Ripping off Medicare?
How
much does a cataract surgery cost Medicare?
I did not receive an itemized bill.
Happy to have the cost taken care of, I didn’t care. I wanted the multifocal lens, to do away with
even reading glasses. That is not
covered by Medicare, so it is an out of pocket expense of $2,500.
I had
one eye done in the United States where I could use my Medicare insurance. The other eye was done in Mexico, a cash
affair. To have a trifocal German Weiss
lens put in, the total cost was 30,000 pesos, or roughly $1,500. Obviously, without the multifocal lens it
would have been well under $1,000.
So, how
much does Medicare shell out to an ophthalmologist for this basic
procedure?
Let us
compare to two procedures.
In the
US, I received the personal attention of the doctor’s technical assistant. She spoke with my by phone about the
medicines I needed prior to the surgery.
There were drops that were needed, to prepare the eye. One small vial of drops cost $300. She arranged to get a discount card for me,
perhaps from the manufacturer, to reduce that cost by half. I was given a detailed schedule for applying
the drops prior to surgery. The
instructions included washing my eye with baby shampoo the night before and the
day of surgery. For the office visits, I
sat in front of about five machines that measured my eyes. Not quite sure what each of them measured,
but it felt professional and efficient.
On the
day of the operation, I was instructed to go to a local hospital. This hospital provides a wing devoted to this
ophthalmology group. Clear directions
sent me from the hospital entrance around to their wing. I was greeted at a polished wood reception
counter, and checked in. There is a
carpeted waiting area with comfortable chairs.
I was invited to put on a hospital gown, to be more comfortable. I was given a bed on wheels, and a tall
shaven head man came to me and introduced himself. He was the technician who was to prepare me. He explained what would happen. He was upbeat. We quickly discovered something in common,
and became best friends. When the time
came, I was wheeled into the operating room.
By this time I am so well informed that I am completely relaxes. The local anesthesia is administered. I am totally awake. I am offered something that might take the
edge off, but I tell them I am fine. The
procedure, done in a dedicated sterile room, was quick and painless except for
one little pin prick. I assume, by its timing
in the event, that it was the lens going in.
After the procedure I return to the
other room. I sit up, and am given a
package of bandages and drops for doing my own after care. Inside the bandage they’ve applied, there is
a concave clear plastic tear-drop shaped perforated disc. This will protect my eye, especially when I
sleep. I am given a sheet of
instructions for the following three weeks.
It is a schedule, clearly written out, of how and when to apply each of
three vial of drops I’ve bought.
I notice that the waiting room as
well as the beds are full. This is clearly
an assembly line. No telling how many of
these procedures the doctor does in a day, although he may only do this
procedure twice a week.
I have a follow up visit the next
day at the town office of this ophthalmology group, which is pretty
routine. The doctor just wants to have a
look at his work. A week later I have
another follow up with the referring optometrist, but I figure this is just his
way of getting his cut, by charging the visit to Medicare. There is nothing for him to do or see. I blow it off.
During and after the surgery I have
no pain or discomfort. Given all the
anti-inflammatory and antibiotic drugs I’ve been given, how could I. I am given the instructions, not to bend
over, not to lift anything heavy for at least a week. They give a safe margin of error for the
prognosis. Three to six weeks and my
vision will return to clarity.
I think about how much all those
machines cost, with which my eye was so closely examined and measured.
For months I have suffered with
crazy vision. One eye is normal, the
other still needs corrective lens. I try
some old contact lenses. They help a
little, but they sat in sealed packets for years, and were probably slowly degrading. Reading, for these months, is a big problem.
Finally I am free to go to
Mexico. I drive there from Florida, and
settle into an unoccupied piece of land where I started and then abandoned a
house. One house on the community land
is completed, and I am allowed to stay there.
I slowly make contact with the medical community, I see one doctor and
then another, and I am told that the required lens is on order. Once it arrives, my surgery will be
scheduled. I am in Mexico about four
weeks before the day comes.
When I first met the doctor,
perhaps the only one in town that does multifocal lens, and apparently he
hasn’t been called upon to do many, he peers into my eye with one machine
only. Later a doctor friend would refer
to this as a sonogram. The appointment
took perhaps five minutes. He then
searched out and ordered the lens, for which I would have to wait another two
weeks or so.
I called ahead of that day to ask
if I needed to do anything to prepare.
Any drops? Shampoo for the
eye? No, there is nothing. Just arrive at 10 am, fasting.
For safe keeping, I squirt my eye
with remaining drops of anti-inflammatory left over from the previous eye
surgery, that morning. I scrub the eye
with baby shampoo. I show up at the
doctors office before 10. Then I am told
the surgery will be at 11;30. The
receptionist said something about needing time to fill out history forms, but I
thought my appointment got bumped. The
doctor was squeezing me in, as it was, as a favor to my physician friend. And so I waited, light headed from a light
supper the night before and no breakfast nor water.
The first referring ophthalmologist
arrives, and waits in the tiny reception room.
I didn’t recognize him at first.
After some time, he came up to me and said softly, are you ready? We are ready.
Yes, I agreed. Ready. It would still be some ten or fifteen minutes
before I was prepared with gown, hair net and booties.
The procedure took place in a back
room, on a guerney or examining table.
The referring doctor gowned up and was assisting. There was not much talking, no mood lifting
banter. So far, three different drops
had been applied, and they all stung to varying degrees of intensity. The last were applied and I laid down.
The procedure took place. I think the US doctor used laser tools, which
this doctor did not have. The first procedure
felt smoother. That being said, there
was very little discomfort.
When it was over the eye was
bandaged. I was instructed to take care
of it, don’t put pressure on it, don’t bend down or lift anything heavy. There
was no plastic disc to protect the eye under the bandage.
These two Mexican doctors had done
cataract surgery for my friends and their elders. None of them requested the multifocal
lens. All had excellent results.
My question is obvious. Is all that primping and pampering given the
US patient and charged to Medicare necessary?
Yes, it feels good, but it doesn’t change the outcome.
Congress doesn’t dare cut Medicare
funding, for fear of an outcry from the public.
I think the reduced funding requirements should come from within. The medical profession in general relies on
more and more instruments of measurement, expensive equipment and lab tests, to
avoid liability from error. Perhaps this
testing is also a cover-up for the poor diagnostic skills acquired during
medical training.
There is so much wrong with health
care in the US. I am only addressing one
small specialty. Of the broader field of
western medicine, I believe that once treatment is applied, it is quality for
the most part. (I am sure there are
studies out there reporting on this; I am not aware. I am being
optimistic.) But the expense around it
is out of control. There is a great body
of traditional healing that is suppressed, not integrated into our system of
health care. When I lived in China I had
access to many affordable natural remedies over the counter that relieved
symptoms I might have gone to the doctor about in the US, if I could afford
it. In Mexico, and among my Mexican
students in America, I have been acquainted with traditional healers. I respect their work.
These are my observations from
undergoing the same procedure in two medical systems. And gratuitous ramblings on the topic of
health care in general. I welcome your
comments.
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