Voices: The Case of the $12,000 Kidney Stone

by Tim Padgett '84

April 6, 2010

Like middle age itself, passing a kidney stone is a long, Dantean death and, as my insurance company found out, an exorbitant one at that.

When you’re diagnosed with a kidney stone, one of the first things the doctor wants is a urine sample.

Which is fine, unless your body at that moment really doesn’t have a sample in storage. In which case the nurse has to utilize a catheter, which she can do quite easily because you’re too busy writhing in pain from the kidney stone to put up much resistance. Then you realize the only thing worse than the stone is the catheter, and you wonder why Dick Cheney ever bothered with waterboarding when he had all this at his disposal. I told the nurse everything I knew about Al Qaeda cells in Miami-Dade County.
 
Such was my initiation into male middle age last summer, via that most male and middle aged of short-term afflictions, the kidney stone.
 
When the sharp, sudden ache first hit my abdomen at around 7:30 in the evening, I thought it must be appendicitis. So my wife drove me, doubled over, to the nearest emergency room, where after some belly prodding the doctor announced that it was instead a stone. By that time, however, the pain was more excruciating than a Mark Sanford press conference. Appendicitis, kidney stone, Argentine mistress, it didn’t matter—I just wanted to die, as quickly as possible. But like middle age itself, a kidney stone is (or at least seems to be when it’s passing) a long, Dantean death and, as my insurance company found out, an exorbitant one at that.
 
The stone itself was a mere three millimeters in diameter. But don’t let that fool you. All through that hot tropical night it drilled its way from kidney to bladder like an Amtrak train plowing through a doggie door. As the nurse pumped me with painkillers, I pleaded with her to tell my wife and kids that I loved them. She said she would and then asked me if I wanted to watch the Lakers-Magic game while I waited for the IV to work.
 
It was at that point, as the physical pain finally stabilized, that I got my first real lesson in the financial pain our warped health-care system is visiting on us and our economy. This isn’t a polemic for health-care reform; but I’ve still yet to figure out how something as common (albeit uncommonly agonizing) as a kidney stone can end up costing $12,000—$11,960, to be precise. That was for less than four hours in an ER bed, the intravenous painkillers, CAT scans, a doctor doing about a minute of diagnostic work and, lest I forget, a urine catheter. The care I received was excellent, and the total cost for my insurer after the discount was $7,100. But had I not been insured, I would have been stuck with the entire $12,000 tab.
 
Most of the health-care experts I talked to afterward agree that even $7,100 was an excessive example of the “defensive medicine” our doctors practice in this country. That is, the ordering up of unnecessary tests and treatment out of fear of being sued for malpractice—that litigious cesspool that needs reforming as much as health-care costs do.
 
Let’s start with the CAT scans I received. The clearer and more comprehensive x-ray imaging known as computerized tomography (CT) is certainly an invaluable advance in medical technology. But doctors are using it to protect their rear ends more often than they use graphite putter shafts to enhance their back nines. In my case, the doc ordered up two CT scans—abdominal and pelvic, at $3,500 a pop—when, I’m told, one would have sufficed. No surprise there: During the past decade, the number of CT scans performed each year has skyrocketed more than 200%; and, according to the New England Journal of Medicine, about a whopping third of them are most likely not necessary.
 
Then there was the physician’s own charge—$3,000—which he coded on the bill as Level 5, the highest, the sort of treatment you’d think he’d designate for a shooting victim or a massive coronary. Even though I do remember calling for a priest from my ER bed, my kidney stone was hardly life threatening.
 
In fairness, experts have since told me that the ER care level often has less to do with the severity of the case than with the diagnostic work the physician is required to do. Still, $3,000 for diagnosing a kidney stone, which I passed myself at about midnight that evening, thank you, with no help from the doctor, “is unfortunately all too typical” in markets like Miami, one South Florida health-care analyst told me. And it’s a big reason that the average annual private health-care provider costs for a family of four in my city is a staggering $20,282.
 
So what can we do? The first thing I can do is drink more water so the crusty deposits that form kidney stones don’t build up in me again. (But just in case another stone does materialize, I now carry around one of those little cyanide pills that wounded spies swallow so they can’t be taken alive.)
 
As for the out-of-control costs of treating even routine maladies like kidney stones—as I said, this isn’t a health-care reform polemic. Whether or not you agree with President Obama’s reform bill, and whether or not you’re satisfied with your own health coverage, the one thing we all agree on is that our economy can’t sustain the medical madness for much longer. One thing I’ve discovered in my own coverage of the issue here in South Florida is that we need more 24/7, down-the-street access to cheaper urgent care instead of having to rely on expensive ER treatment. We also need more primary care physicians—the kind of top-flight GP Wabash has in my classmate Dr. Scott Douglas ’84—to help broaden the preventive medicine that can preclude the costly secondary care of specialists.
 
And what we need most of all is an alternative to the catheter. How about doctors and nurses who can tell really dirty jokes that make me laugh so hard I pee on my own? “Yes, Mr. Padgett, you have a kidney stone. And by the way, a priest and a rabbi walk into a bar…”
 
Tim Padgett is Miami Bureau Chief for TIME Magazine, which published a shorter version of this essay online.
 
Read more of Padgett’s work at www.time.com

 


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