Okay, I'll bite.
A friend with breast cancer recently flew from Canada to the Bahamas with a stopover in California where she was scheduled for a PET scan. The scan revealed a pleural effusion, fluid between the lung sac and chest wall. Her oncologist stated she should not fly again until the fluid was drained. The procedure, a thoracentesis or pleural tap is simple, ordinarily performed in the physician's examining room. My friend has excellent private health insurance and the insurer immediately assigned a case number to the incident. So far so good.
No physician would see us. The universal response was "we don't take walk-ins."
We decided to try face-to-face communication, and visited a large pulmonary practice. "We don't accept walk-ins" the receptionist explained. I replied, "I completely understand. I was a First Responder for 18 years, and every time I left a warm bed at 2 a.m. to help a stranger I knew I was putting my personal assets on the line. I always delivered the department lecture on liability. So I totally get it. Do you mind if we rest a few minutes before returning to the car?"
A few minutes later we were told that Dr. H. would see us. Said he has performed pleural taps countless times in his office. He would charge $100, or for a Canadian visitor would even do it for free, but no longer keeps the necessary tray on hand. Everything is now done in the hospital, where the procedure with tests and overnight stay will cost $30,000 - $40,000.
I telephoned the imaging center where the PET scan had been performed the previous day to ask if their invasive radiologist would perform a thoracentesis; my friend was an established patient there, not a "walk-in." He demurred but stated the condition was life-threatening and advised an immediate trip to ER.
Her PET was loaded on my laptop and we breezed through triage in two minutes flat. However, the thoracentesis was delayed by a mass casualty incident and she was given a room for the night. Hospital wanted to perform a PET scan even though we had the CD and written report from the previous day; finally common sense prevailed.
The following day she was brought to an examining room where a very young physician, still in his bicycle clothes and helmet, entered and introduced himself, drained 1.5 liters of fluid, applied a bandaid, and bade us farewell. A fifteen minute procedure.
Cost in any ER in Canada: $75. Cost in California: we're guessing $20,000. The hospital can sort it out with the insurers and we'll pick up the co-pay.
The experience has forever changed my view on the reasons for runaway health care costs in the U.S.A.
