Last week, I meant to call Joe for a “check-in” conversation (only because we hadn’t talked to each other in 72 hours), but we both ended up getting very worked up about health care costs for some reason.

I don’t remember how it came up, but for example: do you know how much it costs, in your state, for you to get an x-ray if you break your ankle? You probably don’t. Because it isn’t listed anywhere that is particularly easy to access. And I don’t care if you’re a liberal or a conservative - aren’t you even curious about how much it costs?

Now that I’m 3 years into residency, I am amazed that I know how to suture a laceration but I have no idea how much that service, plus the sterile drapes and lidocaine and suture material, costs. This has come up maybe only twice in my training.

Once, a family from France was visiting Boston, and they needed to have their daughter’s foot laceration repaired in the ED. They asked me how the hospital would be able to bill them for the service once they left Boston, and if they could just write a check right then and there for the service.

Another time, I was a third year medical student at SFGH, on a trauma surgery rotation, and a woman visiting from China rolled in strapped to a gurney, after having been badly injured in a car accident.  Through the medical interpreter, she wanted to find out how much a chest x-ray would cost before they x-rayed her; she explained that she had used up all her savings to come visit her daughter in the U.S., and wouldn’t have any money to pay for this accident.  The senior trauma resident rolled her eyes and said to the interpreter, “Explain to her that in America, we save lives first and worry about the cost later.”  I think that despite the patient’s furious protestations, she was wheeled into an OR anyway to stop her massive internal bleeding.

The lesson learned here - maybe people outside of the U.S. are more cost-conscientious about health care than we are?

I am very much in favor of universal health coverage, and I do understand the argument that if you’re in a real pickle - if you are so unlucky as to be a victim of a massive car crash, or your son develops leukemia - you really don’t want to have to worry about the cost of your medical bill.  You don’t want to even be unfortunately jobless and have to see your primary care doctor for a nasty cough and fever - because what if you have pneumonia, and have to pay for a chest x-ray and antibiotics? (And not knowing how much this costs beforehand can be really scary if you have no income but a potentially huge bill looming).  So why can’t we make costs just a little more transparent?

I start in the ED this week, and I just know something about cost containment and the ridiculousness of the ED will make me have a conniption.  (Although there are plenty of other things about the ED that I know will make me have a conniption, but that’s another story…)

And now for a completely separate topic…In more amusing news, Joe and I went to our “birthing class” over the weekend (cost: $185.00! Insurance reimbursement? Questionable!) and Joe learned that amniotic fluid is fetus pee.  “What’s in it that makes it okay for the baby to breathe it in and swallow it?” he asked me later that night.  I really wish he had asked the RN teaching the class instead, but then he pointed out there was another couple in the class with an annoying engineering husband who was asking annoying technical questions, and Joe pointed out “it’s people like him who give nerds a bad rep.”

ME: “It’s got hormones and nutrients and proteins in it that are important for growth and for their lungs to mature. I think.”

JOE: “Okay, but, still, it’s got waste products in it.”

ME: “Yeah, but it’s sterile, not like our urine, because the whole womb is sterile.”

JOE: “Okay, so if I, like, microwave my pee and drink it and aspirate it, will I be okay?”

ME: “Uh.  By all means, give it a shot.  I dare you.”