During the past two years I have had four surgeries. Two of them were fairly major. I am pleased to report that I am now completely recovered, and I am doing very well. However, my experience was enlightening. I saw major use of often cutting-edge electronics technology at many junctures, but one place was woefully lacking in techno-aids: the payment process.
Many Americans believe that medical practices here are the best in the world, because we have so many of the latest and the greatest. I am not completely sure that this is always true. However, there is one thing that I am certain of: America certainly has the highest medical expenses in the world! My abdominal surgeries in 2007 required six days of hospitalization, and the total cost was just under US $100,000. My knee replacement surgery in March of 2008 required five days hospitalization, and had a total cost of about US $60,000. These are large amounts of money, even with the reduced value of the dollar in today's market.
Fortunately, since I am over 65 years old, the U.S. government medical insurance (Medicare) covered about 80 percent of all my medical expenses. While this is significant, the remaining 20 percent expense — a total of US $32,000 — can readily become a personal financial problem. When I retired from Motorola in 2004, I had the foresight to purchase private medical insurance that covers most of the expenses not covered by Medicare. This medical expense "gap" insurance costs me US $100 per month, and is worth every penny. Over the two years of hospitalizations, I personally paid a total of less than US $4,000 in medical expenses. This is very manageable for me.
Why So Costly?
However, the larger question is: "Why is U.S. medical care so expensive?" There are no simple or single answers to this question. Some people believe that medical lawsuits are a big part of the problem. Doctors and hospitals must carry extremely costly medical lawsuit insurance to protect themselves from litigation. Some patients believe that doctors prescribe too many expensive medical tests — mainly to protect themselves from possibly missing a diagnosis. Many believe that U.S. medicine is too "aggressive" (i.e., too many expensive procedures with minimal benefit are done). Yet others say doctors and hospitals are simply paid too much money for the medical services they provide, and government control is required.
My personal experience revealed that lack of centralized medical identification and its supporting computerized infrastructure is one of the biggest problems in the U.S. I believe that with effective electronic identification and a consistent universal computerized healthcare system, U.S. medical costs would be greatly reduced. This would also greatly reduce both medical and billing errors. I understand that there are many privacy issues involved here, and there seems to be a lot of political lobbying from various special interest groups. I think that many developed countries (Japan, Canada, UK, Taiwan, Spain, Germany and others) are far ahead of the U.S. in total healthcare computerization.
Medical ID Cards
During my time at Motorola, I worked on medical smartcard devices for the German and Spanish governments — devices that allowed them to quickly and accurately control (and verify) the billing and provide the vending medical resource with immediate patient information. This can be critically important in an emergency, if the patient is unconscious — which frequently occurs. It doesn't work that way in the U.S. Prior to (and frequently after) my surgeries during 2007 and 2008 I had to repetitiously complete multi-page health history forms at medical provider after medical provider. I have honestly lost count of the number of times I have had to do this. Insurance verification was also a repetitious process, requiring copies of my Texas Driver's License and Insurance card at every stop. Then, information was facsimiled to my insurance carrier for approval, and usually a telephone conversation ensued. This cumbersome process is very time-consuming, and certainly adds a lot of expense, and perhaps transcriptional error, to the U.S. healthcare process.
Immediately following my major abdominal surgery in 2007, my surgeon prescribed a transfusion of two units ("pints") of blood. I have a great deal of confidence in my doctors and hospital, but I remembered that my blood type is "O negative", which is fairly rare (about ten percent of the population). While I am a "universal donor" and most other people can safely receive my blood, I must only receive "O negative". Getting the wrong blood type transfused could prove fatal to me. When the nurse arrived with the blood, she visually checked my hospital wristband, my medical chart folder, and the labeling on the blood itself to insure that it was correct. (Yes, I also inquired.) At the time, I was thinking to myself that this process was perfect for a computerized identification tagging system (my wristband, my medical records, the blood). Some tags would be active RFID and others passive — as required. A central computer would implement the surgeon's orders, directing the activities of the nurse, verifying the blood type, looking for medical conflicts, and even controlling the billing input to the ultimate payer.
Just prior to my full knee replacement surgery of March, 2008, I noted an article in the news where a New York City hospital had just settled (financially) with a patient who had the wrong knee replaced. I assume this is a fairly rare occurrence, but it does seem to happen occasionally. My surgeon specializes in knees and shoulders. I think that these are the only surgeries he performs. He does most of his procedures on a Monday. As I was being prepared for surgery on Monday, March 3, 2008, I asked the surgical nurse how the surgical knee was identified. I was quickly shown. Before I was administered anesthetics, both the surgeon and attending physician appeared to "sign" my surgical knee with an ink pen, while I witnessed it. I am sure that this is effective, but there must be a better way of tagging my knee, insuring that I get the correct appliance on the correct knee.
Should the U.S. have mandatory, government-paid, universal healthcare system as several countries now have? Should we have a hybrid system of company-paid healthcare for those employed, private healthcare insurance for those who can afford it, and government insurance for those who can't? Should we have a voluntary system, with government coverage for just the elderly, or those in great financial need? The answers to those questions are far above my pay grade. However, no matter how healthcare is paid for, I do strongly believe that we need a robust system with a complete ubiquitous identification system at one end (the patients, the drugs, the doctor, the procedures, etc.), and a fail-safe medical information server at the other. The system needs to be accessible, secure, and universal — at least in the U.S. Ultimately, it could be international. I fully understand that producing the "middleware" between the "tagged items" and the proposed healthcare servers would be a massive undertaking. However, we have all the tools to do this today. These tools are already in use in the practice of medicine in other countries. Why not here? The results would be dramatic.