Low Birth Rate

With all the health care reform talk, I thought I'd add a personal perspective.

My mother, who turned 90 this year, always saved everything when it came to official paperwork (like many others of her generation). So I wasn't much surprised when she handed me what was clearly a decades-old piece of paper. "Take a look at this," she said, offering me a faded pink document.

It was the Member's Copy of a Blue Cross Statement of Account. It wasn't until I straightened out the creases and peered more intently that I saw the paper was a breakdown of the hospital charges for my birth -- March 19, 1952 (you do the math).

For Mom's stay in Ward 323, the hospital charged $53 for a seven-day stay -- three days at $7 per and the remaining four at $8 a day. I don't think moms get to stay that long with no complications, do they? Next we add in $10 for the delivery room charges and $7 for my board -- I didn't take up much space, I guess, so I got the $1 a day rate. Throw in $2.25 for drugs (today's paper dispensing cup costs more, I think) and $5 in lab costs and you get the grand total of $77.25 for my entrance into this world.

Now at the time, Blue Cross had a flat-rate maternity benefit in my parents' policy of $9.50 a day for 10 days maximum. That made for a benefit of $66.50 -- leaving my folks to come up with $10.75 if they wanted to take me home.

I realize you have to factor in inflation, but using the Inflation Calculator provided by the Federal government's Bureau of Labor Statistics (no pun intended) tells me that $77.25 translates to $628.77 in 2009. I think hospital maternity charges today are a whole lot higher than that.

So why have health care costs risen so much more than the general rate of inflation? Technology? Labor? Malpractice Insurance? Maybe it's paperwork. A New England Journal of Medicine study showed that U.S. health care paperwork cost almost $300 billion in 1999, and a Harvard/Public Citizen report noted that the U.S. health care bureaucracy in 2003 cost nearly $400 billion! What's it cost today -- half a trillion?

I wouldn't want to go back to the medical technology, salaries or other circumstances of the health care industry of 1952, but maybe if we went back to the paperwork system of that era, maybe we'd save a little money?

Handwritten at the bottom of my mother's Statement of Account were the words: "Paid 3/26/52" along with a signature. I think my mother kept the receipt as proof of payment to keep somebody from the hospital from showing up at her door demanding the return of the "goods" (me).

I'm officially worth just short of $11 -- or $78 if you take out the reimbursement. To Mom -- and Dad (10 years in heaven this fall) -- thanks for coming up with the cash. I hope I've been worth the investment.

This Is Not A Bill

Of all the paperwork I hate – and I find it all insufferable – I detest medical paperwork most of all. It arrives in that dreaded plain white envelope; inside a document with the legend prominently displayed: THIS IS NOT A BILL. After unfurling the treatise from its womb, I am confronted with a thicket of unintelligible jargon known as the “Explanation of Benefits.” It’s never terribly clear. Once I had some periodontal work done and it was classified as “osseous surgery.” Who knew? With that language it could have been the removal of an appendix – or some other vital, rather than vestigial, appendage. God forbid.

Other than the jargon, it’s filled with footnotes and disclaimers relating to who covered what and how much, whether the provider is a participating provider, how much of your deductible you’ve met and so on and on and on.

A 2004 news release issued by the Physicians for a National Health Program cited a study by Harvard Medical School and Public Citizen that found “health care bureaucracy [in 2003] cost the United States $399.4 billion.” (Emphasis added.) For paperwork? As the late U.S. Senator Everett Dirksen supposedly said, “A billion here, a billion there, soon you’re talking real money.”

This isn’t an argument for any particular health care reform. That’s better debated in a much more comprehensive and knowledgeable arena than this blog. There are so many players in the debate, each with his scalpel to grind. I can only hope that whatever reform comes about makes a sizable incision in that $400 billion in bureaucracy costs.

The National Center for Policy Analysis reports on its website that “some three million clerks and managers are employed in the health-care industry – nearly four times the number of doctors now practicing.” Just handling the claims alone, the center says, costs $13 billion. Now those are some telling numbers – could it be part of the reason why there’s some 45 million+ uninsured Americans?

Maybe all that money is for handling those forms you seem to always be filling out – sometimes each and every time you visit the same doctor for the same condition. Maybe it’s all the reports doctors and other professionals have to fill out. Maybe it’s some other paperwork demon.

But surely those THIS IS NOT A BILL printouts are the chief culprit. Why do we need a separate one in most cases for each and every procedure – even those done on the same day? How about a monthly recap, something like a bank statement? Can you imagine a bank sending you a statement every time you wrote a check or made a deposit?

I’m seriously considering a small protest against this excess of paperwork that’s costing us so much time, money and trees. The next time my health insurance premium is due, I think I’ll send a small piece of paper with the invoice that says, “THIS IS NOT A CHECK.” It would save them a small amount of processing time.

I would think that my insurance company would not be amused by my creativity. But, hell, I’ll feel good – and isn’t that what health care is supposed to be all about?