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My One Hundred Million Dollar Pen

I’ve got to introduce you to this pen of mine, just a run-of-the-mill pen, but oh the story it has to tell. Understanding the power of my pen is a useful lesson in health care, and by the end of this two-part piece what you learn might make you healthier. No kidding.

But first, let’s make you a little sick.

You’ve encountered the usual info about our US health care system. Most expensive in the world? Yes indeedy, we spend about 16% of our Gross National Product (GNP) every year on health care. Serious money, totaling in the vicinity of $2.24 trillion dollars ($2,240,000,000,000). You can do this math yourself: Our annual GNP is $14 trillion, ironically now the same as our national debt, and 16% of $14 trillion is $2.24 trillion. (My pocket calculator is audibly panting, challenged by zeroes.)

Now the fun part. Divide this $2.24 trillion by the current US population of 300,000,000 (three hundred million) and you’ll discover we’re spending roughly $7,500 per year on health care for every person living here, or roughly $144 a week. What? What? We’re spending $144 a week on you and yet you have no health insurance? You say all you’ve got when a health crisis looms is some outdated aspirin in your medicine chest? Is something wrong here?

For all this money–and no chump change this $2.24 trillion we’re spending annually—we rank 37th worldwide in terms of the overall health and well-being of our citizenry. Neck and neck with Slovenia.

Okay, so that’s what we spend: $2.24 trillion every year. But wait! Who’s in charge of spending? I am—me and my magic pen. Me and my 900,000 physician buddies around the country (along with their own magic pens), a number kept pretty constant by the AMA to keep doctors steadily employed. In fact, once you’ve got your medical license, it’s really a challenge to be unemployed. Somebody will always hire you.

Because somebody wants access to your magic pen.

And that’s because virtually every penny of that $2.24 trillion dollar health-care budget will be apportioned, “signed off on,” by some physician, somewhere. Your office visit is X dollars. Then add every prescription, every lab test and x-ray, every admission to every hospital, nursing home and hospice center, every referral to every specialist (whether to another MD or a physical/occupational/speech therapist), every visiting nurse, and every piece of medical equipment, whether for personal use (like a wheelchair or a new hip) or hospital use (new EKG machine, new MRI, updating an operating suite). Every last one of these line items must be OKd by a signature ending with the letters “MD.” The dollars are tacked on to X very quickly.

Now, go back to that $2.24 trillion spent per year and divide that number by the 900,000 physicians who do the apportioning. You’ll find that each and every physician approves approximately $2,500,000 worth of health-care “stuff” every year. Then, allowing 40 years as an average for a doctor’s professional life (assuming ages 27 to 67), take that $2.5 million and multiply it times 40 years and you’ll see how one doctor’s magic pen will, over a lifetime, generate in excess of $100 million worth of health-care expenses.

Stand in silent awe of my one hundred million dollar plastic pen.
To be honest, when I completed these calculations, I wasn’t the least bit surprised that my pen was a conduit for $2.5 million a year. Lab tests, x rays, referrals, and emergency room visits day in and day out add up very quickly. An ER admission racks up thousands in a few hours. One hospitalization–let’s say four days in a hospital for elective back surgery–could easily hit you with a bill for around $100,000. Suddenly, $2.5 million sounds like peanuts.

With numbers like these, money loses its meaning, like Germany in the 1920s, when you bought an orange with a wheelbarrow full of worthless Deutschmarks. Except our US cash isn’t worthless—it’s just sort of, let’s say, unequally distributed. Some people have great health insurance, and our health care system vacuums it up like a spilled box of kitty litter. Other people rely on their expired aspirin and pray they stay healthy.

And with that much cash to divvy up, suddenly everyone wants a piece of the action. You need access to the $2.24 trillion to cover the glistening marble acreage of Northwestern Memorial Hospital, the 1950s horror flick-colored amoeba (aka, Rush University Medical Center) glaring down the Eisenhower Expressway, and the crystalline Blue Cross tower vertiginously soaring over Millennium Park.

Access to all this money has created tens of thousands of businesses vying for their share. Billboards urge you to have your baby here, your heart transplant there. Physician ads claim “See me! Me! I’m the best!” “Insurance accepted” really means “I want my share of that $2.24 trillion.” Your TV is clotted with hundreds of drug ads: “Swallow me! Me! Live longer! Feel better!” (30 pills $400, insurance accepted).

Every health care company, from Mayo Clinic on one end to the poor slob with his “Tired of your C-PAP?” ads on the other, wants me to click my magic pen and jimmy open the money valve so a chunk of my allotted one hundred million smackers gushes in their direction.

Gives you a headache, doesn’t it? Too bad your aspirin is outdated.

Now even the most idealistic among us have to admit a system like this is crazy. Bonkers. And you wonder if you, one innocent person with your elderly bottle of aspirin, can avoid getting sucked into this mess. You can. People do. I meet them every day, but we’ll talk about that next week.

Hint: For those about to pro-and-con me on a single-payer health care system, that’s not the answer.

Be well,

David Edelberg, MD

Leave a Comment

  1. Jude Mathews says:

    Well, Dr. E, I’ve tried emigrating to Canada, but I my family doesn’t have enough points to get in. I’ve done my share of preventive care, but it hasn’t prevented me from developing a few chronic conditions I need medical care for, nor my son from needing the ER when he breaks an arm riding his bike. What can the answer be?

  2. Jan Szostek says:

    My mother lives in an assisted living center nearby and just one of her medications. Lovenox or Enoxaparin Sodium, costs $1100 a month even though she has a prescription drug plan from secondary health insurance that is supposed to be better than Medicare coverage. Can I argue with her doctor to switch her from Lovenox back to Warfarin? My mother was so conscientious all her life about spending carefully and saving as much as possible. And now to spend so much of her savings on one medication makes me mad.

  3. Dr E says:

    For Jude: for emergencies and the like, hospital finance departments endlessly negotiate dollar issues. If you have no insurance, then when you receive an ER bill, you could probably negotiate a 75% reduction. They’d still make money.
    For Jan: go back and insist on warfarin. Tell your doctor what lovonox costs and he’ll probably be horrified. Drug companies assiduously avoid telling doctors how much the drugs they are prescribing actually cost their patients

  4. Amy Anderson says:

    I can’t wait to see what you have to say on this topic! It can’t be the answer for self-paying individuals to pay $300+ for a single office visit. Who can afford that but the same people who can afford the best health insurance? What about the people who think and work outside of the box, the artists, actors, writers, entrepreneurs, forward thinkers who pass up the hefty salary to pursue the dreams? What do they do if they get sick, or – god forbid – get hit by a bus?

  5. Ingrid Henson says:

    I appreciate the link to the Institute for Health Metrics and Evaluation article regarding our “37th rank.” However, I believe the vast majority of your readers will take that rank for face value, probably not read the linked article, and not realize the complications behind the ranking.

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Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.


• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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