Whipped Cream Difficulties

Would you believe that IV fluid (specifically, normal saline) is almost as cheap as house-brand cola at the grocery store?

The limit for one liter of normal saline (a little more than a quart) went to $1.07 this year from 46 cents in 2010, an increase manufacturers linked to the cost of raw materials, fuel and transportation. That would seem to make it the rare medical item that is cheaper in the United States than in France, where the price at a typical hospital in Paris last year was 3.62 euros, or $4.73.

That is, if you buy it in bulk from the manufacturer. If you go to the hospital and get an IV…

The charges included “IV therapy,” billed at $787 for the adult and $393 for the child, which suggests that the difference in the amount of saline infused, typically less than a liter, could alone account for several hundred dollars.

Of course, there’s hospital overhead and such involved. You don’t expect to go to Best Buy and pay wholesale price for a laptop, so why would you expect to pay wholesale for IV fluid? But isn’t $786 a lot of markup?

At White Plains Hospital, a patient with private insurance from Aetna was charged $91 for one unit of Hospira IV that cost the hospital 86 cents, according to a hospital spokeswoman, Eliza O’Neill.
Ms. O’Neill defended the markup as “consistent with industry standards.” She said it reflected “not only the cost of the solution but a variety of related services and processes,” like procurement, biomedical handling and storage, apparently not included in a charge of $127 for administering the IV and $893 for emergency-room services.

SmarterTimes has one take on this. I have another. Actually, I have two:

1. If you go to watch a dragon dance, don’t eat lunch from food stalls at the Buddhist monastery.
2. This is one of the reasons I have qualms about health care reform. I really do believe the system is broken and needs reform. But many of the proposed changes seem like tugging at a protruding wire in a deeply intertwingled snarl of wiring, without knowing whether you’re going to rip something vital loose or shock yourself or both.

This also gives me a chance to plug a forthcoming paperback that I’m very excited about: David Goldhill’s Catastrophic Care: How American Health Care Killed My Father–and How We Can Fix It. I haven’t read Goldhill’s book yet, but I have read (and written about, even) his 2009 Atlantic essay that this book is based on. I won’t say it was a huge influence on my thinking, but the essay did help me clarify many of my own thoughts about what’s wrong with the system (particularly the role of insurance) and how things could be changed.

I’m not sure how applicable Goldhill’s prescriptions are to this incident. Much of what he talks about involves changes in routine health care, such as providing consumers with better cost information; being poisoned by monks at a dragon dance is the kind of catastrophic event you’d figure should be covered by insurance, and not the sort of thing where you shop around for the best deal on IV fluids and antibiotics.

Still, this does give me a chance to plug his book, which I was previously unaware of…