Being Nickeled & Dimed...

First, there's Jack's 6-7 story.  Next, Joe brings us a fine example of our run-away healthcare costs & the lack of accountability in that realm.  

 

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Episode Transcript

Speaker 1 (00:00):
Being nickeled and dim. Do we need to adjust that
for inflation? It's one more thing I'm strong and more
before we get to that.

Speaker 2 (00:10):
I had two six seven incidents occur to me a curb,
Can I try this again?

Speaker 1 (00:15):
At me? For me?

Speaker 2 (00:16):
I have two six seven incidents occur in my life
over the weekends. One I was m seeing an event
Saturday night and I made a six to seven joke
in which probably three quarters of the room laughed and
one quarter looked around like what is he talking about?

Speaker 1 (00:34):
Which I thought was interesting.

Speaker 2 (00:36):
And then we're at a Mexican restaurant, and you know,
you hound a restaurant. Sometimes they give you a little
of the little thing with the number on it, so
they don't want number you are to bring your food
out at your table. Our number was sixty seven.

Speaker 1 (00:48):
I said, incident.

Speaker 2 (00:51):
I said, whoa dude, I don't have to pay extra
for this? And he said, what do you mean is
there a problem with that? I said six seven? He said,
uh huh. Good for him, right, and he was like
mid thirties, he has a job exactly. I mentioned to
a few other people.

Speaker 1 (01:09):
Like, oh, I want you to have to pay for that?

Speaker 2 (01:14):
I don't know remember when six seven used to be
sixty seven and it was just a number. I do
remember those were good times, yeah.

Speaker 1 (01:21):
Good times, yeah yeah. So I love how this starts out.
I'll bet everybody can relate to this by Matthew Hennessy.
A young George will once asked William F. Buckley Junior,
how do you come up with things to write about?
And Buckley said to the young George will it's easy.

(01:42):
The world irritates me three times a week, which is plenty,
and that's the start of many columns. And he explains
why he's irritating in this case. But if I asked you,
as a like a carpenter or somebody does a fair
amount of home improvement work, or how much a hammer costs,
you could tell me roughly, or how much a I

(02:05):
don't know, microwave, good micro evoven costs. If I asked
you to tell me how much an MRI costs, even
if you'd had one three days ago, you wouldn't have
any idea. Nope, which is part of the reason our
medical system is just so incredibly screwed up. I want
to drag Craig, the healthcare guru, back on the air

(02:25):
to talk to him about that. But anyway, Matthew Hennessy
is writing about it was not long ago. His mother
in law's been ill for a while. She's lived in
a nursing home in a rural part of the northeast, Okay.
Just to set the scene, long term care for memory
loss other chronic issues, and the nursing home staff, he says,

(02:47):
are generally competent and responsive, a lot of turnover, which
is one of the tough parts of those homes. But anyway,
as part of the care, a member of the nursing
home staff takes her to regular appointments at the clinic
of a large medical center about thirty miles away. The
clinic and medical center are affiliated with a prestigious nearby university,

(03:08):
which he doesn't name. He says, you'd recognize the name.
I'm being vague because I'm not trying to get anyone
in trouble. My irritation is with the whole system's attitude,
not any one persons. So famous medical center, famous university.
So mom in law gets taken to her annual checkup,
no particular problems, no medications needed, just it was on

(03:30):
the schedule. So they went in the healthcare and insurance
lingo we've all been forced to learn and use recent years.
This was a well visit routine. Well visits are typically
covered even couraged by insurance providers at no cost to
the patient. Medicare, in this case, covered mom in law.
When the bill for the visit came, my wife, who

(03:53):
is Mom's legal guardian, noticed two unfamiliar charges. One was
one hundred and fifty dollars facility fee. The other for
forty dollars, was itemized as the Evaluation and Management to
add on the E slash m add on. So just
under two hundred dollars tacked onto a bill for a

(04:15):
well visit, and his wife, to her credit, said wait
a minute, what is this? And she wrote a polite
note to the clinic inquiring as to the nature and
purpose of the charges. Its reply is what irritated me,
he writes. The evaluation and management or EM add on
is used to account for the complexity of EM services

(04:37):
that serve as the continuing focal point for all needed
healthcare services, or with medical care services that are part
of ongoing care related to a patient's single serious condition
or a complex condition. Everybody has expensive headphones on. You're
in the radiots. Can anybody tell me what the flame
and fuck that means?

Speaker 2 (04:58):
Yeah, it means O. Why did you charge me that?
Because I can, because I wanted to. That's what that means.

Speaker 1 (05:06):
I am going I'm gonna read that one more time.
The evaluation and management add on is used to account
for the complexity of EM services that serve as the
continuing focal point for all needed healthcare services, or with
medical care services that are part of ongoing care related
to a patient's single serious condition or a complex condition.

Speaker 2 (05:26):
Oh like Kamala Harris wrote.

Speaker 1 (05:27):
That, Yeah, yeah, if she knew more big words. Yeah,
but so Matthew points out, I work with words for
a living, so I'm hardwired to untangle sentences like this.
My brain immediately begins breaking down the parts and reassembling
them in a way that a person moderately familiar with
the English language might find decipherable. I defy you to

(05:48):
tell me what this blithering piffle actually means. Naturally, there
was more piffle, and it too blithered and I quote.
The complexity captured by the evaluation and management add on
is not in the clinical condition itself, but in the
cognitive load and the continued responsibility of being the focal
point for all needed services for the patient. It emphasizes

(06:09):
the importance of the longitudinal relationship between the practitioner and
the patient in the diagnosis and treatment plan.

