Runaway health costs: What consumers are up against

Here’s a powerful, patient’s-eye view of our healthcare system from the husband of a colleague at Consumers Union. His experience illuminates the painful consequences of a system that tolerates and even rewards piecemeal, uncoordinated, and often unnecessary treatment. See here, here, and here for examples. (I’ve changed the name of his relative out of consideration for surviving family members):

My cousin and I were responsible for managing the affairs of our uncle and aunt because they didn’t have children of their own. I live closer, so a lot of the day-to-day decision-making fell to me. Andrew was about 80 when the couple moved to an assisted living facility nearby. My aunt’s health and memory weren’t what they used to be and she couldn’t keep house any more. After Andrew got there, his condition declined pretty quickly; we were kind of startled. His energy seemed to drop and he needed a walker to get around.

Around Christmas of 2007 he tripped and fell and was taken to a nearby hospital, where he was seen by I don’t know how many doctors. I didn’t even meet most of them. I know he saw them from the bills I got. So many groups and individual doctors seemed to have a little piece of him. I was paying $20 here, $150 there, whatever Medicare didn’t pay. The hospital bill alone was seven pages long.

But I did meet the cardiologist who assured me, almost guaranteed me, that if my uncle got a pacemaker there would be a dramatic change in his mobility and energy. I believe he was the one who put in the pacemaker. My uncle was in the hospital for a couple of weeks, and then at a rehab facility, but afterwards there was literally no change. He could walk just inches at a time with the walker, needed assistance to get in and out of bed, to get to meals.

He was very diminished, depressed, and angry. This was a bright man who spoke six languages, ran a successful independent business out of his home, was a world traveler. I think he hated being so dependent on others to do even the most basic things.

In January of this year, he developed a fever and the living facility asked if it was okay to send him to the hospital for observation because they couldn’t get the fever down. He was there for weeks and weeks. They did all sorts of tests on him. They did an invasive test called a trans-esophageal echocardiogram, where they put something down your throat right on top of your heart. A doctor called me and said some blood work indicated a possible recurrence of colon cancer, which he had in his 70s but had been in remission. He recommended a colonoscopy. I said, "Gee, he’s 83 years old. Does did he really need one more invasive procedure?" The doctor said, "I really think it should be done. We can talk about your uncle’s options afterwards." So he did it. Not only did they not find any colon cancer, but the repeat blood tests came out negative. He had stuff down his throat, stuff up his rear end, and nothing was panning out. When he was discharged, he still had the fever. They never did find an infection.

They sent him back to the living facility’s rehab hospital. That’s when he decided he was not going to accept any more therapy. He refused to eat but would occasionally accept a sip of liquid. He would fight the nurses, telling them he did not want their help. He died on March 25.

At no point did he ever have a doctor or a case manager who was coordinating his care. I’ve since learned that there were hospitalists on staff at the hospital, doctors who are supposed do this. I’d never heard of such a specialty and no one at the hospital ever mentioned anything about it. Most of the time I would just deal with the nurse on duty when I was visiting him. It seemed very piecemeal.

We loved our uncle, and we didn’t want to see him pass away more quickly then he needed to, but in hindsight he basically committed suicide after his last hospitalization. He didn’t want to live any more.

I beat myself up that I was not as on top of things as I could have been, but I don’t know what the entry point would have been. When a doctor was on the other end of the phone saying, "These are the tests. This is what I recommend," I’d say, "Go with your best judgment." I know they all had the best of intentions, but the result was not what I would have hoped.

He was good to me all my life, and I was trying to do the best I could for him in his hour of need.

I looked up Uncle Andrew's hospital on our compare hospitals Web site. It delivers more aggressive care than 87 percent of hospitals nationwide, but is actually on the conservative side in comparison to other hospitals in its geographic region.

There’s no way of knowing whether the doctors who insisted on the colonoscopy and the pacemaker were influenced, even unconsciously, by the fact that they would earn extra fees in the process. There’s no way of knowing whether those long hospital stays shortened or extended Uncle Andrew’s life.

But what is clear is that his extravagant care did nothing for his health or peace of mind, and has left a loving nephew with doubts and self-recriminations over his inability to control an out-of-control system. However a reformed health system might look, it cannot place on patients and their families the burden of identifying and refusing overtreatment.

—Nancy Metcalf, senior project editor

To find out what we're doing to help fix the system, see our Guide to Health-Care Reform. And we'd like to hear from you: Have you or a family member received unnecessary treatment in the hospital and suffered the consequences? Tell us your story.

Comments

[Tara Daves]

Although I don't like his tone, Barrie Bennett is partly right at least in principle. Many illegal workers do pay taxes because the employers take withholding, but many are exploited by employers for cheap labor who do not report them at all. Public schools enroll students whether they are here legally or not, so it has the same challenge as health care in this regard. This is why enforcing the law against employers is the absolute bottom-line foundation of immigration "reform," and could potentially save the taxpayers a good deal of money.

Having said that, from my limited research I believe that the biggest drain on health care cost is administrative bureaucracy. But due to the nature of government requirements, the legal system (with regard to lawsuits), insurance hurdles, and just good ol' "CYA," I don't see this situation changing anytime soon. (Obviously, more bureaucracy is not the answer!)

[Deb Barnhardt]

The comment added by Barrie Bennet is both bigoted and inaccurate and should be removed from the site. I will be contacting Consumer Reports to ask for their assistance. In the meantime - please ignore the remarks of trolls.

[Barrie Bennett]

One of the biggest costs in Healthcare is not even mentioned in Obama's plan.....Illegal Aliens get free healthcare!! The costs are two fold: absuse of Emergency Rooms for routine care and inpatient care for major problems.....both go totally unpaid.

Fix the illegal peoblem and you'll drastically cut health care costs!!