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Monday, July 10, 2017

My Awesome and Cheap Medical Experience…in Lebanon

I paid one tenth of what this great service would have cost in the US

Sometimes it takes a near-death experience to render the obvious observable. This happened to us on our annual summer trip to Lebanon, where a medical emergency sent us back to the future of medicine.

I know this can work because I watched it save my wife’s life.Lebanon is a land of contrasts. Beirut struggles to keep the lights on 24 hours a day, get the garbage collected, and what passes for a highway system would give the most jaded New York cabbie a heart attack. But there is one thing the Lebanese haven’t screwed up that we in the U.S. have turned into a royal mess. And that is the ability to deliver world class healthcare at an affordable price.

Great Medical Service

Our terrifying journey began with a 3:00am ambulance ride to the emergency room of the American University of Beirut Medical Center. As we learned only later, a freak metabolic imbalance triggered a life-threatening cascade in my wife that could have been caused by any number of underlying pathologies, each one scarier than the other.

After stabilization in the ER she was transferred to the Intensive Care Unit where numerous specialists raced the clock to figure out what was happening. I will spare you the details, but the next 36 hours were a wild ride. We are grateful that by day four my wife’s good health was restored thanks to the competent intervention of a sophisticated multidisciplinary medical team, leaving her exhausted but with no long term sequelae.

The treatment she received was as good as you could expect at any first-class teaching hospital in the U.S., including all the latest technology. Having dealt with complex hospitalizations of my late father, who was both misdiagnosed and nearly killed by preventable medical errors, I can tell you that the overall level of coordination, patient care, and staff courtesy at AUBMC was far superior to any I have seen back home.

Finally the Bill 

When it came time to be discharged, I headed to the billing office to figure out how we were going to handle the bill. Medicine is a cash business in Lebanon, no different than the grocery store or car dealer. I knew that my brother-in-law had put down a deposit and signed a financial responsibility form when we were admitted, but I was too distracted by the prospect of losing my life partner to pay attention to the details.

I totaled the likely cost in my mind, aware that my wife’s extensive treatment included not just the ER visit and two days in the ICU but an MRI, CT Scan, X-rays, EEG, EKG, lumbar puncture, and too many blood tests to count. She was treated by multiple internists, neurologists, nephrologists, an infectious disease specialist, residents, a phlebotomist, and a round-the-clock nursing team. Our last days of recovery were in a private room with a view of the sea.

All we paid for was the top quality medical care we actually received.The bill was in Lebanese currency, so the total number of commas made me pale. I asked the billing clerk to convert that into dollars. “Seven thousand dollars,” he said. “You are due a refund on your deposit.”

How could this be? The bill would have been ten times that in Boston.

I’ll tell you how. All we paid for was the top quality medical care we actually received. We did not pay for the healthcare of countless strangers, a hospital bureaucratic staff larger than the medical staff, compliance officers and insurance administrators, lobbyists and legislators, benefits administrators at every employer in the country, mandates to provide medical services we would never use, nor did we pay artificial prices set by some remote pricing czar. Like any other business, we just paid for what we consumed in a market serving cash customers with prices set by the law of supply and demand.

Does this mean that people who show up at the hospital in Beirut seeking care who can’t pay for it get turned away? Yes it does. Lebanon is not a rich society like the U.S., plus the country is dealing with an influx of a million and a half Syrian refugees who would swamp any system that offered ‘free’ services.

Our Soviet System 

So our own national situation is not directly comparable. But as a rich and compassionate society, if we want to provide public charity to subsidize medical care for the unfortunate, why must we do it by Sovietizing the entire medical industry?

Why can’t we just provide the deserving poor with taxpayer-funded medical vouchers in an amount and with whatever conditions and restrictions our political generosity dictates, but let the medical system achieve proper price balancing under the discipline of market forces? 

By conflating medical care with charity then burdening it with social justice mandates, regulated employer benefits, intergenerational Ponzi schemes, and a crippled mockery of insurance underwriting designed by politicians and crony corporatists instead of actuaries, we have created an unsustainable mess destined for self-destruction.

Glimmers of a cash medical services business are already rising from the ashes of Obamacare, a natural response to its massive deductibles. Rather than fight this return to cash with ill-conceived policies conjured up by our dysfunctional Congressional sausage factory, why not lean into this trend and take medicine back to the future by setting it free? I know this can work because I watched it save my wife’s life.