With the presidential election campaign now in full swing and the Supreme Court due to hear oral arguments in March on the controversial Patient Protection and Affordable Care Act of 2010, President Obama's signature legislation is certain to be a focus of political and legal debate this year. That's to be applauded because my own recent experience with the U.S.' healthcare system suggests that the spiraling cost of care needs to be more effectively addressed.
My unexpected tour through America's medical-industrial complex began Saturday morning, January 14, when I went for a walk around a college campus nearby my co-op apartment in Flushing, New York. During the return trip, I first felt faint and short of breath. My heart began to palpitate, then increased to a rapid chest-pounding such as I had never before experienced.
Believing that I was experiencing a heart attack, I called 911. The responding medical team took me Queens Health Center for testing. An electrocardiogram (ECG) showed my heart was beating normally. However, a blood test revealed a higher than normal level of troponin, a cardiac enzyme that is released into the blood stream when the heart has been stressed or damaged.
The emergency room doctor admitted me to the hospital for further observation. A cardiologist on staff then informed me the troponin level made me a "borderline case." Either, he said, I had suffered a mild heart attack or a bout of arrhythmia, an irregular heart beat that is often accompanied by heart attack-like symptoms.
To arrive at a diagnosis, the cardiologist subjected me to further testing. Hospital staffers took additional blood samples, administered two more ECGs, monitored my heart rate and blood pressure, and ran an echocardiogram (cardiac ultrasound). All the while I was kept on a daily regimen of medications, including aspirin and beta blockers to slow the heart and reduce blood pressure; anticoagulants to thin the blood and thereby prevent blood clots; plus nitroglycerin to treat chest pain.
The results of the tests: negative. Nonetheless, the cardiologist recommended that I be transferred on Sunday to Elm-hurst Hospital Center, a neighboring facility to undergo an angiogram. This is an x-ray of the heart's blood vessels that uses a dye and catheter (a long, thin, flexible tube) to look for heart blockages resulting from a build-up of cholesterol-inducing plaque.
Concurring with the earlier assessment that an angiogram was in order, a cardiology team scheduled it for Tuesday; and, in preparation for the procedure, authorized a second round of drug therapy, ECG and echocardiogram tests and (for the eight hours preceding the angiogram) fasting. My vital signs were also monitored by electrode patches wired to my chest.
The verdict of the angiogram: my heart arteries were blockage-free. I was stunned — then angry. All of the doctors with whom I consulted suggested I might have heart disease; when no blockages turned up, I was left with questions: What is my condition? And was it really necessary to put me through four days of tests, drug cocktails and high-tech procedures when perhaps simpler and less expensive means were available to ascertain the cause of the heart palpitation?
I would like to think that only an impartial analysis of my case guided the doctors' recommendations of the medical procedures conducted on me. But I suspect that financial and legal motivations also contributed to the decision-making process.
As so often noted during the debate over PPACA, doctors have little incentive to restrain the consumption of healthcare services. If my doctors had not performed their tests, they might have faced a heightened risk of malpractice litigation.
Also to consider is a hospital's profit motive. As 85-plus million patients covered by Medicaid and Medicare receive care at below-market prices because of the huge negotiating power they wield with providers, doctors and hospitals have to make up for the losses elsewhere if they're to cover their costs. Result: They overcharge privately insured people like me for the same care. The more tests and procedures they administer, the more opportunities they have to overcharge.
My own view is that my four-day ordeal was driven by some combination of the above: well-meaning doctors who apply their expertise to the medical issue at hand, but whose decisions are guided — however subtly — by larger market forces weighing on the profession. PPACA, or whatever new healthcare bill is introduced to amend or replace it, is unlikely to alter this basic dynamic absent an overhaul of the current system.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.