Joe Livernois

Viva Mexico's rational health care system

Published: Sunday, Apr. 7, 2013 - 12:00 am | Page 1E

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Because I'm from California, the Land of Tax Whiners, I suppose I could have worked up some righteous jaundice about the value-added tax a hospital in Mexico tacked on to my father's bill.

Sixteen percent!

But I was too giddy in my relief to complain.

After decades of being conditioned by the outrage of staggering medical costs in the United States, the bill I received from the Mexican hospital was a refreshing peek at what it must be like to navigate a rational health-care cost environment. I barely noticed the tax.

My 90-year-old father spent nine days in a hospital in León, Guanajuato, for severe gastrointestinal problems earlier this year that nearly cost him his life. He has been living in Mexico more than 30 years, and his family here in the United States prepared for the worst when we learned of his hospitalization. My father has told us he wishes to be buried in Mexico, and it seemed it might soon happen.

At the hospital in León, about 240 miles northwest of Mexico City, a team of doctors, internists and specialists performed a battery of tests, and they ultimately fixed his medical issues. By all accounts, my father's treatment was splendid, and he has recovered nicely.

My father gets by on a very limited income, and he is not a citizen of Mexico, which operates a universal health care system. So his sons and daughters were stuck with his hospital bill. My family, along with millions of families across the United States, has been chumps to the barbaric medical- industrial complex for so long that we fully expected a major hit to our bank accounts.

How much would a nine-day stay in a hospital in Mexico cost? The procedures? The medications? The doctor visits? The specialists? Nine days of oxygen? The expensive cotton swabs? The unnecessary CT scans? The $1.50 aspirin? The redundant blood tests? The nursing rates, compounded hourly? The hospital gown? The administrative charges? The cost of keeping the hospital administrator in his Bentley? All that stuff adds up in the United States.

Even with the 16 percent tax, my father's medical bills came as a great shock, to say the least. A bracing shock of relief.

The cost to save my father's life during his nine-day odyssey in a Mexican hospital came to 80,000 pesos. Total. Converted in American currency at the time, the bill came to about $6,375.

The bills included the procedure required to keep my father alive, as well as all the lab work, the anesthesia and the specialists summoned to minister to his other issues. All for less than $6,500.

The hospital bill alone came to $3,120, or about $347 a day. According to the half-page itemized invoice I received from Sanitorio Moderno Pablo Anda, the hospital where my father received his care, the price of keeping him in a private room for nine nights came to about $66 a night. The bill included his pharmaceuticals, a couple of X-rays, oxygen, supplies – and about $250 in tax.

Yes, I could complain about the tax. Americans might face insolvency as a result of our skyrocketing health bills, but at least we are free to whine and complain about our piddling taxes.

Anyway, taxes would have been the least of our problems had my father been treated in California.

To get a sense of what my father's nine days of care might have cost had he remained in California, I recently analyzed the financial statements of two dozen random hospitals in the state and compared his costs against the per-day costs of providing inpatient services here.

As I dug through the financial statements, a hospital administrator cautioned me that the cost of inpatient care in the United States can vary greatly, depending on a hospital's case mix, so I selected hospitals that provided either a range of specialized care or concentrated on basic care. The 24 hospitals I analyzed included facilities large and small, their locations stretching from Humboldt County in Northern California to Imperial County in the south and from big cities to the rural outback, and I avoided specific-care facilities like psychiatric hospitals.

I also browsed through several of the hospitals' "chargemaster" lists to get a sense of the charges a patient in a California hospital is likely to incur. A little-known secret to consumers, every hospital maintains a chargemaster database that lists costs for everything it can possibly charge a patient, from aspirin to open-heart surgery.

In California, the chargemaster list for your favorite hospital can be found under the "Data" tab at www.oshpd.ca.gov.

At one California hospital, the chargemaster showed that it would have cost $60 if my father had needed 40 doses of Bayer aspirin. Sixty dollars is what it cost to administer two X-rays in the hospital in Mexico. By comparison, Wal-Mart will sell you a 40-count bottle of Bayer's top-of-the-line aspirin, its 500-milligram pro-release coated tablets, for $5.56.

At another hospital, I learned from the chargemaster list that patients were assessed a $37 "room temperature handling fee." In Mexico, setting the thermostat is apparently a free service.

Trying to discern from the chargemasters what my father's private hospital room would have cost in California required an advanced university degree in Dante's Circles of Hell. Room costs varied wildly, depending on the level of care and dozens of other factors. Apparently, all that is missing from California's hospital rooms are taxi meters so that patients can track their pending bankruptcy.

Suffice to say, I found no rooms for $66 a day in California, and I finally gave up trying to find a room even in the three-figure range.

Add it all up and the gross inpatient revenues reported by those 24 hospitals are staggering. They averaged $13,805 per day for each patient, and the daily grosses ranged from $5,305 to $26,033. At least three of those hospitals reported single-day net inpatient revenues that exceeded my father's entire medical costs.

Using that average, my father's nine days in a California hospital would have cost about $125,000. And that would not have included the separate billing for procedures, testing and specialists.

To be fair, my father would have certainly been covered by Medicare had he elected to remain in the United States. For most of the 24 California hospitals, the average per-day gross revenue they received from patients covered by Medicare didn't seem to be that different than their overall averages.

The difference, at least for my family, would have been the 20 percent cost-share my family would have paid had my father not purchased supplemental insurance. Under Medicare, his family would have been on the hook for almost $25,000. Taxpayers would have been stuck with the rest of it.

After receiving the medical bills from Mexico, I tried to explain my relief to a friend of his in León. I described the preposterous cost of medical care in the United States compared to Mexico, but she couldn't believe it.

"I don't know how to call it in English," she said, "but in Mexico we call this un robo en despoblado."

Loosely translated, un robo en despoblado is an adage that describes the act of robbing someone in a desolate place because there's nobody around to stop it.

A doctor I know in Watsonville, a farmworker community on the Central Coast of California, told me that many of his patients, including those with the best medical insurance coverage, opt to get their dental care and elective surgeries done in Mexico. Even after factoring in the cost of travel, their Mexican medical bills are less than the co-pay that would be required for similar care in the United States, he said.

Since Americans are shelling out platinum-standard money for our medical care, you'd think we'd be getting commensurate results.

While the United States spent 17.9 percent of its gross domestic product on health care in 2010, by far the largest percentage among other countries in the world, the most recent World Health Organization analysis found that the United States ranked 37th in overall health. People in 23 other countries can expect a healthier life expectancy than those in the United States, according to the WHO.

I'm sure that detractors of Mexico's health care system will insist with virtuous certainty that America's model is far superior. All I know is that a hospital in Mexico saved my father's life during a nine-day medical experience that cost less than $6,500.

Meanwhile, every effort to reform America's health care dysfunction is certain to be met with the inevitable chorus of hysterics. Critics are hard-wired to whine about rising taxes, and they reflexively yowl about nanny-state socialism.

Personally, I've seen the other side. And I'd be thrilled to pay a 16 percent tax on medical bills that were even half as rational as what I've seen from Mexico.

Joe Livernois is the former executive editor of the Monterey Herald.

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