When I first moved to the USA I had the strong impression that the health care system was designed to deliver quality care – the outcomes were good. It’s well acknowledged the the US Healthcare system is the most expensive in the world with annual costs of almost $10k per person, but delivers below OECD average life expectancy.

My assumption was that this is mostly due to economic inequality. I’m still not clear on that, but I have some insight into the quality and cost of care.

The attentiveness of medical workers is pretty good. You can easily get an appointment, in short time, provided you have insurance. You’ll meet some medical aide who takes blood pressure and pulse updating your records before you are able to speak to a ‘doctor’. Everything is wonderfully clean and sterile, the chairs are comfortable, the gowns & outfits are very medically appropriate.

My doctor has given me what I would consider to be some extreme advice. The most recent was a mild fever or allergy – I went to the doctor with complaints of headache, body ache (back, shoulders), lethargy and weakness. I requested some blood work to ensure nothing ‘serious’ was happening, and for general advice – rest or medicate? After all, this is ‘free’ due to my insurance.

“Any other symptoms?”

Well, my stomach was cramping and aching this morning, so I skipped breakfast to allow it to rest too.

Cue some stomach prodding, my discomfort, and a declaration that I need to get a CT Scan.

Wait, what? A CT scan? Yes, I might have appendicitis. Loss of appetite and stomach pain. The stomach pain isn’t in the right place, or severe enough, and I consciously chose to miss breakfast rather than lose my appetite, and there are a bunch of other signs that something else is going on in my body, but the best course of action was to get a CT scan.

The median cost of a abdominal CT scan in Chicago is $1000.

I suggested that instead I monitor my pain levels, and simply proceed with the scan if the pain increases. The doctor begrudgingly agreed. The ran blood tests, and I’m sure they made a tidy sum from the insurance company.

So in this system of detached health insurance, who is monitoring costs? The doctor doesn’t care about spending frivolously. The insurance company gathers their health premium from the subscriber; do they question the excessive expenses that appear in their system? And of course the customer aka ‘patient’ blindly follows their doctors’ sage advice, thinking that they need such procedures.

Health care costs are something like 18% of the US economy.

https://www.nerdwallet.com/blog/health/2014/10/28/how-much-does-a-ct-scan-cost/

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror