CANCER STORY: Success & Hard Truth

Are Medical Bills Killing Patients?

Again please?

Medical bills are killing patients?

Yes, medical bills are killing you!

Do I hear it right?

Medical bills are killing you?

But I am sick! Should it not be the disease that is killing me?

You bet!

Times Magazine of 20 February 2013, carried a lengthy article by Steven Brill: Bitter Pill – Why Medical Bills Are Killing Us. I printed out this article – there are 46 pages in all!

You can read the original article here: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2MjdpIcGO

These are some mind-boggling things that are happening in the hospitals in America today (passages extracted from the said article).

1. Initial Lymphoma Treatment at MDA: $83,900 (approx: RM 251,700)

Sean Recchi, 42-year-old, was diagnosed with non-Hodgkin’s lymphoma. He went to MD Anderson (MDA) Cancer Center in Houston, Texas.

Just to be examined for six days so a treatment plan could be devised: $48,900 to be paid in advance.
Sean’s treatment plan and initial doses of chemotherapy was $83,900.
Every time a nurse drew blood, the charge was $36.00, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done amounted to more than $15,000.
An injection of 660 mg of a cancer wonder drug called Rituxan was $13,702.
“ALCOHOL PREP PAD” $7 each. This is a little square cotton used to apply alcohol to an injection area. A box of 200 can be bought online for $1.91.
Room charge: $1,791-a-day.

Sean Recchi’s dose of Rituxan cost the Biogen Idec–Genentech partnership as little as $300 to make, test, package and ship. MD Anderson paid $3,000 to $3,500 for this medicaton, whereupon the hospital sold it to Recchi for $13,702.

As 2013 began, Recchi was being treated back in Ohio because he could not pay MD Anderson for more than his initial treatment. As for the $13,702-a-dose Rituxan, it turns out that Biogen Idec’s partner Genentech has a charity-access program that Recchi’s Ohio doctor told him about that enabled him to get those treatments for free.

2. False Alarm due to Indigestion: $21,000 (approx: RM 63,000)

Janice is a 64-year-old former sales clerk. She felt chest pains. She was brought by an ambulance to the emergency room at Stamford Hospital about four miles awa. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news. But the bad news were her medical bills …

The ambulance ride (four miles) came to $995.
$3,000 for the doctor and
$17,000 for the hospital.
In total she had to pay $21,000 for a false alarm.
An “NM MYO REST/SPEC EJCT MOT MUL” was billed at $7,997.54. That’s a stress test using a radioactive dye that is tracked by an X-ray or CT scan.
An additional $872.44 just for the dye used in the test.
The cardiologist in the emergency room gave Janice a separate bill for $600 to read the test results on top of the $342 he charged for examining her.

The regular stress test patients are more familiar with, in which arteries are monitored electronically with an electrocardiograph, would have cost far less — $1,200.

Stamford probably paid about $250,000 for the CT equipment in its operating room. It costs little to operate, so the more it can be used and billed, the quicker the hospital recovers its costs and begins profiting from its purchase. According to a McKinsey study of the medical marketplace, a typical piece of equipment will pay for itself in one year if it carries out just 10 to 15 procedures a day. That’s a terrific return on capital equipment that has an expected life span of seven to 10 years. And it means that after a year, every scan ordered by a doctor in the Stamford Hospital emergency room would mean pure profit, less maintenance costs, for the hospital. Plus an extra fee for the doctor.

The costs associated with high-tech tests are likely to accelerate. McKinsey found that the more CT and MRI scanners are out there, the more doctors use them. In 1997 there were fewer than 3,000 machines available, and they completed an average of 3,800 scans per year. By 2006 there were more than 10,000 in use, and they completed an average of 6,100 per year. According to a study in the Annals of Emergency Medicine, the use of CT scans in America’s emergency rooms has more than quadrupled in recent decades.

The dynamics of the medical marketplace seem to be such that the advance of technology has made medical care more expensive, not less. First, it appears to encourage more procedures and treatment by making them easier and more convenient.

3. A Fall Cost Her $9,400 (approx: approx: RM 28,200) in Medical Bills

Emilia Gilbert is a school-bus driver. In June 2008 she slipped and fell on her face one summer evening in the small yard behind her house. Her nose was bleeding heavily and she was taken to the emergency room at Bridgeport Hospital. Gilbert said: I was there for maybe six hours, until midnight and most of it was spent waiting. I saw the resident for maybe 15 minutes, but I got a lot of tests. In fact, Gilbert got three CT scans — of her head, her chest and her face.

The CT bills alone were $6,538.
A doctor charged $261 to read the scans.
Gilbert’s total bill was $9,418 (approx. RM 28,200).

