option C: He can have a lithotripsy electively as an outpatient. Cost $5500 (we negotiated this one for him.)

Now here is the kicker, he is out of money, having spent it on the CT scan and the urgent care center. He is SOL. So here are his real options. He can lose his job, because he can't work through the pain or the narcotics. He can go to the ER, get admitted, and stented, and then have the hospital place a lien on his personal assets (yes, this happens every day in the good'ole USA) as they try to get paid. Or he can place the $5500 on a credit card and go hopelessly into credit card debt (happens every day in the good'ole USA). Of course, he can wait it out and if he is lucky, he won't do irreparable harm to his kidney.

So these 2 cases are illustrative in that they really represent the best and the worst that US health care has to offer. Had he been English, Canadian, Cuban, German, French, Dutch, Greek, Israeli, or Japanese he would have been treated without risk of personal financial ruin. Our Canadian bashing friends are always quick to note that in Canada he would need to wait months for treatment. Not true. Just ask any of my Canadian urologist friends, and I have a few. Anyway, as I see the increased frequency of anti-health reform blogging, I thought I would just add my own personal experience with our system. Not myth. Not exaggerated. Just how it is in my little corner of the world.