Speaker 2 (06:16):
I'm surprised they went to the effort they did to
write some gobbledly gook, because usually, you know, if you
get a charge on anything, and you won't ask what
it is just a formality, it's just routine. Let's say
something like that, and you get what.

Speaker 1 (06:27):
Are you gonna do? What are you gonna fight it?
You can not pay it? What are you gonna do? Well, right,
as he says, So the well visit, which produced no
changes in care, no new diagnoses, no new prescriptions, it
costs an extra two hundred dollars because well, just because.

Speaker 2 (06:42):
I thought you were going to go this direction, because
I Katie, you've got insurance, so you're gonna have a
baby and God willing, and then you know, it'll all
just go and it'll just be a bill. You'll get
a bill and you'll pay it and you won't really
look at the why, because that's the way we all
do with medical bills. But I had a friend who
was a first kid was born. He didn't have any
health insurance, and so he got an itemized list of

(07:04):
everything and what it costs, and was really paying attention
and in advance or after that after the fact, okay
and uh, And several of the examples that stood out,
for instance, because I had at this point it had
been like really recently that we had been there and
Sam had been born, and like when they would come

(07:26):
in and say to you know, mom who's just had
a baby and has all worn out and everything like that,
are you thirsty? Can you anything? And you know, like
apple juice? Would that sound good or anything like that. Yeah,
I'd like an apple juice. It was like twenty dollars
a piece each one of those. Wo that's not just
a you look thirsty? Can I help you out? No,
it's a it's it's it's an up cell.

Speaker 1 (07:46):
And I remember they'll say to dad, can we get
you onto right?

Speaker 3 (07:51):
Sure?

Speaker 1 (07:51):
Yeah, that'd be I'd be thank you. You're thinking, hey,
this is a good.

Speaker 3 (07:54):
Hospital, been in a nice hotel. And then the one
that stood out the most was the little hat that
they put on your kid. It's a little like a
little beanie and it's tiny because your kid is so smart.
It weighs nothing. It's nothing.

Speaker 2 (08:08):
May have a pink one and a blue one, depending
on the sex of your baby. Back in the day
when we believed in those sorts of things. Now when
we were assigning gender, and that little cat, that little
cap they put on the baby's head was eighty dollars.

Speaker 3 (08:19):
Oh what eh?

Speaker 1 (08:21):
You know?

Speaker 2 (08:21):
And you just you either keep it in a drawer
as a keepsake and then forget it or throw it
away or do whatever you do. If you knew it
was eighty dollars and you were paying for it, you'd
bring your own I mean, everybody would everybody, everybody pack
a little kit to go to the hospital. If they
knew it was going to be twenty dollars a juice
and eighty dollars for the hat. You'd go to Target
and buy the little thing for eight bucks, and you'd

(08:41):
bring a case of juice that cost twenty dollars, and
you'd have all those there with you if you were
actually paying for it. Well, you are actually paying for
it big picture, because it all goes through insurance and
this and that and gets spread out through the system
of blah blah blah.

Speaker 1 (08:54):
But it's unbelievable. The whole system is a mess. Oh yeah, well,
back to the mist recharge matt asks. Imagine if your
dry cleaner treated you this way, how quickly would you
take your business to the competitor across the street. Instantly? Obviously. Well,
as we all know, healthcare and insurance don't operate like
normal businesses, nothing but buck passing middlemen in league with

(09:16):
penny pinching hospital executives. When there's trouble, they all point
the finger at big government, which points it right back
at them. Healthcare is ironically a diseased sector of our economy,
where the prices are intentionally obscured and the customer is
never right.

Speaker 2 (09:30):
And if you think the government taking it over would
make it better, your nuts, Oh yeah, yeah, eighty dollars
little hat would become an eight hundred dollars little hat.
Except there wouldn't even be any paperwork to nail that down.

Speaker 1 (09:45):
No, it'd just be siphoned out of the tax revenue.
Getting nickeled and dimed is one thing, he says, Getting
treated like an idiot is something else. Getting exposed to
jarger and deflect. Jargon and deflection turns ordinary people into radicals.
American healthcare is complex, I know, but everyone involved, from
politic and policymakers to hospital administrators, insurance companies, physicians, and
nursing home staff should understand that ordinary people all across

(10:06):
this country have had just about enough.

Speaker 2 (10:11):
Uh you know, yeah, I agree. I just think that
the only political momentum will be for letting the government
take it over. Then.

Speaker 1 (10:19):
Yeah, I think you're one hundred percent right. Then I'll
have to be treated for chronic anchor with a bunch
of mystery charges that you poor suckers will pay for.

Speaker 4 (10:32):
You're talking about upselling as a diabetic. They are trying
to sell me drugs constantly.

Speaker 1 (10:38):
Oh really?

Speaker 4 (10:38):
Oh yeah, and I I can exercise it off, you know,
the blood sugar to get it down, or you could
take this pill, and you know, constantly they're doing that
to me.

Speaker 1 (10:47):
Sure you're a hot prospect.

Speaker 2 (10:48):
Yeah, no kidding.

Speaker 4 (10:49):
Yeah, Well, I guess that's it.