4. One-Day Outpatient Bill, $87,000 (approx: RM 261,000)

Steve, a blue collar worker, was in his 30s at the time and worked at a local retail store. He spent the day at Mercy Hospital in Oklahoma City getting his aching back fixed. He was told that a stimulator would have to be surgically implanted in his back. The good news was that with all the advances of modern technology, the whole process could be done in a day.

The Medtronic stimulator cost $49,237.
Basic medical and surgical supplies was $7,882.
Bacitracin cost $108. This is a common antibiotic ointment.
His total bill was $86,951 (approx. RM 261,000).

Steve ’s bill for his day at Mercy contained all the usual and customary overcharges.

“MARKER SKIN REG TIP RULER” for $3. That’s the marking pen, presumably reusable, that marked the place on Steve’s back where the incision was to go.
“STRAP OR TABLE 8X27 IN” for $31. That’s the strap used to hold Steve onto the operating table.
Yet another item, “BLNKT WARM UPPER BDY 42268” for $32. That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for $13.
“GOWN SURG ULTRA XLG 95121” for $39, which is the gown the surgeon wore. Thirty of them can be bought online for $180.

5. Medical Treatment for Stage 4 Lung Cancer: $902,452 (approx: RM 2.2 million)

This is a case of Steven and his wife Alice. Alice makes about $40,000 a year running a child-care center in her home. In January 2011, Steven was diagnosed with Stage 4 lung cancer. The couple knew that they were only buying time now. The crushing question was: How much is time really worth?

Steven died after 11 months of medical treatment at Seton Medical Centre in Daly, California. His wife, Alice had collected his medical bills totaling $902,452 (approx: RM 2.2 million). Alice said: [Steven] kept saying he wanted every last minute he could get, no matter what. But I had to be thinking about the cost and how all this debt would leave me and my daughter.

Among the items charged in the bills were:

$18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85;
$24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece.
Four boxes of sterile gauze pads for $77 each.
Intensive-care unit for two days at $13,225 a day.
12 days in the critical unit at $7,315 a day and
Total room charges totaled $120,116 over 15 days.
$20,886 for CT scans and
$24,251 for lab work.

As 2012 closed, Alice had paid out part of the bills and still owed $142,000 —I think about the $142,000 all the time. It just hangs over my head, she said in December. One lesson she has learned, she adds: I’m never going to remarry. I can’t risk the liability. In early February, Alice told TIME that she had recently eliminated most of the debt through proceeds from the sale of a small farm in Oklahoma her husband had inherited.

6. Pneumonia Treatment for $474,064 (approx: RM 1.42 million)

Rebecca and Scott are both in their 50s. On March 4, Scott started having trouble breathing. By dinner time he was gasping violently as Rebecca raced him to the emergency room at the University of Texas Southwestern Medical Center. Both Rebecca and her husband thought he was about to die, Rebecca recalls.

Scott was in the hospital for 32 days before his pneumonia was brought under control. Rebecca recalls that “on about the fourth or fifth day … the medical bill was over $80,000! When Scott checked out, his 161-page bill was $474,064.

The top billing categories were $73,376 for Scott’s room ( at $2,293 a day).
$94,799 for “RESP SERVICES,” which mostly meant supplying Scott with oxygen and testing his breathing and
$134 per day for supervising oxygen inhalation
“SODIUM CHLORIDE 9%” cost $84 to $134. He used dozens of this. That’s a standard saline solution probably used intravenously in this case to maintain Scott’s water and salt levels. (It is also used to wet contact lenses.) You can buy a liter of the hospital version (bagged for intravenous use) online for $5.16.
$132,303 charge for “LABORATORY,” which included hundreds of blood and urine tests ranging from $30 to $333 each.
$24 per 500-mg tablet of niacin. In drugstores, the pills go for about a nickel each.

7. Immune Booster Shot That Cost $ 7,346 (Approx: RM 22,000) Every 6 Weeks

About a decade ago, Alan was diagnosed with non-Hodgkin’s lymphoma. He was 78, and his doctors in New Jersey told him there was little they could do. Through a family friend, he got an appointment with one of the lymphoma specialists at Sloan-Kettering. That doctor told Alan he was willing to try a new chemotherapy regimen on him. The treatment worked. A decade later, Alan is still in remission. He now travels to Sloan-Kettering every six weeks to be examined by the doctor who saved his life and to get a transfusion of Flebogamma, a drug that bucks up his immune system.

Sloan-Kettering’s bill for the transfusion is about $7,006.
In addition he had to pay the doctor $340 for a session.
Each visit cost a total of $7,346.
Assuming eight visits (but only four with the doctor), that makes the annual bill $57,408 (This is approximately RM 172,224) a year to keep Alan alive.

Two basic Sloan-Kettering charges are $414 per hour for five hours of nurse time for administering the Flebogamma and a $4,615 charge for the Flebogamma.

According to Alan, the nurse generally handles three or four patients at a time. That would mean Sloan-Kettering is billing more than $1,200 an hour for that nurse.

Flebogamma’s Profit Margin: Made from human plasma, Flebogamma is a sterilized solution that is intended to boost the immune system. Sloan-Kettering buys it from either Baxter International in the U.S. or a Barcelona-based company called Grifols.

The Flebogamma dose for Alan — “can’t cost them more than $200 or $300 to collect, process, test and ship.”
Sloan-Kettering bought this dose from Grifols for $1,400 or $1,500 and charged Alan $4,615 for it!

These are some questions posed by the author:

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab?
Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college?
What makes a single dose of even the most wonderful wonder drug cost thousands of dollars?
Why does simple lab work done during a few days in a hospital cost more than a car?
And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

My Last Word

This is American – the land where people have great dreams! In the 1970s, I did my Ph.D. in that great country with the generosity of the US government. Then my two children went to the US to do their Ph.Ds – also courtesy of the American people. Thank you!

America is a great country – to study and to work in, but it sadden me to know that it is not a great country for the sick – especially if one is not adequately covered by medical insurance as this article tells us. In my next article on medical bankruptcy the situation is even more depressing.

You may ask me why I try to poke my nose into the “domestic” affairs of the US. The reality is, what is happening in the US today can also happen in this part of our world! Better that we know now what is going on and be well prepared for a rude shock!

One patient with pancreatic cancer went to see an oncologist. She spent about 10 minutes consulting him and was charged S$700 (that is RM 1,700 – the pay of an average worker for a month!). What was she told during that ten-minute-encounter? Read her story here: http://cancercaremalaysia.com/2012/05/29/part-1-an-encounter-with-an-oncologist-a-great-disappointment/

But S$700 is already cheap! Read this story: Breast cancer: She died even after a multi-million dollar medical bill http://cancercaremalaysia.com/2011/03/01/breast-cancer-she-died-even-after-multi-million-dollar-medical-bill/

The question under discussion is, what is a fair and reasonable fee a renown doctor can charge his/her patient? These are the figures given by the various medical doctors of Singapore:

Dr. Hong Ga Sze said a reasonable daily fee is $1,000 to $2,000 per day.
Dr. Tan Yew Oo, oncologist at Gleneagles Cancer Centre said $10,000 to $20,000 per day.
Professor Soo Khee Chee, head of the National Cancer Centre said $100,000 a day is fine and agreed that on a day Dr. Susan Lim could have charged as much as $450,000 per day.

The husband of a patient spent about 2 billion rupiahs for the treatment of his wife’s cancer without success. During our conversation he told me that he was billed S$120 (RM 300) each time his wife sat on the chair in the clinic to receive the chemotherapy drip.

You can read more stories here:

Fancy gadget and half a million ringgit failed to cure her http://cancercaremalaysia.com/2011/01/29/breast-cancer-fancy-gadget-and-half-a-million-ringgit-failed-to-cure-her-%E2%80%93-what-now/
She almost died after spending two billion rupiahs on chemotherapy in Singapore http://cancercaremalaysia.com/2011/12/27/utero-ovary-lungs-cancer-part-1-she-almost-died-after-spending-two-billion-rupiahs-on-chemotherapy-in-singapore/
Surgery-27 cycles of chemo and S$100,000 did not cure her http://cancercaremalaysia.com/2012/01/11/colon-lung-cancer-surgery-twenty-seven-cycles-of-chemo-and-sgd-100000-did-not-cure-her/

Let me close with this quotation by Daniel Taylor: Medical tyranny is here, and we can’t say we weren’t warned http://www.oldthinkernews.com/2012/11/benjamin-rush-medical-freedom/ Benjamin Rush, one of the signers of the Declaration of Independence, warned in 1787 that medical freedom needed to be included in the American Constitution. Without this protection, Rush warned that the medical establishment would naturally progress – as many of mankind’s institutions do – into an oppressive dictatorship. His words, echoing from over 200 years ago, ring strikingly true today: The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic. … Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers.

Breaking News

As I was about to post this article, someone sent me the link to this article:

NY, NJ AREA CARDIOLOGIST ADMITS RECORD $19M FRAUD

NEWARK, N.J. (AP) — A cardiologist with offices in New York and New Jersey has admitted taking part in a scheme that subjected thousands of patients to unnecessary tests and treatment and resulted in $19 million in bogus bills, what authorities call the largest case of health care fraud ever by a practitioner in either state.