Healthcare

A few Sundays ago my dad awoke feeling nauseated. My mom assumed it was a hangover from the six tequila shots he drank night before---probably the most he’s drank in my lifetime---but my dad disagreed. My dad drinks once or twice a week, but rarely more than two beers, so he has probably forgotten the pain of a real hangover. As a result he checked his blood pressure that morning and found it was higher than normal and decided to visit his primary care physician.

His PCP referred him to a specialist, and the specialist told him he had suffered a minor heart attack. My dad couldn't believe it.

My dad has never had a heart attack, but the heart-attack-conducive temperament runs in his family. And although he has improved his diet and takes a cholesterol lowering medication, he wasn't exactly exercising regularly and eating grilled chicken salads every night either, so the possibility of him having a heart attack at 70 wasn't completely unreasonable. (But to this day, he insists he didn’t have one.)

The specialist suggested inserting a stent into one of my dad’s arteries to keep it clear and prevent future heart attacks. He recommended my dad stay at the hospital overnight and undergo a simple outpatient procedure (requiring only local anesthetic) the next day.

My dad was skeptical, but the doctor strongly recommended the stent, as did my mom---who may have just wanted the peace and quiet of having my dad out of the house for 24 hours---so he agreed. My dad stayed at the hospital that night and had the procedure the next day. He has been fine ever since, and has even started exercising regularly.

My dad's hospital bill was $120,000, and since he’s 70, it was covered by Medicare.

According to the CIA factbook (which I highly recommend for random perusal) our GDP per capita is $47,000. For the sake of extreme oversimplification, let's say the average retired American made $50,000/year, paid 12% payroll taxes and worked for 45 years. And lets say payroll taxes were split 50/50 between Medicare and Social Security. And lets give him the $50k salary for all 45 years to adjust for inflation.

If we assume my dad is an average American, he contributed $135,000 to Medicare in his life. Add a $150/month premium for the last five years, and his lifetime contribution is still only $149,000. And thanks to the wonders of modern medicine---the effectiveness of which has been accelerated by our readiness to pay top dollar for it---he has a long retirement full of modern medicine consumption ahead of him.

I read an article last week citing studies suggesting that doctors tend to overuse stents. I'm not suggesting that my dad's doctor unnecessarily gave him a stent, but the $120,000 price tag on the operation probably didn’t dissuade him.

The threat of malpractice litigation should ensure that a doctor won’t do anything that may potentially harm my dad. But what about doing something that is unlikely to harm him, but is also unnecessary?

No one in our case is complaining. If the stent decreases my dad's chances of a heart attack by .01% without any adverse effects, then my dad, me, the doctor, the nurse who works for the doctor, the hospital, the stent manufacturer, the steakhouse next door to the stent manufacturer’s office, the former owner of the doctor’s new lake house, the attorneys for all parties, the accountants for all parties, and everyone else through whom this money passes are all glad he has it.

Is perceived productivity the same as productivity?