The first patient is a young male who experienced multiple episodes of tachycardia (fast heartbeat), sweating, anxiety, stress, headache, and weakness for greater than 3 years. He had high blood pressure while on multiple medications with minimal control. His friend consulted me about what could be wrong as she had witnessed several events herself, and decided he wasn't exaggerating or having a panic attack.
We looked up pheochromocytoma also known as PCC is a neuroendocrine tumor of the adrenal glands that secretes high amounts of catecholamines, mostly norepinephrine, plus epinephrine to a lesser extent. His symptom complex matched 9 out of 10 on Google. She wrote down the potential diagnosis and suggested work-up. She presented what she had found to his doctor.
The patient is a Spanish citizen on a national health insurance. The doctor had never heard of this illness, but referred him for testing. It took approximately 60 days to get a specific urine test, which tested positive. He was then referred to the specialists where he was admitted and waited 5 days for a cat scan to confirm and locate the tumor. He was operated on 2 months later and is doing well.
Pheochromocytomas are a potentially high risk problem leading to stroke and other cardiovascular events. He received multiple medications to control his blood pressure with multiple negative side effects. He is off most of his medications now.
The problem was taken care of, but took 6 months. His personal direct cost was negligible, but indirect costs including problems at work, anxiety, and stress were very high.
Our second patient is a young female with non-ruptured appendicitis who went to the emergency room in the US. She was diagnosed and sent to the hospital for outpatient surgery. She was discharged from the surgical area 6 hours post-operatively. She made an uneventful recovery.
Her care was excellent, but the downside is she has a $10,000 deductible health insurance plan. She is basically a de-facto high deductible insurance self-pay patient. Her bill including emergency department, diagnostic tests, ER physician, radiologist, anesthesiologist, operating room and surgeon was approximately $47,000. The event lasted less than 24 hours and shows the major disconnect between actual costs, charges, write-offs, and negotiated prices per insurance plan.
As health care costs spiral out of control, these two examples at different ends of the spectrum show the fundamental flaws in both systems. The present system does not work for the low-income high-deductible patient (majority of people). The single payer system probably does not cost less, but spread the costs over the entire population. The price is lack of efficiency and time wasted.
These real-life examples create an interesting dichotomy.
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