Editor's Note
Paying the Plumber
A few weeks ago, I walked into our utility room and discovered water extending for 12 feet on both sides of our water heater. Employing diagnostic skills honed by years of home ownership, I found a leak in the temperature pressure relief valve, put a pail under it, and promptly turned off the water intake to the heater. Lacking the therapeutic skills to fix the problem, I called our plumber of choice, and he promised to come—in two days. For the next 48 hours, we found that we could take a shower or do the dishes before the pail filled up. Our plumber showed up as promised, replaced an inexpensive valve and pipe, and gave us a bill of $100 for one hour of work.
The purpose of this anecdote is not to complain about our plumber. We needed his services, and he successfully fixed the problem, albeit a bit later than we would have liked. It’s not to bemoan how much it costs to fix plumbing, and I will resist the urge to replay the old joke about the plumber and the doctor that finishes with the punch line “I didn’t make that much when I was a doctor.” Rather, my water heater’s illness provoked thoughts about our topic this month—money: what we need to and want to spend it on, and how that relates to the cost of medical care.
The one truth agreed upon by all is that American health care costs too much. Ask economists who see the health care piece of the GDP passing 17 percent with no sign of a plateau. Ask federal or state officials who cringe at bankruptcy projections for Medicare and Medical Assistance. Ask hospital administrators who are trying to limit the soaring costs of labor and supplies while getting by with less from third-party payers. Ask doctors who see their paychecks decline because of those same factors (see “Cash Is King,” p. 8 and “When Ends Don’t Meet,” p. 36). And ask patients who each year pay more for deductibles, co-pays, and pharmaceuticals. None of them thinks there is enough money to go around.
The list of reasons for the relentless rise of medical costs is long and tattered by overuse—the aging population, new technology, overpaid hospitals, overpaid doctors, and overpaid HMO executives. The list of solutions is shorter. Because aging has no fix and most of us would not want a moratorium on advances in medical technology, solutions frequently target hospitals, doctors, and HMO executives, and, like my plumber, whether we think they’re overpaid depends on what we think they’re worth.
How much should a doctor make? More or less than a plumber? How much should an HMO executive make? More or less than a doctor? How much should Tiger Woods or Tom Cruise make? What do we value as individuals and as a society, and are we willing to pay for what we value? In part, it depends on what we need and how badly we need it. A patient having a myocardial infarction needs a cardiologist badly, just as I needed a plumber and, whether it’s chest pain or water on the floor, the dollars don’t seem to matter.
For the past 40 years, endless renditions of payment mechanisms have disproportionately rewarded procedures and tests over cognitive services. Such systems are either a comment on what society values or what is easy to measure. Regardless, talking to patients pays less than pushing tubes or putting pacemakers into them, even though either can be lifesaving.
I paid my plumber’s bill, and even if it costs me $125 an hour or more, I will pay him to fix the next leaky pipe because when I need him, I need him.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at cmeyer1@fairview.org.